Prevention of falls and fractures

Key Points

  • Falls are the main cause of fractures or broken bones at any age and are preventable.
  • Morbidity and mortality from falls and fractures is high.
  • The major predictors of falls include low bone density, impaired postural stability and reduced lower limb muscle strength.
  • Falls risk should be assessed and risk factors modified.
  • Bone mineral density should be assessed and treated if low.

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Falls are the main cause of fractures or broken bones at any age.

A fall is an event during which a person inadvertently comes to rest on the ground or at other lower level (1). Falls are preventable (2,3).

They result in injuries, loss of confidence and subsequent reduction in activity levels and community participation (4).

Risk of falling is increased with age, 3 or more medical conditions, 4 or more medications, vision or hearing decline, syncope, poor balance, slower gait, vascular diseases, Diabetes, Parkinson’s disease, urinary incontinence, sarcopenia and dementia. With every additional medical condition diagnosed before the age of 60, the risk of falling increases by 8%. After the age of 60, this increases to 35% with every additional medical condition such as high blood pressure, asthma or arthritis (1, 5,6).

90-95% of hip fractures are caused by falls, 25% of those patients will die within 12 months and a further 25% never regain complete mobility. Those who lie on the ground for more than an hour do worse (1,7).

Balance and bone density decline significantly between the age of 40 and 60 and this age usually coincides with menopause. Some sobering statistics are that:

Bone Density

Predicting and assessing Falls Risk

The major predictors of falls include low bone density, impaired postural stability and reduced lower limb muscle strength. These factors are synergistic.(2).

The strongest single predictor of future falls is a history of previous falls. Assessment of physical functioning is the next strongest.(4).

Falls risk screen – ask about 2 or more falls in the past 12 months, presenting after an acute fall or an individual who self-reports or is observed to have difficulty with walking or balance. Yes, to any one of these suggests a high risk of falls and needs a multifactorial assessment. No, but a fall in the last 12 months requires evaluation of gait and balance.(9). Even simpler is the “Stay on Your Feet” approach – investigate any older person who has fallen in the past 12 months or experiences difficulties walking or balancing.(10).

More detailed health professional and self-checks are available and these are important for developing strategies to prevent further falls. These include FROP-Com, Quickscreen.(10, 11), the iSOLVE project.(3), the FRAST.(9) and the STEADI programme.(12).

The Timed Up and Go (TUG) is an objective physical measure, is easy to administer and is a reasonable predictor of risk for community dwelling older people who take more than 12-14 seconds.(1,12,13). It is best combined with an examination of gait.(13).

Recommendations for reducing falls risk

Recommendations for maintaining or improving bone density.

Combining the recommendations for improving balance and bones is the best approach to preventing falls and fractures as you age.


  1. Vieira ER, Palmer RC,Chaves PHM (2016) “Prevention of falls in older people living in the community” BMJ 2016;353:i1419
  2.  Hanafy M ,Hamoud H, Abdulkamin S, Awward,H (2017) “Balance characteristics and frequency of falls in patients with postmenopausal osteoporosis” Ortho & Rheum Open Access 2017;8(1):555730
  3.  Clemson L et al (2017) “Integrated solutions for sustainable fall prevention in primary care - the iSOLVE project” Implementation Science, 12(1), 12
  4. Sherrington C, Tiedemann A (2015) “Physiotherapy in the prevention of falls in older people” Journal of Physiotherapy 61:54-60
  5. Nitz JC, Low Choy NL (2008). ‘Falling is not just for older women’ Climacteric 11; 6, 461-466
  6. Hsu W, Chen C, Tsauo J, Yang R (2014) “Balance control in elderly people with osteoporosis” Journal of the Formosan Medical Association 113,334-339
  7. “Info about falls”
  8. Case for Action – Falls and Fracture Prevention Proposal to NHMRC (Feb 2015) Buchbinder, Haines , Ebeling et al
  9. "Balance and fall screening and assessments”  Florida Physical Therapy Association
  11. “Screening tools for assessing falls risk” Mackenzie L
  12. STEADI Stopping elderly accidents, deaths and injuries. Centres for Disease Control and Prevention (2017)
  13. Browne W, Balakrishnan R (2019) “The timed up and go test” MJA 210(1) 14 Jan 2019
  14. Osteoporosis Australia prevention- calcium, vitamin D, exercise; living with osteoporosis – moving safely, treatment options .
  15. Prevention falls algorithm from “the prevention of falls in older persons: clinical practice guideline’ from the American Geriatrics Society

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Content updated April 2019