Fall risks key in fracture prevention for elderly

Addressing an elderly person's risk of fall is more effective at preventing fractures than treating osteoporosis, according to Finnish research.

The study concluded that 80 per cent of fractures occur in people who do not even have osteoporosis and falling is identified instead as the major risk factor.

To prevent one hip fracture with bisphosphonates, the mainstay of osteoporosis treatment, 577 postmenopausal women would have to be treated for a year, at an estimated cost of £120,000.

GPs aiming to reduce fracture rates in their elderly patients should therefore focus on preventing falls, say the study’s authors.

While welcoming a ‘stronger approach’ to fall prevention, the National Osteoporosis Society (NOS) would like to see integrated treatment strategies.

A NOS spokesperson said: ‘While reducing the risk of falls may prevent some fractures, it will not reduce the risk of spinal fractures, an often spontaneous consequence of osteoporosis. Drug treatment has to go hand in hand with falls prevention.’

Previous research suggests that up to 50 per cent of falls can be avoided, using techniques such as strength and balance training, reducing prescriptions of psychotropic drugs and dietary supplements of calcium and vitamin D. Assessment of hazards in the home can be considered in high-risk groups.

The Finnish researchers dismissed the WHO suggestion that risk of falling is ‘too difficult to assess for GPs’. They argue that simple steps such as taking a fall history, carrying out a review of medication and watching a patient walk can identify at-risk individuals.


BMJ Online

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