Primary prevention

High-energy trauma is best prevented by promoting safety among motor vehicle drivers and passengers (e.g., proper seatbelt use, safe driving), in the workplace, and in the home (e.g., falling precautions for older people, appropriate window and balcony guards to prevent falls from heights).

Fall-prevention programmes (e.g., exercise, physiotherapy) for older people and those with neuromuscular disorders can be useful. There is some evidence that multifaceted interventions in hospital inpatients may reduce the relative risk for number of falls; this may be more likely in a subacute setting.[38][39]​​​ These interventions include risk assessment, risk factor assessment, care planning, medical/diagnostic approaches, changes in the physical environment, education programmes, medication review, hip protectors, removal of physical restraints, and exercise.[39]​ 

Appropriate safety gear can decrease the incidence of acute fractures in athletes.​ Proper training techniques, correct performance technique, adequate rest, avoidance of over-training, and proper footwear may decrease the incidence of stress fractures in athletes.[40] Screening for and treatment of eating disorders and female athlete triad (disordered eating, menstrual dysfunction, and decreased bone mineral density) may similarly decrease the risk of stress/insufficiency fractures in these populations.​[40][41]

Appropriate calcium and vitamin D supplementation can help to decrease the effects of chronic corticosteroid use on bone mineral density among those with corticosteroid-dependent chronic inflammatory conditions.[42]

Primary prevention and/or appropriate treatment of osteoporosis can reduce the incidence of osteoporotic fractures. The identification of decreased bone mineral density in people with any risk factors for osteoporosis suggests a greater risk of osteoporotic fracture. Primary prevention of fractures requires optimisation of peak bone mass in childhood, which is influenced mainly by genetic factors, adequate nutrition, and exercise. Thereafter, primary prevention depends on minimising loss of bone mass and maintaining skeletal trabeculae microarchitecture and cortical thickness. Important factors to consider are good nutrition (especially adequate intake of protein, calcium, and vitamin D), regular physical activity, and avoiding smoking and excessive alcohol consumption.[43] Pharmacological treatments available for prevention/treatment of osteoporosis include antiresorptive drugs (to inhibit bone resorption) and anabolic drugs (to stimulates bone formation).[43] See  Osteoporosis.

Secondary prevention

In an older patient (e.g., 65 years or above) with a fracture resulting from a fall, consider an underlying condition such as osteoporosis, which would put the patient at higher risk of a subsequent fracture. If available, arrange for referral to a fracture liaison service for further investigation and treatment; or refer to orthogeriatricians as needed. It is important to explain to the patient (or caregivers) that their bone health needs to be evaluated and that they may be at risk of future fractures.[120] See Osteoporosis.

Patients who are at a high risk of developing a stress fracture (e.g., female long-distance runner with a history of a prior stress fracture) should be followed up and encouraged to report any pain to their physician immediately.

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