A major cause of fractures is not just weak bones but also falls. And a key factor in falls is poor balance, which tends to become more and more of a problem as people age.
The good news: good balance can help prevent falls. Clearly, if you have low bone mass, maintaining good balance is important. And attention to balance is even more critical if you have fallen recently or have had two or more falls in the past 12 months, because this means you are at risk of falling again.
Regardless of whether you’re experiencing balance troubles, osteoporosis experts recommend the following strategies to prevent falls and bone fractures:
1. Add balance exercises to your daily routine. If you have osteoporosis or have had an osteoporotic vertebral fracture, you should perform balance training exercises daily- even if you don’t have impaired balance. This advice, from an international panel of osteoporosis experts, was published in the journal Osteoporosis International and has been endorsed by the National Osteoporosis Foundation. Examples of low-intensity balance training exercises include walking heel to toe (tandem walking) or standing on one leg as you balance.
As you get better at performing these types of balance exercises, you should make them more challenging. For example, if you’re holding onto a chair for support while standing on one leg, gradually reduce your contact with it, and eventually let go altogether (be sure it’s nearby to grab onto should you lose your balance). Your doctor or physical therapist can advise you on specific exercises to perform.
The expert panel also recommends tai chi. Studies have documented its ability to improve balance, increase flexibility and decrease falls in people with osteoporosis. Originally a Chinese martial art, this ancient practice involves slow, balanced, low-impact movements done in sequences. It builds neuromuscular coordination, muscle strength, postural stability, and confidence in one’s ability to maintain balance, thus reducing the risk of falls. Classes are often available at adult education centers and health clubs. Keep in mind that there are different styles of tai chi, so if the first class you find isn’t a good fit, consider trying another.
2. Strengthen your muscles. In addition to reducing bone loss, strength training exercises are effective at increasing muscle strength and have been shown to reduce falls and fractures in people with osteoporosis.
With strength exercises (also known as muscle-training and resistance exercise), you are working against resistance until your muscles feel tired. Muscle-strengthening exercises can include basic moves such as standing and rising on your toes or doing squats. You can also use resistance bands or weights.
The panel recommends exercising each of the six muscle groups (upper back, chest, shoulders, arms, upper legs, lower legs) two or three times each week.
3. Be more flexible (your joints, that is). With advancing age, your joints become stiff and less flexible and can even get stuck in position. One simple way to increase hip flexibility is to take some longer strides when walking. It’s also a good idea to loosen your calf muscles by stretching them. Tight calf muscles make it difficult to lift your toes when you walk, which can increase your chances of tripping and falling.
4. Get enough vitamin D. Vitamin D is also important because it has been shown to help reduce the risk of falls, which can result in fractures. Adequate vitamin D intake helps reduce age-related muscle loss and improves muscle function, especially in the lower legs. Thus, in its current guidance on fall prevention in community-dwelling people age 65 and older, the U.S. Preventive Services Task Force (USPSTF) recommends vitamin D supplements as well as exercise or physical therapy to improve muscle strength and balance.
For most people, foods supply only a small proportion of the vitamin D they need. Few foods naturally supply significant amounts. Oily fish and some types of mushrooms contain the most; egg yolks and liver have small amounts. The main source in the U.S. diet is fortified cow’s milk. Some soy milk, yogurt, orange juice, margarine, and breakfast cereals are also fortified.
The National Osteoporosis Foundation recommends 800 to 1,000 IU a day for people age 50 and older. Unless you know your blood level is adequate (your doctor can perform a simple blood test), you’ll likely need a supplement to reach that goal. Other expert groups, such as the International Osteoporosis Foundation and the Endocrine Society, advise 1,000 to 2,000 IU daily, or even more for people who have low blood levels of vitamin D (below 20 ng/dL), especially those who have osteoporosis.
Though the skin makes the vitamin in response to sun, you shouldn’t rely on this, since vitamin D production can vary widely, depending on many factors. Notably, the skin’s ability to manufacture vitamin D declines with age, and the liver and kidneys become less efficient in converting vitamin D to its active form.