Strong Bones, Steady Steps: 9 Ways to Prevent Falls and Fractures With Osteoporosis

Most broken bones in people with osteoporosis happen after a fall, so the best protection is to look after your bones and your balance together. Preventing falls with osteoporosis comes down to a few steady habits: knowing your risk, getting the right treatment, feeding your bones, keeping your legs strong and making everyday life a little safer.

This Tuesday, 20 October, is World Osteoporosis Day. It is a good moment to check in on your own bones, or on a parent you worry about. This guide is written by a physiotherapist for older adults and the families who support them. It focuses on the whole picture of fracture prevention, not just exercise.

Why osteoporosis and falls go hand in hand

Osteoporosis (bones that have become thin, fragile and more likely to break) is very common. The Royal Osteoporosis Society says over 3.5 million people in the UK are living with it. Here is why bones and balance are so closely linked.

• It is silent until something breaks. The NHS explains that osteoporosis develops slowly over years and is often only found when a fall or sudden knock causes a fracture. Many people do not know they have it.
• A fall is usually the trigger. The NHS lists the wrist, the hip and the bones of the spine as the most common breaks. A bone that would survive a trip at 40 may not survive the same trip at 80.
• Muscles weaken when we move less. The NHS says being inactive makes both muscles and bones lose strength. Weaker legs mean more wobbles, and more wobbles mean more falls.
• Fear can make it worse. After a diagnosis or a fall, many people cut back on walking and going out. That feels safer, but it slowly makes legs weaker and balance worse.
• Autumn adds extra pressure. Darker evenings and wet paths raise the chance of a slip. And from October, the sun in the UK is not strong enough for your body to make vitamin D, which your bones need.

So a good plan protects the bone and reduces the chance of the fall. The nine steps below do both.

9 steps for strong bones and steady steps

1. Treat a "small fall, big break" as a warning sign

If someone over 50 breaks a bone after a fall from standing height or less, that is called a fragility fracture (a break from a knock that would not normally break a healthy bone). It can be the first clue that the bones are weak. Too often the break is fixed but the cause is never checked.

Try this: If your parent has broken a wrist, hip, rib or spinal bone after a minor fall, ask the GP for a bone health check. The NHS also suggests asking your GP surgery whether there is a fracture liaison service (a team that helps prevent further breaks) in your area.

2. Check your risk in a few minutes

Some risk factors are out of your control, such as age and family history. The NHS lists others, including high-dose steroid tablets taken for more than three months, an early menopause, a low body weight, smoking, heavy drinking and a parent who broke a hip.

Try this: If you have not been diagnosed, use the free Royal Osteoporosis Society risk checker. It takes about three minutes. Take the results to your GP, who may work out your fracture risk or refer you for a bone density scan (a short, painless X-ray scan of bone strength).

3. Keep bone treatment going, and ask questions

The NHS explains that osteoporosis can be treated with bone-strengthening medicines. Whether you need one depends on your personal risk of breaking a bone. These medicines only help if they are taken as prescribed, and some have quite specific instructions.

Try this: If you or your parent has stopped a bone medicine, or finds it hard to take, do not just leave it. Speak to the GP or pharmacist about side effects or other options. Never stop a prescribed medicine without advice.

4. Start your vitamin D this month

Vitamin D helps your body absorb calcium. The NHS advises all adults to consider a daily vitamin D supplement, especially from October to March. People who are frail, housebound, in a care home or who have darker skin may need one all year round. Calcium matters too. Good sources include dairy foods, leafy green vegetables, tofu and dried fruit.

Try this: Put a vitamin D reminder next to the kettle this week. Ask a pharmacist which supplement suits you, especially if you already take other tablets. If you have osteoporosis, your GP may also suggest calcium.

5. Protect your appetite and your protein

Muscles need protein, and bones need a steady supply of nutrients. The NHS notes that appetite often drops with age, and that being underweight is linked to a higher risk of fractures. Small, regular meals are easier than big ones.

Try this: Add one protein food to each meal, such as an egg, a yoghurt, beans, fish or a glass of milk. If your parent is eating less or losing weight without trying, mention it to the GP.

6. Build strength and balance twice a week

Exercise is safe for most people with osteoporosis and is one of the best ways to prevent falls. The NHS recommends activities for strength and for balance on at least two days a week for people over 65. Our guide to exercise with osteoporosis explains what to do and which movements to adapt, so we will not repeat it here.

Try this: Choose two fixed days, such as Tuesday and Friday, and write them on the calendar. Start with five sit-to-stands from a firm chair and a few seconds of standing with feet together, holding a worktop.

7. Review medicines, eyes and ears

Bones rarely cause the fall. Dizziness, blurred vision and poor balance often do. The NHS advises a medicines review with your GP or pharmacist, regular eye tests and a hearing check, as ear problems can affect balance. Light-headedness when standing up is another common cause, which we explain in our post on dehydration, low blood pressure and falls.

Try this: Book an eye test and ask the pharmacist for a medicines check this month. Bring a list of everything taken, including shop-bought tablets.

8. Lift, reach and bend the bone-friendly way

Everyday jobs can put strain on fragile spinal bones. The NHS advises bending your knees when lifting and avoiding awkward bending and lifting movements if you have a high fracture risk. Reaching up to high shelves or down to low cupboards also makes people more likely to lose their balance.

Try this: Move everyday items, such as mugs, tins and towels, to between waist and shoulder height. Ask for help with heavy shopping, laundry baskets and bins.

9. Make the home and feet fall-proof

Loose rugs, trailing wires, poor lighting and worn slippers cause many falls. The NHS recommends well-fitting footwear with a good grip, non-slip bath mats, grab rails and a personal alarm or phone within reach. Our room-by-room home safety check walks you through the house.

Try this: Walk the route from bed to toilet in the dark tonight. Fix anything that trips you, and add a plug-in night light along the way.

What to do if a fall happens with osteoporosis

Falls can still happen, even with the best plan. Staying calm and knowing the steps makes a big difference.

1. Stop and check. The NHS advises taking a couple of minutes to check for pain or injury before trying to move.
2. Do not rush up. If it feels safe, roll onto your side, get onto hands and knees, crawl to a sturdy chair and stand up slowly. Our guide on how to get up from a fall shows each step.
3. If you cannot get up, use your phone or alarm, or shout and bang on the floor for help. Keep warm with anything you can reach, and change position about every 30 minutes.
4. Helping someone else? Keep them warm and comfortable. Do not try to lift them yourself.

⚠️ Call 999 if: the person may have hurt their head, back, neck or hip, or cannot get up. With osteoporosis, also call 999 if a leg looks shorter or turned out, or they cannot put weight through it.

Call NHS 111 if: they may be in pain, injured or unwell after a fall. Get the same advice for any sudden new back pain after a minor fall, cough or lift, as this can be a spinal fracture.

Even if nobody is hurt, tell the GP about any fall. The NHS says a GP may refer you to a falls service, which can check for weak bones, muscle weakness and eyesight problems.

When to get a physiotherapy assessment

A physiotherapy assessment makes sense if you notice any of these:

• a fall, or several near-misses, in the past year
• a recent fragility fracture, or a new diagnosis of osteoporosis or osteopenia
• holding on to furniture to get around the house
• struggling to stand up from a chair without using the arms
• going out less because of fear of falling
• a slower or shuffling walk, or new stooping

NICE guidance on falls recommends exercise programmes tailored to the person. That is where a physiotherapist helps. We look at strength, balance, walking, posture, footwear and the home itself, and set exercises that are safe for fragile bones. If your parent has already broken a hip, our hip fracture recovery guide explains the stages of getting back on their feet.

Rehalign's HCPC-registered physiotherapists visit homes across Birmingham, Solihull, Walsall, Wolverhampton, Coventry, Dudley, Telford and the wider West Midlands. Seeing someone in their own home means we can practise on their real stairs, chairs and routes, which is where falls actually happen. Age UK also has helpful free information on staying steady.

Book a falls prevention visit