Objective To analyze the trends in the disease burden of fall-related fractures among elderly Chinese from 1990 to 2023, and to examine the disparities by age, gender, and fracture site, in order to inform the development of targeted strategies for the prevention of such fractures. Methods Data on the incidence, prevalence, and years lived with disability (YLDs) of fall-related fractures among elderly Chinese from 1990 and 2023 was sourced from the 2023 Global Burden of Disease (GBD) study. The disease burden across age groups, genders, and fracture sites was assessed. Furthermore, temporal trends by these strata were analyzed using Joinpoint 5.4.0.0 software. Results From 1990 to 2023, the average annual percent changes in the age-standardized incidence rate (ASIR), age-standardized prevalence rate (ASPR), and age-standardized years of life lost rate (ASYR) for fall-related fractures among elderly Chinese were 1.81%, 1.03%, and 0.83%, respectively. In China, the disease burden of fall-related fractures among the elderly increased with advancing age, and the rate of this increase accelerated in older age groups. Females had higher values than males in terms of ASIR, the rates of increase for all burden measures were greater in males. Fall-related fractures among the elderly Chinese can be classified into 12 sites, among which hip fracture had the highest ASIR, with values of 538.15 and 963.57 per 100 000 in 1990 and 2023, respectively. Fractures of the patella, tibia, fibula, or ankle had the highest ASPR and ASYR. Their ASPR were14 836.73 and 19 727.74 per 100 000 in 1990 and 2023, respectively, and ASYR were 740.84 and 989.54 per 100 000, respectively. Conclusion The increasing and heterogeneous burden of fall-related fractures among elderly Chinese calls for targeted management strategies, in addition to enhanced osteoporosis prevention, that address the distinct risks by gender, age, and fracture site.