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Clinical Review

Preventing fractures in elderly people

BMJ 2003; 327 doi: (Published 10 July 2003) Cite this as: BMJ 2003;327:89

This article has a correction. Please see:

  1. Anthony D Woolf, professor of rheumatology (,
  2. Kristina Åkesson, associate professor2
  1. 1Institute of Health and Social Care, Peninsula Medical School, Royal Cornwall Hospital, Truro TR1 3LJ
  2. 2 Lund University, Department of Orthopaedics, Malmö University Hospital, S-20502, Malmö, Sweden
  1. Correspondence to: A D Woolf
  • Accepted 3 June 2003

Preventing fractures in elderly people is a priority, especially as it has been predicted that in 20 years almost a quarter of people in Europe will be aged over 65. This article describes the factors contributing to fracture, interventions to prevent fracture, and the various treatments.


Fractures in elderly people are an important public health issue, especially as incidence increases with age, and the population of elderly people is growing. Evidence based interventions do exist to prevent fractures, but they are not being applied.1 2 The challenges are to identify those most risk and to ensure that treatment is cost effective. Elderly people should be taught to improve their bone health and to reduce the risk of injury, but these measures are not restricted to this age group, as prevention should be throughout the life.3

Sources and methods

Recommendations are made following a comprehensive review of the literature, concentrating on systematic reviews and evidence based guidelines on fracture prevention that have been identified by a standardised search strategy as part of the European Bone and Joint Health Strategies Project. Priority was given to those systematic reviews and guidelines that met quality criteria, including criteria for guidelines from the Appraisal of Guidelines Research and Evaluation (AGREE).4

A universal problem

Around 310 000 fractures occur each year in elderly people in the United Kingdom. The cost of providing social care and support for these patients is £1.7b ($2.8b; €2.4b). Hip fractures place the greatest demand on resources and have the greatest impact on patients because of increased mortality, long term disability, and loss of independence. Although less common, vertebral fractures are also associated with long term morbidity and increased mortality.5 By 2025 it has been predicted that almost a quarter of the population in Europe will be aged over 65 years. The mean age …

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