Primary prevention

Prevention of hip fractures includes appropriate identification and treatment of those at risk for osteoporosis, as well as identifying those at risk for falls. Previous distal radius fracture has a significant impact on the risk of subsequent hip fracture.[38]​ Diagnosing osteopenia or osteoporosis in these patients is important to prevent a future hip fracture.[39]

There is some evidence that multi-faceted interventions in hospital inpatients may reduce the relative risk for number of falls.[40][41]​​ [ Cochrane Clinical Answers logo ] [Evidence C] [ Cochrane Clinical Answers logo ] ​ These interventions included risk factor assessment, care planning, medical/diagnostic approaches, changes in the physical environment, education programmes, medication review, nutritional risk screening, and exercise.[40] See Assessment of falls in the elderly.

Guidelines recommend that older people should be offered a multifactorial risk assessment and an individualised, multifactorial intervention if they present for medical attention because of a fall, report recurrent falls in the past year, or demonstrate abnormalities of gait and/or balance.[42]​ In postmenopausal women, regular low-intensity physical activity, such as walking, bowling, and golf, has been shown to lower hip fracture risk.[43]​ The benefit-risk ratio of hormone therapy appears favourable for the prevention of bone loss or fracture among women (without contraindications) who are aged under 60 years or are within 10 years of menopause onset.[28]​ Women with an intact uterus should receive combined oestrogen/progestin therapy to protect against endometrial hyperplasia and cancer, whereas women without a uterus should receive oestrogen alone if they do not have contraindications for systemic oestrogen therapy.[28]​ It is important to provide information on the benefits and risks of hormone therapy, to help women make an informed choice about which, if any, treatment to use. Bisphosphonates may be appropriate to prevent bone loss in women with early menopause when oestrogen is contraindicated, or when hormone therapy is discontinued.[28]​ See Menopause.

Secondary prevention

Preventive actions include management of osteoporotic conditions using optimisation of nutrition, reduction in alcohol intake, and smoking cessation. However, calcium and vitamin D supplementation alone will not reduce risk of future fractures and additional pharmacological measures should be considered in all patients.[28][119]​​[120]​​​​ Pharmacological measures may include bisphosphonates and parathyroid hormone analogues.[121] Further measures include removing trip hazards in the home and re-evaluating the need for medications that may cause syncopal episodes.

There is evidence that multi-faceted interventions in hospital inpatients may reduce the relative risk for number of falls.[40][41]​​ [ Cochrane Clinical Answers logo ] [Evidence C] [ Cochrane Clinical Answers logo ] These interventions included risk factor assessment, care planning, medical/diagnostic approaches, changes in the physical environment, education programmes, medication review, nutritional risk screening, and exercise.[40] 

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