Falls, fractures, and hip pads.

Improvement of balance along with bone-enhancing pharmacotherapy can improve the level of an individual's physical activity and mobility. Balance can be improved with enhancement of postural proprioception and muscular strength. Postural deformities have been shown to impair quality of life of osteoporotic individuals. Kyphotic posture has been demonstrated to contribute to propensity to fall in osteoporotic individuals. Kyphotic posturing and gait disorders can be managed through proprioceptive training, use of a weighted kypho-orthosis, muscle re-education, and safe resistance exercises. Proprioceptive balance training can reduce falls and fracture. Sarcopenia and osteoporotic fractures create musculoskeletal challenges that cannot be met with pharmacotherapy alone. Bone loss, imbalance, and gait disorder along with cognitive concerns can increase with aging. Even in healthy persons, predisposition to falls increases with age-related neuromuscular changes. Muscle strength decreases approximately 50% from age 30 to 80. Furthermore, the amount of body sway increases with reduction of proprioception. Therefore, measures that can decrease imbalance can reduce the risk for falls and fracture. In normal balance, ankle strategies are recruited rather than hip strategies. Strengthening of the lower extremity muscles reduces the risk for falls. Gait aids can also decrease the risk for falls. During a fall, the risk for hip fracture increases 30-fold if there is direct impact to the hip. The use of hip protectors can decrease the risk for hip fracture during a sideways fall. Training in effective safe-landing strategies should be included in fall prevention programs.