One-third of people over 65 fall each year and the risk of falling increases with age [1]Compston, J., et al., UK clinical guideline for the prevention and treatment of osteoporosis. Arch Osteoporos, 2017. 12(1): p. 43.

[2]Cummings, S.R. and M.C. Nevitt, Falls. N Engl J Med, 1994. 331(13): p. 872-3.

[3]World Health Organization: WHO Global Report on Falls Prevention in Older Age. 2007  [26.02.2019];

See link. Falls can seriously impact independence, resulting in disability, changes in lifestyle, reduced activity and as a result social isolation and death. Hence fall prevention is important. Extrinsic (or environmental) and intrinsic factors cause the majority of falls within the elderly population. Generally, the risk of falling is positively correlated with the number of risk factors.

The impact of falls is compounded in people with osteoporosis, often resulting in multiple appendicular and axial skeleton fractures [4]Woolf, A.D. and K. Akesson, Preventing fractures in elderly people. BMJ, 2003. 327(7406): p. 89-95.

. Once one fracture has occurred, the chances of having another fracture increases. This 'cascade effect' means women who have suffered a fracture in their spine are over four times more likely to have another fracture within the next year, compared to women who have never had an osteoporotic fracture.

Hip fracture is a serious complication when a person with osteoporosis suffers a fall. The mortality rate increases from 12 per cent to 20 per cent when compared to people of the same age and sex who have not sustained a similar fracture [5]Parker, M.J. and C.R. Palmer, Prediction of rehabilitation after hip fracture. Age Ageing, 1995. 24(2): p. 96-8.

. Among people who survive surgical intervention for an osteoporotic hip fracture, only one-third are restored to their former physical status [6]Greendale, G.A., et al., Late physical and functional effects of osteoporotic fracture in women: the Rancho Bernardo Study. J Am Geriatr Soc, 1995. 43(9): p. 955-61.

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Trials have shown that reducing the risk of falls is possible [7]Gillespie, L.D., et al., Interventions for preventing falls in older people living in the community. Cochrane Database Syst Rev, 2012(9): p. CD007146.

[8]Oliver, D., et al., Strategies to prevent falls and fractures in hospitals and care homes and effect of cognitive impairment: systematic review and meta-analyses. BMJ, 2007. 334(7584): p. 82.

and that it is one of the many lifestyle measures that can make a big positive difference in improving or at least maintaining bone health. Preventing falls by for example exercising and home safety interventions has been shown to reduce the risk of falls [1]Compston, J., et al., UK clinical guideline for the prevention and treatment of osteoporosis. Arch Osteoporos, 2017. 12(1): p. 43.

. Finally, reducing falls could be correlated with a lower fracture risk [9]El-Khoury, F., et al., The effect of fall prevention exercise programmes on fall induced injuries in community dwelling older adults: systematic review and meta-analysis of randomised controlled trials. BMJ, 2013. 347: p. f6234.

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Extrinsic (or environmental) factors 
These include any home hazards such as slippery floors, any objects on the floor that can cause tripping (loose cords, carpets, etc.), insufficient lighting and unstable furniture or lack of handrails. 

Intrinsic factors
These mainly include disabilities:

• Impaired balance, mobility and gait 
• Muscle weakness
• Impaired vision (decreased visual acuity)
• Decreased sensory perception of the lower extremities
• Blackouts and impaired cognition
• Chronic diseases such as neurological disorders, heart diseases and stroke
• Kyphosis (also known Dowager's Hump) 
• Slow walking speed
• Use of medications that can cause dizziness and drowsiness (antidepressants or sedatives)
• Multiple drug therapies.

Some of these factors can be modified. For example, acting on home hazards, a diminished visual acuity or decreasing if possible any medications that affect balances and alertness can significantly help in preventing falls [10]Pocket Reference to Osteoporosis, S. Ferrari, Roux, C., Editor 2019, Springer International Publishing.

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Floors

• Removing objects that can cause a person to trip, such as throw rugs, electrical cords and clutter
• Ensuring mats are firmly affixed and repairing loose carpet or raised areas in the floor
• Moving furniture out of walking paths and being aware of raised doorways

Bathrooms

• Installing handrails
• Installing non-skid mats in the toilet, bath or shower

Lighting

• Keeping an apartment or house well lit, especially in hallways, stairways, porches and outside walkways
• Adding extra light switches or using remote switches such as motion sensors

Kitchen

• Using non-skid floor wax and wiping up spills immediately
• Keeping regularly used kitchen items at an easy-to-reach level

Stairs

• Checking handrails are sturdy and secure

Studies have shown external hip protectors markedly decrease hip fractures in people when worn at the time of the event. These shells of propylene or polyethylene are designed to absorb part of the energy from the impact of falling and shunt energy toward the tissue around the hip [11]Kannus, P., et al., Prevention of hip fracture in elderly people with use of a hip protector. N Engl J Med, 2000. 343(21): p. 1506-13.

. However, there is poor compliance among people to wear them because they find them to be uncomfortable and not practical [1]Compston, J., et al., UK clinical guideline for the prevention and treatment of osteoporosis. Arch Osteoporos, 2017. 12(1): p. 43.

[12]Kannus, P., et al., Non-pharmacological means to prevent fractures among older adults. Ann Med, 2005. 37(4): p. 303-10.

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