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Fall prevention in older adults: towards an integrated population-based perspective

¹ Institut national de santé publique du Québec, and Department of Social & Preventive Medicine, Université de Montréal, Montréal, Quebec, Canada
² Department of Social & Preventive Medicine, Groupe de recherche interdisciplinaire en santé, Centre de recherche Léa-Roback sur les inégalités sociales de santé de Montréal, Université de Montréal, Montréal, Quebec, Canada

Dr Y Robitaille, Institut national de santé publique du Québec, and Department of Social & Preventive Medicine, Université de Montréal, Montréal, Quebec, Canada; yvonne.robitaille@inspq.qc.ca

Accepted 17 April 2008

The first 150 words of the full text of this article appear below.

Two articles in the 19 January 2008 BMJ^{1 2} highlight tension between the clinical and public health approaches to fracture prevention among older adults. Järvinen et al¹ review drug therapy for osteoporosis and conclude that "bone mineral density is a poor predictor of an individual’s fracture risk" and thus that practitioners should focus on fall prevention rather than treatment for osteoporosis as a strategy for fracture prevention. Meanwhile, Gates and colleagues² note in their systematic review a troubling lack of evidence of efficacy for one respected falls prevention intervention, a multifactorial risk assessment with targeted management at the individual level.^{3 4} How can these apparently opposing views be reconciled?

Firstly, let’s place the review of Gates et al into a broader context. Their systematic review does not focus on all fall prevention interventions—rather it centers on interventions that screen clinically for fall risk with subsequent action or referral aimed at reducing risk . . . [Full text of this article]