FALLS' GUIDELINES AND OSTEOPOROSIS ASSESSMENT

To the Editor: The AGS guidelines for the prevention of falls in older persons that were published in the May issue of the Journal of the American Geriatrics Society represent an excellent effort to provide evidence-based recommendations for the prevention of falls in older individuals.1 I believe that measures that have been shown to decrease fall-related injuries should be part of any fall prevention program. Although the guidelines addressed the use of hip protectors as one intervention that may decrease the risk of sustaining a hip fracture as a result of a fall, it did not emphasize the importance of osteoporosis prevention and management in patients who are at an increased risk for falling. This is particularly important in view of growing evidence showing that osteoporosis assessment and management in individuals who fall (even when a fall results in a hip fracture) are frequently overlooked.2,3 It is important to assess all older patients who are at increased risk of falling for the presence of risk factors for osteoporosis.4 In addition, preventive measures aimed at conserving bone mineral density (BMD) should be stressed in such individuals.5 If one or more osteoporosis risk factors are identified, BMD should be assessed. If osteoporosis is diagnosed (T score <2.5 standard deviation), clinicians should prescribe therapies that have been shown to decrease the risk of sustaining a hip fracture as a result of a fall. These include calcium and vitamin D supplements6 and a bisphosphonate (alendronate7 or risederonate8).