What does your balance have to do with preventing bone fractures?
Poor balance increases the risk of falling and therefore of bone fractures; targeted balance training can reduce that risk by tens of percentage points, especially when you practise for more than three hours per week.
Ninety percent of all hip fractures result from a fall. That makes balance one of the most important modifiable factors in preventing bone fractures. Three systems work together to maintain your equilibrium: the sensation in your muscles and joints, the balance organ in your ear, and your vision. When these systems deteriorate with age, the risk of falling increases.
A skewed or poorly functioning balance organ turns out to be concretely detectable in people who have already suffered a fracture. Of people who sustained a wrist fracture after a fall, 65% had a measurable left-right difference in the balance organ, which was associated with greater balance problems. Older adults who suffered a hip fracture after a fall also significantly more often had a measurable disorder in the balance organ than older adults without a fracture. This suggests that targeted screening for balance problems is a worthwhile step, alongside the usual bone density measurement. A simple test that partially captures this: the Romberg test, in which you stand in one place with your eyes closed. In an observational study of 125 postmenopausal women, scoring poorly on this test was associated with already having fragility fractures.
Women with osteoporosis and a curved upper back also sway more while standing than peers without osteoporosis. They compensate differently, relying more on hip movements. A small study (21 participants) found this, so it is a preliminary finding that does not allow firm conclusions, but it fits within the broader pattern.
Fortunately, balance is something you can train. A meta-analysis of 88 randomised studies involving nearly 20,000 participants shows that exercise programmes reduce the number of falls among community-dwelling older adults by an average of 21%. Programmes that actively challenge balance and last more than three hours per week achieve a reduction of as much as 39%. This effect was not found in nursing homes or after a stroke. Targeted training of the balance organ itself also showed improvement in a randomised study (68 participants): more people lost their left-right difference in the balance organ after nine weeks of group exercises, although other balance measurements did not improve significantly.
Professional associations such as the American Geriatrics Society therefore advise that everyone over the age of 65 be screened annually for balance problems. For those at increased risk of falling, the recommendation is: actively work on your balance, strength, and walking ability, and also consider discussing vitamin D, your medication list, and the safety of your home environment with your doctor.
Sources include a meta-analysis of 88 RCTs (PMID 27707740), a systematic review (PMID 11394562), an RCT (PMID 25471256), an observational study (PMID 29304151), two review/guideline articles (PMID 25700584, 28925664), and two smaller studies (PMID 9084349, 15065358). The strongest evidence concerns fall prevention through balance training; the evidence for the role of the balance organ in fractures is moderate and largely based on associations.
Are there dietary patterns that have been proven to reduce bone fractures?
Fermented dairy, sufficient vegetables and fruit, and a varied diet with protein and calcium are best supported for bone protection, while soft drinks, alcohol and an overly narrow (vegan) diet without supplementation increase your fracture risk.
How do you prevent bone loss when losing weight at an older age?
Strength training while losing weight is the best protection against bone loss, but cannot prevent it entirely. Combine it with adequate protein intake and discuss it with your doctor if you are losing weight quickly or in large amounts.
Does diabetes increase the risk of bone fractures?
Both type 1 and type 2 diabetes clearly and demonstrably increase the risk of bone fractures. If you have diabetes, discuss with your doctor whether your bone health is being properly monitored, as the standard risk score underestimates this risk.
Is walking enough to slow down bone loss?
Walking helps a little with mild bone loss, but is probably not enough if you genuinely want to build or preserve bone density in osteoporosis. Add resistance exercises for a measurably stronger effect.
Which type of training has the best-proven track record against bone loss in later life?
High-intensity resistance training (at least 70-85% of maximum load, two to three times per week, for at least eight to twelve months) works best for bone preservation. If you also want to address your fall risk and muscle strength, a combined programme of strength, balance and fitness is the smartest choice.
Does too little protein increase your risk of bone fractures as you age?
Yes, too little protein increases your risk of bone fractures in older age. This works through weaker bones as well as through poorer muscle condition. Aim for at least 1.0 to 1.2 grams of protein per kilogram of body weight per day, preferably together with adequate calcium and vitamin D.