Fractures continue to constitute a major public health problem of aging despite recent evidence that the age-specific rate may be falling.1 The facts that before dying at a median age of approximately 83 years, 50% of women would have sustained a fracture with its consequent morbidity, and health care costs give some idea of the magnitude of the problem. As with other common health problems such as atherosclerotic cardiovascular disease, a combination of the whole of the population public health approach with pharmaceutical intervention for those at highest risk is recommended. In this regard, increased calcium supplementation to counteract reduced intestinal calcium absorption and increased renal excretion due to the loss of the effect of estrogen on these two mechanisms2 is now widely accepted as is vitamin D supplementation due to a reduction in skin exposure to sunlight. Interestingly this latter factor, which in the absence of adequate sunlight can be replaced in the diet, has also been shown to play a significant role in falls prevention which together with osteoporosis constitute the pathological basis for fracture.
