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We read with enormous interest the research by Fabienne El Khoury et al about the effect of fall prevention exercise programmes. We believe in the power of exercise as a very useful intervention in reducing obesity, hypertension, diabetes and all cardiovascular risk factors, against depression and anxiety, and in maintaining health.
In our Rehabilitation Unit, we started a programme for hip fractured patients after two months from discharge with the aim of improving balance, leg extensor strength, reducing falls and subsequent hip re-fractures. This was an hypothesis because of lack of evidence. So we thank El Khoury et al for their paper showing evidence in reducing injurious falls and we hope to contribute. As we said in a response to a BMJ article published in January (1), as geriatricians and physiotherapists, we would like to cover not only the 30-40% hip fracture risk reduction that drug treatment can assure but also the remaining 60-70% that drugs cannot. If drugs can reduce by 20-45% the relative risk reduction, the fall prevention programme could do more. It is hard to do, but the question is to standardize a multifaceted evaluation of the single patient including the risk of falling and not only consider the bone related aspects. We hope to publish our results next year. We believe that falling, and not osteoporosis, is the most important single predictive factor for hip fracture (2).