Understanding What is the Most Common Cause of Fractures in the Elderly?

Oct 17, 2025 4 min read •

senior care Healthy Aging bone health

Over one-third of men and nearly half of women over 65 will suffer a major osteoporotic fracture in their lifetime. A combination of weakened bones and falls answers the question of what is the most common cause of fractures in the elderly.

Quick Summary

The most common cause of fractures in the elderly is the synergistic combination of weakened bones due to osteoporosis and a fall, which acts as the triggering event.

Key Points

Osteoporosis is the underlying cause: The disease weakens bones, making them fragile and highly susceptible to breaking, even from minor incidents.
Falls are the most frequent trigger: For many older adults, a simple fall is the immediate event that causes a fracture in already weakened bones.
Hip fractures are a major concern: These are particularly common and serious among the elderly, often resulting from a fall and leading to significant disability.
Prevention is a dual-pronged effort: Effective strategies involve both strengthening bones through nutrition and exercise, and minimizing fall risks by modifying the home environment and reviewing medications.
Risk factors increase with age: Balance issues, vision loss, certain medications, and a sedentary lifestyle all contribute to the increased likelihood of falls and fractures in seniors.
Regular check-ups are vital: Bone density screenings and medication reviews with a doctor can help identify and mitigate major risk factors before a fracture occurs.

The Dual Threat: Osteoporosis and Falls

While a fall is the immediate event leading to most fractures in older people, the underlying vulnerability is due to weak and brittle bones caused by osteoporosis. An older person with healthy bones may experience a fall with little or no injury, but the same fall for someone with osteoporosis can result in a serious fracture, most notably of the hip, spine, or wrist. This interaction makes prevention a two-pronged effort: improving bone density and minimizing fall risk.

The Silent Disease: Osteoporosis

Osteoporosis, meaning 'porous bone,' is a disease that thins the framework inside bones. In early stages, it presents no symptoms, progressing silently for years until a minor bump or fall results in a fracture. Bone is living tissue that is constantly broken down and rebuilt, but with age, this process falls out of balance, leading to a net loss of bone mass.

Risk factors for osteoporosis

Advanced Age: The most significant factor, as bone density naturally decreases over time.
Gender: Women are at a higher risk, especially post-menopause due to a rapid drop in estrogen, which protects against bone loss.
Nutritional Deficiencies: A lifelong lack of calcium, vitamin D, and protein contributes to lower bone density and increased fracture risk.
Lifestyle: A sedentary lifestyle, long-term alcohol misuse, and smoking weaken bones.
Medical Conditions and Medications: Conditions like arthritis and kidney disease, along with certain medications (e.g., long-term corticosteroids), can accelerate bone loss.

The Precipitating Event: Falls

For the vast majority of hip fractures in the elderly, a fall is the cause. A decline in physical abilities and the presence of certain medical conditions increase the risk of a fall.

Why seniors are more prone to falling

Weakened Balance and Vision: Sensory functions like balance and vision weaken with age, affecting coordination and stability.
Slowed Reflexes: Slower reflexes make it harder to catch oneself during a stumble.
Medication Side Effects: Many common medications can cause side effects like sedation, dizziness, impaired balance, and orthostatic hypotension (a drop in blood pressure when standing). Benzodiazepines, antidepressants, and some high blood pressure medications are frequently cited.
Environmental Hazards: Poor lighting, throw rugs, clutter, and a lack of safety features like grab bars are major contributors to falls at home.
Fear of Falling: Paradoxically, a prior fall or the fear of one can lead to reduced mobility, resulting in muscle weakness and a higher risk of future falls.

Common Types of Fractures

Osteoporosis makes certain fracture types more likely, especially those caused by a simple fall or even non-traumatic events.

Hip Fractures: Extremely common and dangerous in older adults, often occurring after a fall to the side. They frequently require surgery and can severely impact independence.
Vertebral (Spinal) Fractures: Can occur from minor trauma like bending over, lifting, or even coughing. These can lead to severe back pain, loss of height, and a hunched posture.
Wrist Fractures: A natural reaction to a fall is to put your hands out to break it. For people with osteoporosis, this can easily result in a wrist fracture.

Comparison of Risk Factors for Fragility Fractures


Factor	Modifiable	Non-Modifiable
Diet	Yes (increase calcium, vitamin D, protein intake)	No
Physical Activity	Yes (regular weight-bearing and strengthening exercises)	No
Smoking	Yes	No
Alcohol Consumption	Yes	No
Body Weight	Yes (maintaining a healthy BMI)	No
Environmental Hazards	Yes (home safety modifications)	No
Medications	Yes (reviewing prescriptions with a doctor)	No
Age	No	Yes
Sex	No	Yes (women are at higher risk)
Genetics	No (family history of fractures increases risk)	Yes

Strategies for Prevention

Preventing fractures in the elderly requires a holistic approach that addresses both bone health and fall risk.

Strengthening Bones Through Nutrition and Exercise

Diet: Ensure a diet rich in bone-building nutrients. A balanced intake of calcium (from dairy, leafy greens), vitamin D (from sun, fortified foods, or supplements), and protein is crucial. For more on dietary strategies for bone health, see the International Osteoporosis Foundation's recommendations.
Exercise: Weight-bearing exercises, where your feet and legs support your body weight, help build and maintain bone density. These include walking, jogging, and climbing stairs. Muscle-strengthening exercises, like using resistance bands or light weights, also put stress on bones, promoting growth. Balance exercises like Tai Chi are also highly effective at reducing fall risk.

Creating a Safer Home Environment

Remove Trip Hazards: Secure loose rugs with double-sided tape, or better yet, remove them completely. Clear clutter from floors, especially in walkways and on stairs.
Improve Lighting: Ensure all areas of the home are well-lit. Consider nightlights in hallways and bathrooms to make nighttime trips safer.
Install Grab Bars: Place grab bars in the bathroom, particularly near the toilet and in the shower or tub, for extra stability.
Use Non-Slip Surfaces: Use non-slip mats in the tub and shower to prevent slipping.

Managing Medications and Health Conditions

Medication Review: Talk to a pharmacist or doctor about all medications, including over-the-counter drugs, to assess and minimize fall-related side effects.
Regular Check-ups: Routine health screenings, including bone density scans (DEXA scans), can help identify osteoporosis early for appropriate treatment.
Vision and Hearing Checks: Impaired vision and hearing can affect balance and awareness of surroundings. Regular checks are important to correct any issues.

Conclusion

Understanding what is the most common cause of fractures in the elderly is key to effective prevention. It is not a single factor but a combination of underlying bone weakness from osteoporosis and the increased risk of falls. By addressing both bone health through proper nutrition and exercise, and reducing fall risks with home safety modifications and medication management, seniors can significantly lower their chances of experiencing a life-altering fracture. A proactive, multi-faceted approach empowers older adults to maintain their independence and quality of life for years to come.

Frequently Asked Questions

A fragility fracture is a break that results from a low-energy trauma, such as a fall from standing height or less. These are the main clinical consequence of osteoporosis, as the bone is too weak to withstand normal forces.

Hip fractures are common because they are often caused by a fall to the side, which is a frequent type of fall among older adults. The combination of a fall and osteoporotic weakening of the hip bone (femur) makes this specific injury very common and serious.

Yes. In severe cases of osteoporosis, bones can become so weak that a fracture can occur from simple, non-traumatic actions like coughing, bending over, or twisting the wrong way. These often result in vertebral compression fractures.

Several types of medications can increase fall risk. Common examples include benzodiazepines, certain antidepressants, antipsychotics, muscle relaxants, and some high blood pressure medications. Side effects often include sedation, dizziness, and impaired balance.

A diet rich in calcium and vitamin D is essential for building and maintaining bone density throughout life. Adequate protein and other nutrients also support muscle mass and overall skeletal integrity. Without these nutrients, the body takes calcium from the bones, weakening them over time.

Weight-bearing exercises, such as walking, dancing, and stair climbing, are highly beneficial. Strength training using light weights or resistance bands also helps stimulate bone growth. Balance exercises like Tai Chi are also crucial for reducing fall risk.

Osteoporosis is often called a 'silent disease' because there are typically no symptoms in the early stages of bone loss. Symptoms usually only appear after a bone has been significantly weakened or has already fractured.

Simple modifications include securing or removing loose rugs, improving lighting throughout the house, and installing grab bars in bathrooms and stairways. Ensuring walkways are clear of clutter is also important.

References

Medical Disclaimer

This content is for informational purposes only and should not replace professional medical advice. Always consult a qualified healthcare provider regarding personal health decisions.