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Falls: Epidemiology, Pathophysiology, and Relationship to Fracture

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Sarah D. Berry, MD, MPH and Ram Miller, MDCM, MS


Falls are common in the elderly, and frequently result in injury, disability, and institutionalization. Although the causes of falls are complex, most falls result from an interaction between individual characteristics that increase an individual’s propensity to fall and acute mediating risk factors that provide the opportunity to fall. Predisposing risk factors include age-associated changes in strength and balance, age-associated comorbidities such as osteoarthritis, visual impairment and dementia, psychotropic medications, and certain footwear. Fewer studies have focused on acute precipitating factors, but environmental and situational factors are clearly important to the risk of falls. Approximately 30% of falls result in an injury that requires medical attention and with fractures occurring in approximately 10% of falls. Fractures associated with falls are multi-factorial in origin. In addition to the traditional risk factors for falls, the fall descent, fall impact, and bone strength are all important determinants of whether a fracture will occur as a result of an event. In recent years, numerous studies have been directed toward the development of effective fall and fall-related fracture prevention interventions.

Resource: Curr Osteoporos Rep. 2008 Dec; 6(4): 149–154.