We’ve been told that the best way to prevent fractures is to prevent or treat osteoporosis—diet, exercise and, if needed, medications. But that approach has not been successful.

For people with osteoporosis, medications do prevent many spinal fractures—but fewer than half of hip and other fractures, according to a major study published in The New England Journal of Medicine. And many people who fall and break bones don’t even have osteoporosis.

Example: An overweight or obese person may have good bone density (from carrying that extra weight) but still get fractures. Unless he/she has the muscle strength to carry that extra weight, mobility issues—such as difficulty getting up off the toilet or climbing stairs—can lead to falls that cause fractures. Rather than hip fractures due to weakened bones, they tend to get ankle or lower-leg fractures.

In the end, it’s preventing fractures—from any cause—that really matters. Many of us think that if we break a bone, our friendly orthopedic surgeon will put it back together and life will go on as usual. But after age 50—and especially after age 65—a fractured bone can threaten independence and quality of life. And that’s what we fear most about aging—losing independence…not being able to drive…and winding up in a nursing home. The classic example is a hip fracture, which often sends people to nursing homes and is linked to a shorter life span. But breaking an ankle, an arm or even a wrist can make daily life harder at home…and make it tougher to be mobile.

To find out what is really needed to prevent fractures, we spoke with geriatrician and endocrinologist Neil Binkley, MD. He started with a simple question—“What causes most fractures in older people?”

The answer: Falling.

Here’s how to prevent falls—and the fractures that could end your ­independence…

Eat for muscle strength, not just bones. Getting enough calcium and vitamin D—standard elements of ­osteoporosis prevention—still is important. But pay close attention to calories and protein, too. These are essential to maintaining muscle strength—and that’s as important as strong bones in preventing fractures. After all, when our muscle strength declines, we fall. And when we fall on weak bones, guess what? They break.

Protein needs are based on your body weight. To calculate your individual needs, multiply your body weight by 0.45. For a 150-pound woman, that’s 67 grams a day…for a 185-pound man, 83 grams. To get a sense of what that looks like, a three-ounce serving of tuna or salmon contains about 22 grams of protein and an egg contains six grams, on average. Aim to include good sources of protein—seafood, lean meat, poultry, eggs, nuts, seeds, soy and legumes such as beans and peas—at every meal.

For some older people, a waning appetite also can mean that they just don’t eat enough calories. If you’re not eating enough, a registered dietitian can help find practical ways to help you get enough protein and calories each day.

Get strong—and balanced. Now that you’re nourishing muscles, make them work. Exercise helps keep your bones and muscles strong, so it’s ­vital for lowering your fracture risk. The best exercise is the one that you’ll actually do, whether it’s walking, biking, swimming or team sports. Beyond general fitness, exercises that improve core strength and balance are key to fall prevention. Suggestions…

Join a tai chi class. This ancient ­Chinese set of gentle, slow-moving exercises strengthens lower limbs and improves balance. Several studies have found that practicing tai chi regularly significantly reduces fall risk in older adults.

Yoga may help, too. It can strengthen bones, and while it is less well-studied for fall prevention, it has been shown to improve balance and mobility in older people.

Take fall-prevention classes. One popular, evidence-based program is Stepping On, a seven-week, two-hours-per-week workshop, first developed in Australia, that now is offered in 20 US states. It is geared to healthy adults over age 65. One study, published in Journal of the American Geriatrics Society, reported that people who participated in Stepping On had 31% fewer falls over the next 14 months, compared with a similar group of people who didn’t go through the program. To find programs like this in your area, check with the National Council on Aging’s Fall Prevention website (NCOA.org/healthy-aging/falls-prevention).

Consider physical therapy. If you’ve fallen and have been injured—even if you didn’t break a bone—you’re waving a red flag that a fracture could be in your future. A physical therapist can do a formal strength-and-balance assessment…show you exercises to strengthen muscles, bones, walking posture and balance…and help you find classes in your ­community.

Make your home safer. A key part of fall prevention is taking a look at what you can do to make it less likely that you’ll trip and fall…

Do you have night-lights in your home? Consider putting a night-light in your bathroom for those middle-of-the-night trips.

Are there throw rugs that you might slip on? Get rid of them!

Is there clutter on the floor or stairs that you could stumble on? Declutter!

Do you need to get on a chair or step stool to reach things on high shelves? Put everyday items on lower shelves that are easy to reach.

Is it hard to get in and out of your bathtub without slipping? Consider installing grab bars or replacing your tub with a walk-in shower.

Some of your safety changes may need to be in your own behavior—such as drinking less alcohol. That’s a fall risk that many older people don’t consider.

And don’t forget to get your vision checked regularly. If you can’t see it, you can trip on it.

Review your medications. Some medications (prescription or over-the-counter) or medication interactions can cause dizziness, light-headedness or low blood pressure, which can increase the risk of falling. Key medications to be aware of include antihistamines, sleep aids, pain pills, antidepressants and antianxiety medications. In addition, some medications, such as glucocorticoids (steroids taken for inflammatory and autoimmune conditions) contribute to bone loss. If you are taking medications that increase your fall risk, talk to your doctor to see if you can reduce the dose, find an alternative—or modify how you take it, such as only at bedtime.

It’s not that strong bones aren’t important—they’re a key part of a ­fracture-prevention plan…but only one part. If your doctor has prescribed a diet, exercise program or medication for you to prevent or treat osteoporosis, continue following those instructions. Osteoporosis medications often are prescribed based on an individual’s estimated risk for fracture. For individuals at high fracture risk, the benefits of reducing that risk far outweigh the risk of side effects. But just taking medications is not enough.

Now you know what else you need to do to protect yourself.

THIS EXERCISE PREVENTS FALLS

One of the simplest and most effective exercises—and one that you can do almost anywhere—is the Chair Rise. Do this daily to strengthen the muscles in your thighs and buttocks, which can help keep you steady on your feet and prevent falls…

• Sit toward the front of a sturdy chair, with your knees bent and feet flat on the floor, shoulder-width apart.

• Rest your hands lightly on the seat on either side of you, keeping your back and neck straight and chest slightly forward.

• Breathe in slowly. Lean forward and exhale as you stand up—feel your weight on the front of your feet.

• Pause for a full breath in and out.

• Breathe in as you slowly sit down. Try not to collapse down into the chair. Rather, control your lowering as much as possible.

• Breathe out.

Repeat for a total of 10 to 15 stand/sits. Rest and breathe for a minute, then do another set of 10 to 15. You may need to work up to this level over several days or a few weeks. The goal is to get to the point where you can complete two sets without using your hands at all.