Both falling and bone fragility should be targeted to prevent hip fracture
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Effectiveness of two year balance training programme on prevention of fall induced injuries in at risk women aged 75-85 living in community: Ossébo randomised controlled trial
Both falling and bone fragility should be targeted to prevent hip fracture
Dear Editor,
We do agree with El-Khoury and colleagues (1) and Sarah and Jill Lamb (2) that balance training is strongly recommended to reduce falls in older adults, but fall prevention is a very hard task.
It has been recently suggested that exercise can effectively reduce hip fracture risk by quoting a recent meta-analysis including 17 trials (3); however, the number of trials with participant selection criteria ≧75 years was only 3 (4). More than 75% of hip fractures occur among people over 75, indicating that evidence for hip fracture prevention by exercise is insufficient. Here, in women aged 75-85, two-year balance training did not significantly reduce serious falls associated with fractures (hazard ratio 0.83, confidence interval 0.60 to 1.16), although frail women at high risk of injurious falling (thus high risk of hip fracture) were excluded (1).
In future, it is highly expected that the effectiveness of this kind of exercise could be enhanced by pharmacological therapies of sarcopenia currently in development. Nevertheless, it is important to note that not only falling but also bone fragility should be targeted to prevent hip fractures (5, 6).
Toshihiro Sugiyama, Yoon Taek Kim and Hiromi Oda
Department of Orthopaedic Surgery, Saitama Medical University, Saitama, Japan
1 El-Khoury F, Cassou B, Latouche A, et al. Effectiveness of two year balance training programme on prevention of fall induced injuries in at risk women aged 75-85 living in community: Ossebo randomised controlled trial. BMJ 2015;351:h3830. (22 July.)
2 Lamb SE, Lamb JE. Better balance, fewer falls. BMJ 2015;351:h3930. (23 July.)
3 Jarvinen TL, Michaelsson K, Jokihaara J, et al. Overdiagnosis of bone fragility in the
quest to prevent hip fracture. BMJ 2015;350:h2088. (26 May.)
4 El-Khoury F, Cassou B, Charles MA, 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:f6234.
5 Sugiyama T, Kim YT, Oda H. Both falling and bone fragility should be targeted. www.bmj.com/content/350/bmj.h2088/rr-4. (2 June.)
6 Sugiyama T, Kim YT, Oda H. Both falling and bone fragility should be targeted: the
limited effectiveness of exercise on fall www.bmj.com/content/350/bmj.h2088/rr-30. (25 July.)
Competing interests:
No competing interests
30 July 2015
Toshihiro Sugiyama
Assistant Professor
Professor Yoon Taek Kim, Professor Hiromi Oda
Department of Orthopaedic Surgery, Saitama Medical University
Rapid Response:
Both falling and bone fragility should be targeted to prevent hip fracture
Dear Editor,
We do agree with El-Khoury and colleagues (1) and Sarah and Jill Lamb (2) that balance training is strongly recommended to reduce falls in older adults, but fall prevention is a very hard task.
It has been recently suggested that exercise can effectively reduce hip fracture risk by quoting a recent meta-analysis including 17 trials (3); however, the number of trials with participant selection criteria ≧75 years was only 3 (4). More than 75% of hip fractures occur among people over 75, indicating that evidence for hip fracture prevention by exercise is insufficient. Here, in women aged 75-85, two-year balance training did not significantly reduce serious falls associated with fractures (hazard ratio 0.83, confidence interval 0.60 to 1.16), although frail women at high risk of injurious falling (thus high risk of hip fracture) were excluded (1).
In future, it is highly expected that the effectiveness of this kind of exercise could be enhanced by pharmacological therapies of sarcopenia currently in development. Nevertheless, it is important to note that not only falling but also bone fragility should be targeted to prevent hip fractures (5, 6).
Toshihiro Sugiyama, Yoon Taek Kim and Hiromi Oda
Department of Orthopaedic Surgery, Saitama Medical University, Saitama, Japan
1 El-Khoury F, Cassou B, Latouche A, et al. Effectiveness of two year balance training programme on prevention of fall induced injuries in at risk women aged 75-85 living in community: Ossebo randomised controlled trial. BMJ 2015;351:h3830. (22 July.)
2 Lamb SE, Lamb JE. Better balance, fewer falls. BMJ 2015;351:h3930. (23 July.)
3 Jarvinen TL, Michaelsson K, Jokihaara J, et al. Overdiagnosis of bone fragility in the
quest to prevent hip fracture. BMJ 2015;350:h2088. (26 May.)
4 El-Khoury F, Cassou B, Charles MA, 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:f6234.
5 Sugiyama T, Kim YT, Oda H. Both falling and bone fragility should be targeted. www.bmj.com/content/350/bmj.h2088/rr-4. (2 June.)
6 Sugiyama T, Kim YT, Oda H. Both falling and bone fragility should be targeted: the
limited effectiveness of exercise on fall www.bmj.com/content/350/bmj.h2088/rr-30. (25 July.)
Competing interests: No competing interests