If you’re over 65 and want to keep from falling and breaking a hip, arm or ankle, then start focusing on getting some regular exercise. It’s the most effective action older people can can take to prevent fractures, according to the latest recommendations from the United States Preventive Services Task Force (USPSTF).

And unless you have been diagnosed with osteoporosis or with a specific illness that puts you at risk for a vitamin D deficiency, you don’t need vitamin D supplements — with or without calcium — as added insurance against a fall. In a change from its 2012 recommendations, the USPSTF now says there’s little good evidence to support that practice. 

It’s really important that older people take steps to reduce their risk of falls. Falls are the leading cause of injury and the leading cause of death from injury among Americans aged 65 and older, according to the Centers for Disease Control and Prevention (CDC).

Each year, more than one in four adults over the age of 65 falls, leading to 2.8 million visits to hospital emergency departments and 800,000 hospitalizations, the CDC says. 

In 2014 alone, more than 27,000 older Americans died as a result of an injury sustained during a fall.

Analyzing the best evidence

The updated USPSTF recommendations, which were published Tuesday in the Journal of the American Medical Association (JAMA), are based on an analysis of 62 randomized controlled trials involving more than 35,000 older adults living independently “in the community” (not in nursing homes, assisted living or other long-term care facilities).

The studies looked at seven different types of fracture-preventing strategies, but the USPSTF focused on the three with the best evidence: exercise, vitamin D supplementation and “multifactorial interventions.” That last category involves evaluating and addressing a mixture of factors that can lead to falls, such as poor balance, poor vision, foot problems, postural blood pressure, and the side effects of some medications. 

Based on their analysis of the evidence, the USPSTF experts graded each strategy for its effectiveness in reducing falls and then made a recommendation based on that grade: 

• Regular exercise received a B rating, which means the task force members found moderate evidence that it helps prevent falls in people aged 65 and older. They therefore recommend exercise programs and/or physical therapy to people in that age group. The exercise programs in the studies tended to focus on resistance training and building strength, as well as on improving balance and gait. The programs were most often offered three times a week, both in individual sessions (such as with a physical therapist) or in group classes. 
• Multifactorial interventions for reducing the risk of falls received a C rating. The task force members found that these interventions offered a limited benefit — and only for some older adults. They recommend that doctors selectively offer these interventions to individual patients “based on professional judgment and patient preferences.”
• Vitamin D supplements, including those combined with calcium, received a D rating.  This rating means there’s “moderate or high certainty” that such supplementation “has no net benefit or that the harms outweigh the benefits.” Those harms include an increased risk of kidney stones. The task force members therefore recommend against the use of vitamin D supplements for reducing the risk of falls — except in people diagnosed with osteoporosis or with a disease that can lead to a vitamin D deficiency.

In a separate statement of recommendations, the task force also gave low doses of vitamin D and calcium (less than 400 IU of vitamin D and less than 1,000 mg of calcium) a D rating for preventing fractures in women who have gone through menopause. They said there is not enough evidence, however, to recommend for or against higher doses of vitamin D and calcium in that group of women. They also found insufficient evidence to make a recommendation for or against vitamin D and calcium to prevent fractures in older men or premenopausal women.

Additional benefits

“The USPSTF recommendation, with increased emphasis on exercise, warrants adoption and should prove helpful, especially because exercise interventions reduce injurious falls,” write the authors of a JAMA editorial that accompanies the updated recommendations. 

“Moreover, the emphasis on physical activity should improve general health by reducing risks of other chronic diseases of aging, including coronary heart disease, stroke, type 2 diabetes, vascular dementia, and even cancer, as well as reducing the burden of mobility disability,” they add. 

It’s never too late to get moving. The National Institute on Aging’s Go4Life program offers useful tips and information on how to improve your endurance, balance, strength and flexibility, no matter what your current physical limitations might be. 

UPDATE: This post has been updated to clarify the USPSTF’s recommendations regarding vitamin D supplementation and the risk of falls vs. the risk of fractures.

FMI:The USPSTF’s recommendations can be read in full on the JAMA website.