Shifting the focus in fracture prevention from osteoporosis to falls

Dr Järvinen and colleagues’ concept of shifting the focus in fracture
prevention from osteoporosis to falls seems logical; especially that if
patients do not fall they will not break bones. However one can argue that
if bones are not osteoporotic they are unlikely to break from low trauma.
For every one standard deviation that bone mineral density decreases, the
risk of all future osteoporotic fractures increases by about 50%.

Fractures are the product of two interactive components, falls and
bone mineral density, the contribution of each is variable in different
clinical scenarios. Our approach to preventing fractures should be
multidimensional and holistic, as in other areas of geriatric medicine
when pathology is multifactorial. So we should try our best to reduce
falls and also prevent bone mineral density decline especially in high
risk group, mainly those with low bone mineral density who had previous
fractures. Interestingly in one study nearly half of the patients
attending Falls Clinic were osteoporotic and one third were osteopenic
(1). It seems that there are many links between osteoporosis and falls,
and they should be approached concurrently.

(1) Michael A, Obiechina N, James R, Tiwary A. “Bone Mineral Density
(BMD) In Patients With Falls”. Abstract. Osteoporosis International. 2007;
18 (supplement 3): 8269.

Competing interests:
None declared