[Multifactorial pathogenesis of gait disorders, falls and hip fractures in the elderly]

Age, gait disorders, falls, and hip fractures are connected in a pathological cascade. 90% of hip fractures happen at the age of 70 and older; 90% are a consequence of a fall. Only a minority of these patients regain their former level of locomotion. For many of them a hip fracture ends in dependence on personal help, placement in a nursing home, or even death. About 80% of falls occur due to pathological balance and gait disorder and are not due to syncope or overwhelming external force. 5% of all falls result in a fracture, including 1% of all falls with hip fractures. What determines the fracture risk is the relation of bone fragility to geometrical and physical factors of the fall. Regarding the cascade gait disorder-fall-hip fracture, there are always multiple factors interacting. It is useful to give this distinct entity of multifactorial gait disorder with high risk of falling a new diagnostic label: We suggest "age-associated multifactorial gait disorder." To identify individual risk factors and regard their interactions can be a basis for therapy and interventions to prevent falls.