Denser bones help. But if you never fall, you never fracture. Balance training and fall prevention reduce fracture rates in older adults by 20–40%, comparable to the benefit of bisphosphonate medications. And unlike pills, it also improves your strength, confidence, and independence.
More than 90% of hip fractures in older adults are caused by falls. The fracture risk equation has two components: bone strength (how much force your bone can absorb before breaking) and applied force (how hard you hit the ground). Working on both sides of that equation makes more sense than focusing exclusively on bone density.
In Canada, falls are the leading cause of injury-related hospitalizations in adults 65 and older. The Public Health Agency of Canada estimates that about one-third of people over 65 fall at least once per year. Among those who fall, approximately 5% sustain a fracture. The goal of fall prevention is to reduce that probability — through better balance, stronger muscles, and a safer home environment.
Balance, strength, and coordination are related but distinct. Strength — particularly leg strength — reduces fall risk because stronger legs can catch you when you stumble. Balance training specifically trains the neuromuscular system's ability to detect instability and respond with corrective movements. Coordination work, like Tai Chi, trains the whole-body integration of vision, vestibular input, and muscle response.
The most effective fall prevention programs combine all three. For bone health specifically, the exercises also need to be weight-bearing — putting mechanical load on the skeleton to stimulate bone-building. See our full exercise and bone density guide for the strength training side.
These exercises can be done at home with no equipment. Use a sturdy chair nearby for support when you're learning them, and progress gradually. Consistency matters more than intensity — aim for balance practice on most days.
How to do it: Stand next to a chair or counter. Lift one foot off the floor and hold for 10–30 seconds. Switch sides. Keep your core gently engaged and look at a fixed point on the wall ahead.
Why it works: This is the gold-standard basic balance test. Inability to hold a single-leg stance for 10 seconds has been shown to predict fall risk and increased mortality in older adults. Practicing it improves it.
Progression: Eyes closed (much harder). Standing on a folded towel or foam mat. Reaching with the free arm while standing on one leg.
How to do it: Walk in a straight line placing the heel of your front foot directly against the toe of your back foot with each step. Walk 10–20 steps forward, turn slowly, and walk back. Use a hallway wall for reassurance.
Why it works: Tandem walking challenges dynamic balance — the ability to stay stable while moving. It closely mimics the narrow base of support that makes real-world walking tricky on uneven surfaces.
Progression: Add a head turn (look left, look right while walking). Carry a light object in one hand. Walk on carpet vs. smooth floor.
How to do it: Sit on a firm chair with your feet shoulder-width apart. Cross your arms over your chest (don't push off with hands). Lean slightly forward and stand up slowly and with control. Lower back down slowly — the lowering phase is equally important. Do 8–12 repetitions.
Why it works: Hip and quad weakness is one of the strongest predictors of falls. Sit-to-stand is both a test of strength and a training exercise for getting up safely — a critical real-world skill.
Progression: Slower lowering phase. Higher chair → standard chair → lower surface. Add a small pause at mid-movement.
How to do it: Stand holding a chair. Lift one leg out to the side, keeping your torso upright. Hold 2 seconds, lower slowly. 10–15 repetitions per side.
Why it works: Hip abductor weakness is directly linked to lateral instability — the kind that causes falls to the side, which are more likely to cause hip fractures than forward falls.
Progression: Resistance band around ankles. Increase speed of movement. Combine with standing on the non-working leg.
How to do it: Stand with feet hip-width apart, holding a chair for balance. Rise onto your toes slowly, hold 1–2 seconds, lower slowly. 15–20 repetitions.
Why it works: Calf strength is critical for push-off during walking and for corrective steps when balance is disturbed. It also loads the heel and ankle bones — good for bone density in those areas.
Progression: Single-leg heel raises. Standing on a step (greater range of motion). Hold weights in each hand.
Tai Chi is the most extensively studied balance and fall prevention intervention in older adults, and the evidence is strong. A 2020 meta-analysis in JAMA Internal Medicine found that Tai Chi reduced fall rates by 19% and the number of people who fell by 20%. For people with a history of falls, the reduction was even larger.
The reasons Tai Chi works go beyond simple balance drills: it trains weight shifting, controlled movement, attention and body awareness, and lower-body strength simultaneously. It's also low-impact, making it accessible to people with arthritis or after joint replacement.
Tai Chi classes are widely available across Canada. In major cities — Toronto, Vancouver, Calgary, Edmonton, Ottawa, Montréal — community recreation centres (YMCA, community leagues, municipal rec programs) offer weekly Tai Chi classes, many at low or subsidized cost for seniors. Search your municipal recreation portal or call your local seniors' centre.
About half of all falls in older adults happen at home. Most of these falls are preventable with simple modifications that cost very little. A home hazard assessment takes 30 minutes and can genuinely reduce fall risk.
Osteoporosis Canada offers the Bone Fit program — exercise classes specifically designed for people with osteoporosis or low bone density. Certified instructors teach safe, bone-loading exercise with appropriate modifications for people at fracture risk. Classes run across Canada. Find your nearest class at osteoporosis.ca under the exercise section.
Most provinces have dedicated fall prevention programs through their provincial health authority:
If you've already had a fall, or if your balance feels notably impaired, a physiotherapy assessment is worthwhile. A physiotherapist can identify your specific deficits (ankle stability, hip strength, vestibular issues), prescribe an individualized exercise program, and refer you for vestibular rehabilitation if dizziness is a contributing factor. OHIP in Ontario does not cover physiotherapy, but many private insurance plans do. Some provinces offer limited publicly funded physio for seniors post-hospitalization.
This is often overlooked: several common medications significantly increase fall risk in older adults. These include sedating antihistamines, sleep aids, benzodiazepines (Ativan, Xanax, Valium), opioids, tricyclic antidepressants, and many blood pressure medications that can cause orthostatic hypotension (dizziness when standing up). If you're on any of these and have concerns about falls, talk to your pharmacist about a medication review — this is a covered service under most provincial pharmacare programs.
Also see our guides on weight-bearing exercise for bone density, hip fracture prevention, and osteoporosis exercise programs in Canada.