Falls and osteoporotic fractures are a major public health challenge for countries with ageing populations. In the United Kingdom, approximately 30% of people over 65 years and 50% over 80 years will fall in a given year.1 In addition to the morbidity and mortality associated with the injuries they cause, falls are a principal reason for emergency attendance at hospital, hospital bed utilisation, and transfer to nursing home care.

Systematic underestimation of the problem results from the lack of an ICD (international classification of diseases) diagnostic code for falls in older people (which are classified instead as “senility”) and the tunnel vision of health staff who fail to list falls as the underlying reason for presenting injury. Approximately 200 000 osteoporotic fractures occur each year in Britain, with most fractures of the hip and radius caused by falls.2 Because of this strong association, the consensus view is that falls, osteoporosis, and fractures must be managed together. In practice, however, this is rarely the case.

This is frustrating, …