How to Reduce Your Fall and Fracture Risk

By Dr. John Neustadt

Gait and mobility, or how steady people are on their feet, are among the most reliable predictors of falls and fractures in people with bone loss. Although many large studies and clinical guidelines recommend assessing patients for fall risk, most doctors aren’t trained on how to evaluate this or advise patients on what steps to take. Therefore, it’s crucial that you learn how to improve your strength and stability to stay steady on your feet.

Fear of falling

When it comes to falling, fear creates a self-fulfilling prophecy. A study of 354 people aged 65 and older found that having a fear of falling was linked to a 414% higher risk of falling compared to those without that fear.¹ Fear of falling is also associated with poorer physical health, reduced mobility, and impaired cognitive functions.^2,3

There are a couple of compelling explanations for this. People afraid of falling limit their activities, leading to a decline in functional fitness and increasing their fall risk.⁴ Fear can also cause people to walk more cautiously. Their step length, how wide apart their legs are, and their walking speed may all change as a result. This might lead to an unsteady gait and an increased risk of falling.⁵

I’ve spoken to thousands of patients who often share their fears with me. Women have told me they’ve stopped doing activities they enjoy, like dancing and hiking, because they’re so scared of breaking a bone. I understand this fear, but I also know there are many ways to empower yourself, build confidence, and overcome it. One of those is to exercise safely to improve your strength and stability, which increases confidence and reduces fear.

Inadequate footwear

Wearing proper footwear is important to reduce risk. Your home can be one of the most dangerous places for falls, and a study of adults 70 and older found that over half of the falls in people’s homes happened when they wore socks without shoes or were barefoot.⁶

Instead, getting a comfortable pair of sneakers is a better option. Researchers followed 1,371 volunteers aged 65 and older for two years and monitored them for falls. They found that people wearing athletic or canvas shoes (sneakers) had the lowest number of falls. The risk of falling was 11.2 times greater in people who walked barefoot or in socks compared to people wearing sneakers.⁷

Researchers questioned a group of 100 patients with an average age of 78 years who had fallen, fractured their femoral necks, and had to have surgery. Patients were asked what they had on their feet when they fell. Seventy-two percent were wearing socks, slippers, or were barefoot.⁸ Another study, this one involving elderly women, found that wearing slippers with open heels predicted falls resulting in hospitalization.⁹

Foot pain and structural abnormalities, such as bunions and flat feet, are also recognized risk factors for falls and fractures, especially in the elderly.^10-12 These changes alter your walking mechanics, causing uneven shoe wear that affects your gait, center of gravity, and balance. Asymmetrical shoe wear, especially around your instep, also decreases traction and stability.¹³  Research linked foot pain with a 62% increased risk and flat feet with a 78% increased risk of multiple falls.¹⁴

The research points to this simple advice: choose a comfortable, well-fitting pair of indoor sneakers instead of walking barefoot or in slippers at home. If you experience foot pain, pronation, or have flat feet, consider using orthotics and schedule an appointment with a podiatrist to get evaluated and explore your options.  

Fracture-Proof Your Home

No one wants to feel unsafe in their house. Unfortunately, most falls occur at home, so dealing with dangers where you spend most of your time is crucial. The North American Menopause Society (NAMS) recommends you:¹⁵

• Fix loose steps and handrails that could cause you to lose your balance and fall.
• Get rid of throw rugs you could trip over.
• Keep walkways well-lit.
• Clear furniture you could stumble over and fall.
• Add railings to your bathtub and toilet area.

Loose steps and handrails

Loose steps inside and outside the house are dangerous. They increase your risk of losing your balance and falling. In addition to fixing the steps, ensure that handrails are securely attached to the wall. Can you imagine how horrifying it would be to lose your balance and grab the handrail to save yourself, only to have it come loose from the wall and tumble down an entire flight of stairs?

Throw rugs

Get rid of your throw rugs and fix loose carpets. It’s easy to catch your foot on the edge of a throw rug or a slightly raised carpet. They’re particularly dangerous for people who shuffle as they walk. I’ve had too many patients fall and end up in the hospital precisely because of this hazard. That’s what happened to my mother-in-law, Dee. A frequent shuffler, Dee once caught her foot on the edge of a throw rug, fell, and broke her hip. Checking out and fixing what’s on your floors is a no-brainer.

Lighting

Make sure all common walkways are well-lit, even throughout the night. If you get up in the middle of the night to go to the bathroom or head into the kitchen to get a drink of water, the hallway lights allow you to see anything you might trip over, such as the leg of a chair or the corner of a table. You can purchase motion-detection lights that automatically switch on at night when walking near them. They’re inexpensive and easy to install, so you don’t need an electrician or technical expertise. You can buy ones that plug into existing outlets or battery-operated ones with adhesive backing that you can stick to a wall. You can also install lights programmed to turn on at sundown or another time you choose and stay on all night.

Clear furniture and other obstructions

Ensure all walkways are clear of anything you can trip over, including boxes, unfinished projects, and furniture. It is important to sacrifice attractive decorating for clear, wide walkways. When your bone density is low, even stubbing your toe could cause a break. Peggy, a 91-year-old retired teacher, told me how she broke her toes multiple times by bumping into furniture in her house.

The living room can be particularly hazardous. A low coffee table can be hard to navigate when you’re groggy in the middle of the night, and a footstool in front of a couch can be difficult to see. Table corners can jut into walkways just enough for you to bump into them and fall.

Secure your bathroom

The bathroom is a common area for slips and falls. It’s especially dangerous for frail people with balance issues. Often, people wake up in the middle of the night to pee. When you’re groggy and a bit disoriented, it’s a perfect combination for a disaster. Plus, when you take sleep medication, your fall risk is even higher.

In addition to removing throw rugs in your bathroom, including those in front of your sink, toilet, and shower, put a slip-resistant bathmat in your shower or bathtub. Add grab bars wherever you lift a leg to step over something, where the ground might be slippery, or when you’re getting up from a seated position. The wall next to the toilet, in the bathtub, and just outside the shower are good places for handrails. These bars will give you something to grab onto and maintain your balance or regain it in case you start to wobble.

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