Introduction High injury rates have been reported in Para Alpine skiing at the Winter Paralympic Games, yet sport-specific injury characteristics remain limited. This study aimed to describe the proportion and incidence of injuries among athletes competing in Alpine skiing at the Sochi 2014, PyeongChang 2018, and Beijing 2022 Games, and to examine injuries by sex, age, impairment type, competition period, onset, anatomical area, and estimated time-loss burden. Method Prospective injury data were collected by team medical staff via the validated web-based Injury and Illness Surveillance System (WEB-IISS) and Paralympic polyclinics. Injuries were coded and analysed per IOC Para consensus guidelines using descriptive and analytical statistics. Results The overall injury incidence was 29.4 (95% CI 24.9-34.6) per 1000 athlete days, with an incidence proportion of 28.4%. Injury rates were significantly higher in the pre-competition period (54.4; 95% CI 42.5-69.7). Acute injuries predominated, affecting 24% of athletes. The most commonly injured regions were the head/face/neck (24%) and knee (20%). Frequent mechanisms included collisions and loss of control. Ten percent of injuries led to >28 days of time loss, with an overall burden of 70.6 days lost per 1000 athlete days. Athletes with limb deficiency had the highest injury rates, followed by those with spinal cord injury. Conclusion Nearly one-third of Para Alpine skiers sustained injuries across three Paralympic Games. These findings highlight the need for targeted injury prevention strategies to enhance athlete safety and inform future risk mitigation efforts
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