Falls, balance, and fracture prevention

Why falls belong in a bone-health plan

A strong skeleton matters, but many hip, wrist, shoulder, and spine fractures begin with a fall. Exercise programs that target balance, gait, and strength can reduce falls in community-dwelling older adults.¹

Fall risk is not a character flaw. It is often a mix of vision, footwear, medications, blood pressure, neuropathy, muscle weakness, home setup, prior falls, fear of falling, and medical conditions. Muscle loss matters because sarcopenia is linked with fragility fracture risk, which is why strength and balance belong in the same plan.

Common fall-risk domains

Questions to bring to a visit

• Have I had any falls or near-falls in the last year?
• Could any of my medications increase dizziness, sedation, or low blood pressure?
• Should I have vision, footwear, neuropathy, or balance evaluated?
• Would physical therapy help me build strength and confidence safely?
• Are there home changes that would reduce my risk quickly?

A prevention plan is usually layered

The most useful plan often combines bone-health treatment when appropriate, strength and balance work, home safety, medication review, vision correction, assistive-device decisions, and practical fall planning. It is not one magic supplement or one exercise.

Evidence review

Biology

Fracture prevention is partly about bone strength and partly about whether a fall happens in the first place. Muscle loss, slowed reaction time, neuropathy, vision changes, sedating medications, orthostatic symptoms, pain, and home hazards can all convert low bone reserve into an injury.¹²

Epidemiology and risk

Frailty and sarcopenia increase vulnerability even when the DXA result is not dramatic. This is why a person with moderate bone loss but repeated falls may be at higher practical risk than the T-score alone suggests.²⁴

Evaluation

A fall-risk review should ask about prior falls, near falls, gait, footwear, vision, blood pressure symptoms, sleep medicines, alcohol, neuropathy, pain, stairs, lighting, and fear of movement. Nutrition and protein intake matter because muscle is part of the safety system.³⁵

Treatment strategy

The best plan is usually layered: progressive strength training, balance practice, medication cleanup when possible, vision and foot care, home-safety changes, vitamin D correction when deficient, and treatment of osteoporosis when fracture risk is high. After hip fracture or major frailty, nutrition and rehabilitation become central, not optional.¹⁶

References

1. Dent E, Daly RM, Hoogendijk EO, Scott D. Exercise to prevent and manage frailty and fragility fractures. Curr Osteoporos Rep. 2023;21(2):205-215. doi:10.1007/s11914-023-00777-8.
2. Wong RMY, Wong H, Zhang N, et al. The relationship between sarcopenia and fragility fracture: a systematic review. Osteoporos Int. 2019;30(3):541-553. doi:10.1007/s00198-018-04828-0.
3. Wilson-Barnes SL, Lanham-New SA, Lambert H. Modifiable risk factors for bone health and fragility fractures. Best Pract Res Clin Rheumatol. 2022;36(3):101758. doi:10.1016/j.berh.2022.101758.
4. Morin SN, Leslie WD, Schousboe JT. Osteoporosis: a review. JAMA. 2025. doi:10.1001/jama.2025.6003.
5. Robinson SM, Reginster JY, Rizzoli R, et al. Does nutrition play a role in the prevention and management of sarcopenia? Clin Nutr. 2018. doi:10.1016/j.clnu.2017.08.016. PMID:28927897.
6. Inoue T, Maeda K, Nagano A, et al. Undernutrition, Sarcopenia, and Frailty in Fragility Hip Fracture: Advanced Strategies for Improving Clinical Outcomes. Nutrients. 2020. doi:10.3390/nu12123743. PMID:33291800.