The rising number of underfoot accidents after the menopause causes both fractures and non-fracture injuries.

To test our hypothesis that the onset of the menopause would be associated with an increased number of underfoot accidents in the female population for both fracture and non-fracture injuries, we analysed 90061 accidents recorded by the Home Accident Surveillance System and classified them as to (a) whether a fracture resulted, and (b) whether they were 'underfoot'. We defined 'underfoot' accidents to have an event such as a trip, slip, missed footing, twisted or turned ankle, on the level or on stairs. All other accidents, including falls from or off structures, or falls caused by medical conditions were classified as 'not underfoot'. Overall, 51.3% of women and 32% of men were injured in underfoot accidents. There was an increase with age in the percentage of fractures in both men and women, mainly due to an increased risk of fracture in underfoot accidents: underfoot accidents caused 75.9% of all fractures in women and 55.4% in men. The number of women who had fractures following underfoot accidents increased sharply after the age of 50 years, and the number continued to rise up to 80 years. The number of non-fracture injuries in elderly women from underfoot accidents also increased with age. Osteoporosis on its own does not explain our result, and changes in muscle strength and reaction time, with age in both men and women, and at a greater rate in postmenopausal women, may be an important factor in underfoot accidents.