Prevention of Osteoporotic Fractures in the Elderly: A Comprehensive Narrative Review

Osteoporotic fractures represent a major public health challenge with significant morbidity, mortality, and economic burden, particularly among elderly populations. These fractures result from a combination of reduced bone mineral density and increased fall risk, both of which are modifiable through targeted preventive interventions. This narrative review examines evidence-based strategies for preventing osteoporotic fractures in older adults, focusing on bone health optimization, fall prevention programs, and fracture risk assessment tools (FRAX). Key preventive measures include calcium and vitamin D supplementation, pharmacological therapy with bisphosphonates and other antiresorptive agents, resistance and balance training exercises, environmental modifications, and comprehensive geriatric assessment. This review explores screening protocols using dual-energy x-ray absorptiometry and FRAXs such as FRAX to identify high-risk individuals requiring intervention. Special emphasis is placed on primary prevention through lifestyle modifications, including adequate nutrition, weight-bearing exercise, smoking cessation, and alcohol moderation. Secondary prevention following initial fractures is discussed, highlighting the importance of fracture liaison services in preventing subsequent fractures. The review addresses barriers to implementation, including poor adherence to osteoporosis medications, limited access to screening services, and inadequate healthcare provider awareness. Cultural and socioeconomic factors influencing prevention strategies in diverse populations are examined. This synthesis provides orthopedic surgeons, primary care physicians, and public healthcare professionals with comprehensive guidance for developing and implementing effective osteoporotic fracture prevention programs that reduce fracture incidence, preserve functional independence, and improve quality of life in elderly patients.