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Imagine a scenario in which your elderly aunt walks across her living room and, in a moment of distraction, trips on the carpet, falls, and breaks her hip. Or your 60-year-old friend stumbles on the sidewalk while walking her dog and breaks her wrist as she reflexively throws out her hands to avoid hitting the pavement. People trip and fall all the time without breaking bones; why do these simple accidents have such serious consequences? Bone that breaks from minor trauma is weak bone, and for decades, what scientists and clinicians have sought to understand is why this happens.
But osteoporotic fractures aren’t just a result of weak bone — they’re a combination of two components. The first is the weakened bone vulnerable to fracture from low-impact trauma, such as a fall or sudden turn, and the second is the trauma itself. For decades, efforts to prevent osteoporotic fractures have focused on the weakened bone component — trying to build bone strength by building bone density, so bone would be less vulnerable to breakage. Today, however, there is a growing awareness that simply having weak bones doesn’t necessarily mean fractures are inevitable. Factors that increase the risk of falling (such as poor balance and coordination, muscle weakness, and factors related to lifestyle) have a strong bearing on a person’s risk of fracture. Thus, fall prevention is becoming a cornerstone of fracture prevention efforts.
Finnish bone specialist Dr. Teppo Järvinen nicely summarizes this new perspective, saying “The mainstay of current strategies to prevent fractures is to screen for osteoporosis by bone densitometry and then treat people with low bone density with anti-resorptive or other bone-specific drugs. However, the strongest single risk factor for fracture is falling, and not osteoporosis.”
This proposed shift in focus from bone density to falls merits serious attention, as we now know bone density does not predict fractures. Furthermore, the majority of people who experience an “osteoporotic” bone fracture do not have an “osteoporotic” bone density — they have either just osteopenia or normal bone density.
On the other hand, for the vast majority of people, osteoporotic bone fractures occur as a result of a fall. Ninety percent of hip fractures are caused by falls, as are at least 50% of vertebral fractures and most wrist and forearm fractures. And falls among people 65 years and older are very common, affecting one in three Americans in this age group. Moreover, approximately 30% of all women and 20% of all men older than 50 will fall each year. While less than one fall in 10 results in an identifiable fracture (it’s not known how many small or hairline fractures might go undiagnosed), 20% of all fall incidents require medical attention. Seeing osteoporotic fractures in this light highlights the notion that fall prevention is indeed fracture prevention.
So how do we prevent falls? In reviewing the growing scientific literature on falls, four major fall intervention areas stand out. These are:
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