The scale of the problem is staggering. In 2019 alone, an estimated 4.3 million new fragility fractures occurred across the EU27, Switzerland, and the United Kingdom, including approximately 827,000 hip fractures. The direct cost of these new fractures reached 36.3 billion euros, with an additional 19.0 billion euros attributable to long-term disability from fractures sustained in previous years. When pharmacological assessment and treatment costs of 1.6 billion euros are added, the total direct cost climbed to 56.9 billion euros in a single year. Healthcare costs remain elevated above pre-fracture levels for five full years after the injury, placing an unsustainable strain on health systems already stretched by aging populations.

What makes these figures particularly troubling is how preventable many of these fractures are. More than 95 percent of hip fractures are caused by falling, yet the clinical systems designed to prevent falls and those designed to prevent fractures operate almost entirely in isolation from one another. Hip fracture outcomes are grim: one-year mortality reaches 20 to 24 percent, and among survivors, 40 percent are unable to walk independently while 60 percent still require assistance a full year after injury. Approximately one-third of patients become fully dependent or require residential care within twelve months of sustaining a hip fracture.

The biological logic for integration is compelling. The paper presents a conceptual framework showing how bone fragility and fall risk jointly determine fracture probability, with their relative contributions shifting over time. A common geriatric syndrome called osteosarcopenia—the combination of sarcopenia and osteopenia or osteoporosis—illustrates this overlap, affecting an estimated 5 to 37 percent of community-dwelling older adults and elevating the risk of both falls and fractures simultaneously. Crucially, researchers have documented an imminent subsequent fracture risk after both an incident fracture and an incident fall, and conversely, an increased risk of falling soon after a fracture. This bidirectional cascade means that missing one risk dimension inevitably undermines the other.

Despite this, clinical practice lags badly. In a recent survey among European healthcare professionals, fewer than 60 percent of respondents reported including fracture risk assessment often or always within the multifactorial fall risk assessment. On the fracture side, fall risk assessment is not routinely performed in many Fracture Liaison Services, the specialized secondary prevention programs established after a first fracture. In a 2025 national UK evaluation, only about 65 percent of FLS patients received or were referred for a fall risk assessment, with substantial variation between services, and the picture is likely worse or entirely absent in many other countries. The authors contend that FLS programs are uniquely positioned to operationalize integrated care but frequently remain predominantly bone-focused rather than comprehensively risk-focused.

The paper lays out a detailed technical roadmap for how fracture risk assessment can be embedded within fall prevention services, drawing on the 2022 World Guidelines for Fall Prevention and Management. These guidelines introduce a fall risk stratification algorithm for community-dwelling older adults and recommend that those at moderate to high risk of falls undergo bone health assessment using validated tools. Fracture risk calculators such as FRAX, Garvan, and QFracture can identify older adults at high fracture risk, with Garvan and QFracture already incorporating falls as a predictor. FRAXplus further refines conventional FRAX estimates by accounting for the number of falls in the previous year, allowing clinicians to treat fall history as a modifiable fracture risk amplifier that directly informs both risk stratification and therapeutic choice.

Conversely, established osteoporosis management pathways should embed fall prevention. An internationally applicable algorithm for postmenopausal women categorizes fracture risk into low, intermediate, and very high zones using FRAX, with bone densitometry and recalculation refining intermediate cases. Women with a prior fragility fracture are automatically considered at least high risk. The authors emphasize that fall prevention strategies must be embedded within treatment pathways for patients at high and very high fracture risk, and that cognitively impaired and dementia patients should never be denied fracture prevention measures, including pharmacological osteoporosis treatments. This population deserves particular attention: 60 to 80 percent of people with dementia fall annually, and cognitive impairment is present in approximately 40 percent of all older adults with hip fractures.

Education represents another critical pillar. Among nearly 4,000 European healthcare professionals surveyed, approximately 12 percent reported low or very low knowledge of both falls and bone health, and 35.9 percent reported low knowledge of orthogeriatric care. Only about a quarter of surveyed professionals agreed that their undergraduate education adequately prepared them for fall prevention in clinical practice. The authors call for interprofessional training that bridges medicine, physiotherapy, nursing, pharmacy, and dietetics, alongside a core set of competencies for integrated fall and fracture assessment that local teams can adapt to their resources while remaining evidence-based.

On the policy front, the paper argues that integrated fall and fracture prevention must be recognized as a public health priority and incorporated into national healthy aging strategies aligned with the WHO’s Decade of Healthy Ageing. Promising national initiatives already exist: France launched a 2022 plan targeting a 20 percent reduction in fall-related fractures and deaths; the Netherlands has introduced an Integrated Approach to Fall Prevention strategy; and Belgium operates a dedicated Center of Expertise for Falls and Fracture Prevention in Flanders. Hip fracture registries, another policy instrument, should include fall prevention quality markers, as the Danish National Hip Fracture Database has done since 2010.

Emerging technologies offer powerful new tools. Wearable sensors capturing real-world balance and mobility data, combined with AI-driven predictive models, demonstrate superior fall prediction performance compared with traditional approaches, while in silico clinical trials enable simulation of virtual populations to optimize preventive interventions before deployment. Emerging pharmacological findings add intrigue: pooled analyses suggest that romosozumab and denosumab may each reduce fall risk in postmenopausal women with osteoporosis, hinting at mechanisms that might involve muscle mass, though the authors caution that studies with falls as the primary outcome are still needed. The WHO and ESCEO have signed a five-year collaboration agreement to develop a strategic global roadmap on bone health and aging, signaling that momentum toward truly integrated prevention may finally be building. The authors’ message is unambiguous: unify the science, unify the services, and millions of preventable fractures and falls could be avoided.

Subject of Research: Integrated fall and fragility fracture prevention in older adults through coordinated international clinical, educational, policy, and research strategies

Article Title: Position paper: a coordinated approach to fracture and fall prevention from seven international organizations

Article References: van der Velde, N., Seppala, L. J., Bahat, G., Blain, H., Casas Herrero, A., Harvey, N. C., Masud, T., Rizzoli, R., Reginster, J.-Y., Ruggiero, C., Barbagallo, M., de Lima, A. B., Bonnici, M., Bousquet, J., Cortet, B., Chiari, L., Dionyssiotis, Y., Dreinhöfer, K., Duque, G., … Öztürk, Y. (2026). Position paper: a coordinated approach to fracture and fall prevention from seven international organizations. European Geriatric Medicine. https://doi.org/10.1007/s41999-026-01596-7

Image Credits: AI Generated

DOI: 10.1007/s41999-026-01596-7

Keywords: fall prevention, fragility fractures, osteoporosis, geriatric medicine, Fracture Liaison Services, hip fracture, osteosarcopenia, integrated care, healthy aging, bone health, wearable sensors, public health policy