Fracture risk and guidance
Fracture risk
In addition to fall risk are factors which can make the impact greater and bone fracture more likely. People with low bone mineral density and osteoporosis, as well as low body weight with a BMI<19, are more likely to experience a fracture following a fall. Low calcium or vitamin D levels, smoking, alcohol, diabetes, or corticosteroids also impair bone health.3
Vitamin D supplementation for older people who are vitamin D deficient may be recommended for falls prevention in some sources. However, NICE says there is insufficient evidence to support this per se, but it is reasonable to recommend people follow general vitamin D guidance to maintain bone and muscle health.2,7
Guidance
There is a great deal of guidance available on falls, from international bodies to national charities and professional organisations, as well as throughout the NHS.4,7,10,11
The World Guidelines for Falls Prevention and Management for Older Adults, published in 2022, is aimed at a wide range of health professionals, including pharmacists, in all care settings and for use by non-specialists as well as specialists.5,12
NICE issued new guidance on falls assessment and prevention in April 2025, with NG249 replacing the falls clinical guideline CG161 of 2013. The new guidance considers falls in relation to people aged 65 and over and people aged 50 to 64 whose condition(s) may put them at higher risk of falling.2
NICE advises against using falls risk prediction tools to predict a person’s risk of falling, as they can be a distraction because they only stratify people into high or low risk categories without recommending any further intervention.
Instead, for people in community settings, the approach should be to ask about details of any falls. This could be when the person presents after a fall or by asking during a routine appointment or annual health check whether the person has had any falls in the past year.