A pro-active approach to prevent falls should receive at least as much attention as drug therapy for osteoporosis in hip fracture patients, but is often an area of care that is neglected. The concept of frailty has received increasing attention in recent years as neither BMD nor clinical risk factors such as age and weight can capture fully the risk of osteoporotic fractures in elderly. GDC-0973 price Frailty is a state of poor well being, related to muscle weakness and sarcopenia, poor endurance, a low level of physical activity and easy exhaustion and with a slowness of gait

[86]. Physical activity and exercise form part of the post-hip fracture rehabilitation but in the elderly, also serve to increase muscle mass and strength, improve body function, reduce risk of fall, and contribute to a better quality of life. Immobilization accelerates bone loss and should be avoided as far as possible. Nonetheless the minimal NVP-LDE225 nmr level of physical activity and exercise required to prevent bone loss remains a matter for debate [87]. Exercises that improve balance, including Tai-Chi,

reduce the incidence of falls and fall-related injuries in community-dwelling, physically inactive individuals of mean age 77 years [88] but do not reduce the risk of fracture. In a meta-analysis of four studies that involved community-dwelling individuals aged 65 to 97 years, a home exercise training program reduced falls and fall-related injuries, with the effect being more pronounced in participants aged 80 years and above [89]. In hip fracture patients with reduced mobility and poor balance, careful evaluation is required before exercise is prescribed: without adequate balance training the subject may be at higher risk of falls and hence fractures. In post-hip fracture subjects with Astemizole poor mobility, poor motivation, and easy fatigability, whole-body vibration is a potential promising alternative to conventional exercise. Whole-body vibration can induce gain in muscle strength similar to that achieved with conventional resistance training. It also improves BMD in postmenopausal women [90]. Data on fall prevention and reduction in fracture risk are as yet unavailable. The benefit of wearing

hip protectors in hip fracture prevention is controversial as patient compliance is often a problem and study results thus unreliable. Recent systemic review and meta-analysis failed to confirm the effect of hip protectors in community-dwelling subjects or nursing home residents [91, 92]. Medical risk factors that predispose the elderly to fall should be identified and treated. These include correction of cataract and other causes of visual impairment, evaluation of gait and balance, and avoidance of sedatives or medications that may affect balance and stability. Elderly individuals who are physically unstable should be prescribed appropriate walking aids and gait-training exercises. Assessment of home and environmental safety is often neglected and should be emphasized.