BMJ  2008;336:124-126 (19 January), doi:10.1136/bmj.39428.470752.AD

Analysis

Shifting the focus in fracture prevention from osteoporosis to falls

¹ Division of Orthopaedics and Traumatology, Department of Trauma, Musculoskeletal Surgery and Rehabilitation, Tampere University Hospital, 33 520 Tampere, Finland, ² Bone Research Group, UKK-Institute, Tampere, Finland, ³ Department of Family Practice and Centre for Hip Health, University of British Columbia, Vancouver, British Columbia, Canada, ⁴ Department of Health Sciences, University of Jyväskylä, Jyväskylä, Finland

doi: 10.1136/bmj.39435.656250.ADdoi: 10.1136/bmj.39412.525243.BE

Preventing fractures in older people is important. But Teppo Järvinen and colleagues believe that we should be putting our efforts into stopping falls not treating low bone mineral density

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

Fractures are a rapidly growing problem among older people. Hip fractures alone cost over $20bn (£10bn; 13bn) in the United States in 1997.¹ Any intervention that may reduce the risk of fracture at either the individual or population level therefore warrants critical appraisal. The mainstay of current strategies to prevent fractures is to screen for osteoporosis by bone densitometry and then treat people with low bone density with antiresorptive or other bone-specific drugs.²³⁴ However, the strongest single risk factor for fracture is falling and not osteoporosis.^{5 6} Despite this fact, few general practitioners will have assessed the risk of falling among their elderly patients or even know how to do it.⁷ Risk of falling is also completely overlooked in many important publications on preventing fractures.⁴ We argue that a change of approach is needed.

Predictive value of bone density measurements

Bone densitometry does not give reliable estimates of a person’s true bone mineral density. The planar scanning . . . [Full text of this article]

Absolute fracture risk

Drug treatment is not a panacea

Shifting the focus

Preventing fall related fractures in general practice

General practice guidelines for assessment of risk of falling
Summary points

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This article has been cited by other articles:

• Cheung, A. M., Detsky, A. S. (2008). Osteoporosis and Fractures: Missing the Bridge?. JAMA 299: 1468-1470 [Full text]  
• Bayly, J., Masud, T. (2008). Not at the expense of osteoporosis care. BMJ 336: 343-343 [Full text]  
• Williamson, L. (2008). Try the stork challenge. BMJ 336: 343-344 [Full text]  

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