BMJ  2003;327:89-95 (12 July), doi:10.1136/bmj.327.7406.89

Clinical review

Preventing fractures in elderly people

¹ Institute of Health and Social Care, Peninsula Medical School, Royal Cornwall Hospital, Truro TR1 3LJ, ² Lund University, Department of Orthopaedics, Malmö University Hospital, S-20502, Malmö, Sweden

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.

The first 150 words of the full text of this article appear below.

Introduction

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 . . . [Full text of this article]

A universal problem

Bone fragility, falls, and people at high risk

Pharmacological interventions

Combined calcium and vitamin D
Bisphosphonates
Selective oestrogen receptor modulators
Oestrogen
Calcitonin
Parathyroid hormone

Impact and prevention of falls

Lifestyle

Selective case finding

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Selection of treatment and monitoring response

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