Falls Prevention

Falls are a leading cause of injury and loss of independence in older adults, and in someone with osteoporosis a fall can cause a vertebral, hip or wrist fracture. Preventing the fall in the first place is therefore a direct way of protecting the spine. Falls are rarely down to a single cause — they usually reflect a mix of reduced strength, poorer balance, medication effects, eyesight, and hazards in the home — which means the most effective prevention tackles several factors at once.

Falls prevention sits alongside bone-health treatment as a two-pronged defence against fragility fractures: strengthen the bone, and reduce the impacts that break it. My role, as a surgeon, is to recognise people at risk — particularly those who have already had a fragility fracture — and to make sure that falls prevention and osteoporosis treatment are both in place, referring to the right teams. It is prevention rather than treatment, but it is prevention that keeps people out of my operating theatre, which is exactly where they would rather be.

Delivered by a physiotherapist or a specialist falls service, a programme generally combines strength training for the legs, balance and gait exercises, and practice of the kinds of movements that challenge stability, together with practical measures — reviewing medications that cause dizziness, checking eyesight, and removing hazards at home. Structured, progressive balance and strength exercise is the core, because it directly improves the physical abilities that keep a person upright.

This is an area where the evidence is genuinely strong. Well-established balance-and-strength programmes such as the Otago Exercise Programme have been shown in randomised trials and meta-analyses to reduce falls meaningfully — commonly in the region of a quarter to a third — and to improve balance, gait and lower-limb strength, with the greatest benefit in those most at risk. Other approaches, including Tai Chi and multi-component strength-and-balance training, show similar reductions in falls, and longer programmes tend to sustain the benefit. In short, the right exercise reliably reduces falls, which is why it is a cornerstone of protecting fragile bones.

Falls prevention is safe, effective and worthwhile, especially for older adults and anyone who has already had a fragility fracture. As a surgeon, I would particularly encourage assessment for anyone who has fallen, has a fear of falling, or notices worsening balance or unsteadiness. It is also important to seek prompt review for any new or worsening leg weakness, numbness, difficulty walking or problems with bladder or bowel function, since these can point to a spinal cause that needs proper assessment rather than exercise alone. And anyone at risk of fragility fracture should have their bone health assessed and treated alongside their falls prevention.

• —The Otago Exercise Programme's effect on fall prevention: systematic review and meta-analysis. (PubMed 40529705 / PMC12172654)
• —The effects of the Otago Exercise Programme on balance in older adults: meta-analysis. (PubMed 34358276 / PMC8345836)
• —Effects of physical exercise on balance and prevention of falls in older people: systematic review and meta-analysis. (PMC7466089)
• —Balance- and strength-based exercise for fall prevention in community-dwelling older adults: systematic review of RCTs. (PMC12842942)