Falls and bone density
Two problems that are usually discussed as one. The fracture needs both a weak bone and a fall, and only one of those gets treated.
settledLarge, consistent evidence base. Unlikely to reverse.Revised 26 Jun 2026
Most falls in older adults happen at home, on ground level.Photograph: Minha Baek / Unsplash
Definition
Bone mineral density is the mineral content of bone per unit area, the measurement behind an osteoporosis diagnosis. Falls are the event that turns low density into a fracture. Neither causes a hip fracture alone.
Why the pairing matters
Bone loss is silent and treatable; falling is visible and largely under-addressed. A person with osteoporosis who does not fall does not fracture. A person with normal bone who falls badly enough still can.
The practical consequence is that fracture prevention has two independent levers, and the one most often neglected — not falling — is also the one most amenable to training.
What reduces falls
The evidence here is unusually good:
- Exercise programmes that include balance and functional training, done several times a week. The WHO specifically recommends multicomponent activity emphasising balance on three or more days a week for older adults, for exactly this reason.
- Medication review. Sedatives, some antihypertensives and polypharmacy in general raise fall risk, and a review by a pharmacist or GP is free.
- Vision correction. A new prescription, cataract surgery, and care with varifocals on stairs.
- Home hazards. Loose rugs, poor lighting on stairs, no handrail in the bathroom. Unglamorous, effective.
What maintains bone
- Loading. Bone responds to force. Resistance training and impact activity — brisk walking, stair climbing, hopping where appropriate — maintain density in a way swimming and cycling do not.
- Calcium and vitamin D adequacy, which is a prerequisite rather than a treatment: correcting a deficiency helps, and adding more on top of adequacy does not.
- Medication, where density is low enough to warrant it. Bisphosphonates and related drugs reduce fracture risk substantially and are a clinical decision.
What does not work
Balance training with no progression. Standing on one leg while brushing your teeth is a fine habit and it is not a programme. The exercise trials that reduce falls use challenging, progressive balance work — narrowing the base, removing hand support, adding movement — done consistently for months.
Open questions
Whether high-dose intermittent vitamin D helps or harms fall risk has produced genuinely contradictory trial results, with some evidence that very large infrequent doses increase falls. Regular modest supplementation where intake is low remains the mainstream position.