Only 15 percent of fractures among older adults may be due to having low bone density. Without a fall, even fragile hips don’t fracture. A combination of resistance exercise to improve lower limb muscle strength and balance training can beat out drugs for preventing osteoporotic bone fractures.


What about calcium supplements? See my videos Are Calcium Supplements Safe? (https://nutritionfacts.org/video/are-calcium-supplements-safe/) and Are Calcium Supplements Effective? (https://nutritionfacts.org/video/are-calcium-supplements-effective/).


What about drinking milk? See my video Is Milk Good for Our Bones? (https://nutritionfacts.org/video/is-milk-good-for-our-bones/).


For more on how to live your longest, healthiest life, preorder my new book How Not to Age (https://nutritionfacts.org/book/how-not-to-age/). (As always, all proceeds I receive from all of my books (https://nutritionfacts.org/books/) are donated to charity.)

“Fall Prevention Is the Most Important Thing

for Preventing Osteoporosis Bone Fractures”

0:08.38

Bone mineral density screening

may be a billion-dollar industry,

0:12.42

but only 15 percent

of low trauma fractures

0:15.06

are due to osteoporosis in older women

0:17.33

(meaning from a fall

no more than from standing height)

0:20.56

Only 15 percent of fractures

are due to having low bone density.

0:24.36

Between the ages of 60 and 80,

0:26.53

hip fracture risk increases 13-fold

in men and women,

0:29.86

whereas the age-related decline

in bone mineral density

0:32.28

accounted for only

a twofold increased risk.

0:34.56

So, the contribution

of declining bone density

0:37.38

to the exponential increase

in hip fracture risk with age

0:39.96

is relatively small.

0:41.16

The vast majority of our age-related rise

in hip fracture risk

0:46.26

appears to have nothing to do

with the measured density of our bones.

0:49.50

So, what’s the main contributor?

0:51.60

Fall risk. Without a fall, even

fragile hips don’t fracture.

0:57.42

Falls are the primary cause of fractures—

including vertebral fractures.

1:02.34

The disparity between men and women

in hip fracture rates

1:04.98

is primarily not because

men have stronger bones,

1:07.20

but because women fall more often.

1:09.36

Doctors just asking the simple question,

“Do you have impaired balance?”

1:13.98

can predict about 40 percent

of all hip fractures,

1:16.74

more than a bone scan diagnosis

of osteoporosis.

1:19.98

Even a weak osteoporotic bone

is strong enough to survive

1:24.06

normal life activities

without the excessive loading

1:27.06

that comes from a fall impact

or, in the case of the spine,

1:29.70

bending with your back to lift something

rather than your knees.

1:32.94

The primacy of falls

in fracture risk explains

1:36.84

a number of apparent

osteoporosis paradoxes.

1:39.66

For example, despite the fact

that about 75 percent of your bone mass

1:43.80

may be determined by your genes,

the heritability of bone fractures

1:47.58

appears negligible at older ages

1:50.10

(because the propensity to fall

is much less inherited).

1:54.24

It also explains

the poor predictive value

1:56.76

of bone density screening

for fractures.

1:58.80

Adding bone mineral density measures

to a hip fracture risk score

2:02.40

based just on age, sex, height,

weight, the use of a walking aid,

2:06.42

and cigarette smoking, did little

to improve its predictive power.

2:11.16

A provocative editorial published

in the Journal of Internal Medicine

2:14.82

entitled “Osteoporosis:

The Emperor Has No Clothes”

2:18.50

suggested that it would be safer

and more effective

2:21.06

to focus on fall prevention

rather than pharmaceutical intervention.

2:27.06

Even though only about 5 percent

of falls result in a fracture,

2:30.30

falls are very common

among the aged, due in part

2:33.78

to age-related muscle weakness

and loss of balance.

2:36.48

More than a third of those aged 65

and older fall each year,

2:40.05

and after a hip fracture,

fewer than 50 percent

2:43.03

regain their pre-fracture function

2:44.88

in terms of walking ability

and independence.

2:46.86

What can we do to prevent injurious falls?

2:50.70

Based on dozens

of randomized controlled trials,

2:53.46

the single intervention

most strongly associated

2:56.28

with a reduction in fall rates: exercise.

3:00.37

So, exercise

doesn’t just boost bone density,

3:03.66

more importantly, it also reduces

the number of falls over time

3:07.80

by 23 percent and the number

of fallers by 15 percent.

3:10.86

So, if you followed

1,000 people around age 75 for a year,

3:14.94

and 480 fell a total of 850 times

without exercise,

3:18.90

adding exercise

would be expected to result

3:21.84

in 72 fewer fallers

and 195 fewer falls.

3:26.52

Tai Chi appears to reduce falls

by 19 percent,

3:30.09

balance and functional exercises

(like sit to stand)

3:32.76

may reduce falls by 24 percent,

3:34.71

and multiple exercises—

typically balance and functional exercise

3:38.10

plus strength training—

may reduce falls by 34 percent.

3:42.36

The reduced falls rate

then translates into fewer fractures.

3:46.92

A recent meta-analysis found

that exercise interventions—

3:49.56

mostly using a combination

of resistance exercise

3:52.20

to improve lower limb muscle strength

and balance training—

3:55.14

cut fracture rates nearly in half.

3:58.80

One year-long trial

that combined strength training

4:01.14

with step and jumping aerobics

and focused on balance and agility

4:04.74

resulted in 74 percent fewer fractures

over the 5-year period

4:08.82

after the study ended.

4:10.32

Furthermore, more than 70 percent

of the women in the combo exercise group

4:13.98

went those five years

without a single injurious fall,

4:16.80

compared to less than half

of those in the control group.

4:20.46

Trials on hip protectors,

which cushion a sideways fall on the hip

4:25.26

with plastic shields or foam pads

sewn into special underwear,

4:29.22

are often plagued with poor compliance.

4:32.10

Studies have not found them to be useful

for reducing hip fracture rates

4:35.34

among those living at home,

but trials in nursing homes

4:38.22

or residential care facilities

do show a small reduction in risk,

4:41.52

translating into about 11 fewer people

out of a thousand

4:44.88

suffering hip fractures

due to wearing hip protection.

4:48.36

There are also common-sense

measures one can employ.

4:51.60

Quality improvement trials involving

interventions like patient education

4:56.10

have shown a 10 percent reduction

in fall rates.

4:58.68

For example, keep things within reach

so you don’t need to use step stools,

5:02.64

use non-slip mats in the bath and shower,

add grab bars in the bathroom,

5:07.74

keep floors clutter free,

remove small throw rugs

5:12.06

or use double-sided tape

to keep them from slipping,

5:14.52

and make sure all staircases

have handrails and adequate lighting.

5:18.00

You could also avoid taking walks

during inclement weather,

5:21.60

and for those who walk leashed dogs,

consider choosing smaller breeds

5:25.92

to prevent them from lunging.

5:28.74

Otherwise, the main ways

to prevent fractures

5:32.10

may not have changed much over the decades

since the classic paper entitled

5:36.78

“Strategies for Prevention

of Osteoporosis and Hip Fracture.”

5:39.72

The main ways to prevent these fractures

are to “stop smoking,

5:43.56

be active and eat well.”