What does your balance have to do with preventing bone fractures?

As we age, balance gradually declines alongside muscle strength. That combination is one of the main reasons older adults fall. And a fall is the direct link to a bone fracture: the less you fall, the fewer bones you break.

Exercise programmes cut that risk substantially. Across 59 randomised studies, researchers found that active older adults fall an average of 23% less often. That may sound abstract, but if you work that out for a group of 1,000 people, it amounts to roughly 195 fewer falls per year. On top of that, 15% fewer people experience even a single fall.

Balance and functional exercises are the best supported in this regard: 24% fewer falls, based on nearly 8,000 participants. Those who also add strength training see fall reductions of as much as 34% in smaller studies, although that evidence is somewhat less certain because less research has been done on it. Tai Chi also shows positive signals, but the evidence there is thinner. One thing is clear: simply walking more on its own is not enough; walking as the sole form of training shows no proven reduction in falls.

For fractures themselves, the evidence is somewhat less pronounced. Ten studies with more than 4,000 participants found 27% fewer fall-related fractures in people who exercised, but the certainty is lower than for the fall figures. The link is biologically logical: fewer falls means a lower chance of a fracture. And a hip fracture is a serious blow to quality of life, particularly in the first months afterwards.

Programmes that work best are supervised, continue for longer than three months, and combine balance with strength training. Side effects do occur: minor injuries or muscle soreness are not uncommon, and in one study there were two serious cases. Overall, however, exercise is a safe strategy against fall risk. Pilates and core muscle training show promising early results in smaller groups of older women, but have been too little studied for firm conclusions.