Should future risk-of-fracture analyses include another major risk factor? The case for falls

This article proposes two things. (i) The major risk of so-called osteoporotic fractures that affect extremity bones (hips, wrists, etc.) consists of falls. Impairments of balance, vision, muscle strength, and neuromuscular coordination increase falls in aging adult humans, and when an osteopenia coexists, that makes such fractures more likely than otherwise. (ii) Risk- of-fracture studies should separate patients who develop fractures from falls or other injuries, from patients in whom fractures occur spontaneously, meaning during ordinary voluntary physical activities instead of from any kind of trauma.