For someone with osteoporosis, preventing falls is as important as treating bone density. A fall that causes a hip fracture can be life-altering — carrying a 20–30% one-year mortality rate in older adults and significantly reducing independence for survivors. Evidence-based falls prevention combines balance exercise, home modification, medication review, and appropriate footwear.
About 30% of Canadians aged 65 and older fall at least once per year. Most of the time, falls result in bruising or minor injury. But when bones are fragile — T-score below −2.5 at the spine or hip — the same fall can cause a hip fracture, vertebral fracture, wrist fracture, or fracture at multiple sites. This is why Osteoporosis Canada's clinical guidelines address falls prevention as a core component of osteoporosis management, not a separate issue.
The Public Health Agency of Canada estimates that fall-related injuries cost the Canadian healthcare system over $2 billion annually. Hip fractures alone account for a disproportionate share of that cost — and more importantly, of the disability, loss of independence, and mortality that follow.
The Otago Exercise Programme (OEP) is a set of leg strengthening and balance exercises developed in New Zealand and validated in multiple large randomized trials. It is one of the few falls-prevention interventions with consistent evidence showing reduced fall rates in older adults — a 35% reduction in falls in the original trials, and similar results in replications. It's been adapted for Canadian settings by several provincial health authorities.
The programme consists of two components done 3 times per week:
Seated in a chair, slowly extend one knee to horizontal, hold 1 second, lower slowly. Use an ankle weight or resistance band to progress as strength improves. Strengthens the quadriceps, which are critical for safe stair descent and standing from a chair.
Standing behind a sturdy chair, slowly bend one knee to bring the heel toward the buttocks, hold 1 second, lower slowly. Strengthens hamstrings and improves knee stability. Hold the chair back lightly for balance.
Standing beside a chair, lift one leg sideways 30–40 cm, hold 1 second, lower slowly. Do not lean to the side. Strengthens hip abductors — the muscles that stabilize the hip during single-leg phases of walking.
Standing behind a chair, rise onto tiptoes, hold 1 second, lower slowly. Strengthens gastrocnemius and soleus — important for push-off during walking and ankle stability on uneven surfaces.
These progress over weeks. Start with maximum hand support and reduce it as balance improves. Always exercise near a wall or sturdy furniture.
Stand with the heel of one foot directly in front of the toes of the other — like standing on a tightrope. Hold. This challenges the mediolateral (side-to-side) balance control that most people lose gradually with age.
Stand on one foot with the other slightly lifted. Touch the wall only if needed. Progress to eyes closed (adds significant challenge — the eyes normally compensate for balance deficits). The ability to stand on one leg for 10+ seconds is associated with reduced fall risk in research.
Walk placing each foot directly in front of the other, heel-to-toe. Walk alongside a wall for safety. Backward walking is especially challenging and improves proprioception and rearward-fall recovery.
From a standard chair height, stand up without pushing off with your hands. This is both an exercise and a functional skill — many falls in older adults happen during the transition from sitting to standing. If you can't yet do it without hands, use hands but work toward independence.
The full Otago programme is available free from the New Zealand Accident Compensation Corporation and has been adapted by BC's Falls Prevention Coalition (bcfalls.ca) and by several regional health authorities. Ask your physiotherapist or family doctor for a referral to an OEP program in your area.
This is one of the most under-addressed aspects of falls prevention. Many medications increase fall risk — either by causing drowsiness, dropping blood pressure, impairing balance, or a combination. A structured medication review by a pharmacist or physician can identify drugs that can be reduced, switched, or discontinued.
| Drug Class | Common Examples | Fall Risk Mechanism |
|---|---|---|
| Benzodiazepines HIGH RISK | lorazepam (Ativan), diazepam (Valium), clonazepam (Rivotril) | Sedation, slowed reaction time, impaired balance |
| Z-drugs (sleep aids) HIGH RISK | zopiclone (Imovane), zolpidem | Sedation, residual drowsiness the next morning, nighttime disorientation |
| Opioids HIGH RISK | oxycodone, hydromorphone, codeine, tramadol | Sedation, orthostatic hypotension, impaired coordination |
| Antidepressants (especially TCAs) HIGH RISK | amitriptyline, nortriptyline; also SSRIs/SNRIs at initiation | Orthostatic hypotension, sedation, hyponatremia with SSRIs |
| Antipsychotics HIGH RISK | quetiapine (Seroquel), risperidone (Risperdal), haloperidol | Sedation, orthostatic hypotension, extrapyramidal effects (gait disturbance) |
| Blood pressure medications MODERATE | amlodipine, ramipril, metoprolol, hydrochlorothiazide | Orthostatic hypotension (blood pressure drop on standing) |
| Diuretics MODERATE | furosemide, hydrochlorothiazide, spironolactone | Dehydration, electrolyte imbalance, orthostatic hypotension, urgency causing rushed trips to the bathroom |
| Antihistamines MODERATE | diphenhydramine (Benadryl, Gravol), doxylamine | Sedation; older adults particularly sensitive; commonly found in OTC sleep and allergy products |
| Anticonvulsants MODERATE | gabapentin, pregabalin, phenytoin | Sedation, dizziness, ataxia; gabapentin and pregabalin increasingly prescribed for pain |
Footwear is one of the most modifiable fall risk factors and one of the most overlooked. Research on footwear and falls consistently shows:
For outdoor winter walking, traction aids (Yaktrax or similar screw-on cleats) significantly reduce slip-and-fall risk on ice and packed snow. These are available at most Canadian sporting goods stores and are inexpensive relative to the cost of a fracture.
The bathroom is where most home falls occur. For people with osteoporosis, the bathroom is the highest-priority room for modification. Key facts on grab bars:
Professional installation is recommended unless you're confident about locating studs and using appropriate anchors. Some provincial home modification programs (see below) include installation.
Canadians have access to publicly funded falls prevention resources in every province:
The BC Falls Prevention Coalition (bcfalls.ca) is one of the most comprehensive provincial falls prevention programs in Canada. It coordinates falls prevention across health authorities, publishes evidence summaries, and provides public-facing resources including the Preventing Falls in BC guide. Fraser Health, Interior Health, and Vancouver Coastal Health each run community exercise programs based on Otago and similar evidence-based approaches. BC also offers the Seniors' Home Renovation Tax Credit — a 15% refundable tax credit on up to $10,000 of eligible home modifications including grab bars and non-slip surfaces.
Ontario's Home and Community Care Support Services (formerly CCACs) provides occupational therapist home safety assessments for eligible clients. Ontario also funds falls prevention exercise programs through its Active Living Coalition for Older Adults. The Seniors Active Living Centres program includes balance and strength classes at over 250 locations province-wide.
Alberta Health Services runs the Injury Prevention Program which includes falls prevention initiatives for older adults. The Seniors Home Adaptation and Repair Program (SHARP) offers low-interest loans for home adaptations including safety modifications. Alberta Blue Cross and some employer plans cover OT home assessments.
Available to all Canadians, this non-refundable federal tax credit allows claiming 15% of up to $20,000 in eligible renovation expenses per year. Eligible modifications include grab bars, non-slip flooring, handrails, ramps, and widened doorways. Expenses can be claimed by the individual or a supporting family member. See CRA's website for the current list of eligible modifications.
The Régie de l'assurance maladie du Québec (RAMQ) covers occupational therapy assessments and some home modification costs. The provincial Programme d'adaptation de domicile (PAD) provides grants for home adaptations for people with significant physical limitations.
If you're not sure where to begin, a structured room-by-room assessment is the most efficient approach. See our detailed fall prevention home checklist for a complete room-by-room guide.
The highest-priority areas in order of fall frequency and injury severity:
If you fall and have osteoporosis:
For more on protecting your bones, see our overview of osteoporosis medications in Canada and our guide to exercise for bone density.