Falls Prevention

The vast majority of fragility fractures are caused by falls. Preventing falls is therefore just as important as treating bone density when it comes to reducing fracture risk. The good news is that many falls are preventable, and simple changes can make a significant difference.

Why Do Falls Lead to Fractures?

When bones are weakened by osteoporosis, the force from even a simple fall — from standing height, for example — can be enough to break them. The most vulnerable sites are the hip (from a sideways fall), the wrist (from an outstretched hand to break a fall), and the spine (from sudden compression).

Falls become more common as we age for a number of reasons, including reduced muscle strength, impaired balance, slower reactions, vision problems, dizziness from medications, and home hazards. Addressing these factors is central to falls prevention.

Exercise for Falls Prevention

Regular exercise specifically targeting balance, strength, and coordination is one of the most effective falls prevention strategies. Evidence-based options include:

• Tai chi — particularly well supported by research for reducing falls in older adults
• Balance exercises — standing on one leg (holding a support), heel-to-toe walking, stepping exercises
• Strength training — leg and core strength are particularly important for balance
• Functional exercises — practice getting up from a chair without using hands; step practice

Aim for at least three sessions of balance-focused exercise per week. Your GP can refer you to a physiotherapist for an individualised programme.

Home Safety Checklist

Many falls happen at home. Going through the following checklist room by room can help identify and remove hazards:

Footwear

Footwear is a frequently underestimated falls risk. For safety indoors and outdoors:

• Wear shoes or slippers with a good grip sole and closed heel
• Avoid loose slippers, flip-flops, or high heels
• Ensure shoes fit well — loose footwear increases trip risk
• Consider asking your GP for a referral to a podiatrist if you have foot problems affecting your gait or balance

Vision

Good vision is critical for detecting hazards and maintaining balance. If you have not had an eye test recently, arrange one — deteriorating vision significantly increases fall risk. The HSE recommends an eye test at least every two years for adults over 60.

If you wear multifocal glasses, be aware that these can sometimes cause difficulty judging step heights. Your optometrist can advise on the best lens type for everyday use and outdoor activities.

Medication Review

Some medications can affect blood pressure, balance, coordination, or cause dizziness — all of which increase fall risk. These include:

• Blood pressure medications (especially if the dose is too high, causing lightheadedness)
• Sedatives, sleep aids, and some antidepressants
• Diuretics (water tablets) — can cause urgency rushing to the toilet, leading to falls
• Some antihistamines (particularly older-type ones causing drowsiness)
• Parkinson's medications

Ask your GP or pharmacist to review your medications to identify any that may be contributing to falls risk. Never stop a prescribed medication without medical advice, but do raise the question.

What to Do If You Fall

If you fall but do not think you are injured:

1. Stay calm. Do not rush to get up
2. Check if you are injured by moving each limb gently
3. If on the floor, try to roll onto your side, push yourself up to hands and knees, and crawl to a sturdy piece of furniture
4. Use the furniture to help push yourself to standing
5. If you cannot get up or are in pain, call for help or use a personal alarm if you have one

If you have a fall and experience pain, particularly in your hip, back, or wrist — even if you can walk — seek medical attention promptly. Fragility fractures are not always immediately obvious.