Ivers et al. describe DM as risk factor to suffer from fractures, particularly in terms of fractures of the proximal humerus. Two different pathological explanations exist: on the one hand lower bone mineral density (BMD) scores are described in people with DM (especially type I DM) compared to healthy people. A low BMD results in higher fracture rates in patients with type I DM because of the higher bone fragility. On the other hand Ivers et al. showed different associations between the late-onset complications of DM, particularly in terms of diabetical retinopathy and neuropathy, and a higher risk for falls. Patients with diabetical retinopathy have a higher risk of falling as soon as DM affects their visual ability simply overlooking obstacles in daily life. This is similar to patients with diabetical neuropathy. An increasing loss of proprioception can lead to an impairment of balance resulting in falls. Hereby the possibility of suffering from a proximal humerus fracture is increased. The longer the patients suffer from DM and the worse the patients are adjusted to the diabetical medication, the higher is the probability of the occurrence of proximal humerus fractures. Preemptively attention should be paid to the guidelines of the “international diabetes federation” (http://​www.​idf.​org/​) [5, 6].

About 50 million people worldwide suffer from epilepsy [7]. Most of them take antiepileptic drugs (AEDs) as prevention from seizures and to improve their quality of life.

A research group lead by Carbone tried to establish an association between the use of AEDs and the fracture risk. In a prospective study they were able to show that there is a significant correlation between taking AEDs and a higher risk to fall along with a higher fracture risk. There was no evidence of a correlation between changes in the bone mineral density though [7].

A combination of AEDs and antidepressants shows an increased fall risk and an increased fracture rate compared to a monotherapy with only AEDs [8].

However, not only the side effects of antiepileptic drugs lead to a higher fracture risk, but the acute seizure correlates with higher fracture rates as well. This might be due to falls in the beginning of the seizure and because of the enourmous forces affecting the patient during a generalized tonic clonic seizure (grand mal). The typical seizure induced fracture pattern is a bilateral locked posterior fracture dislocation of the shoulder [9, 10].

To minimize the fracture risk regular check-ups and an ideal adjustment to the antiepileptic medication is needed. Current guidelines can be found at the “American Epilepsy Society” (http://​www.​aesnet.​org/​).

Left handed people have a higher fracture risk compared to right handed persons [11]. The reason for this phenomenon is not completely understood by now. It is supposed that left handed people do not get along well in a world created mostly for right handed people leading to a higher fall risk and thus a higher fracture risk [11, 12].

Visual impairment is assumed as an indicator for a higher risk to fall since reduced vision leads to an possible overlooking of obstacles in the daily life on the one hand. On the other hand there are different comorbidities that go along with visual impairment e.g. DM going along with higher risk of falling. In the current literature a higher fracture risk is described for both explanations [13, 14].

Chu et al. describe a correlation between reduced hearing capability and risk of falling. Patients that suffer from hearing problems have a higher risk to fall. An explanation for this is the limited awareness of the environment that conciliates an insecurity in the daily routine. Above all presbyakusis, resulting of a degenerative process of the corti organ in the old age, is deemed to be a risk factor for recurrent falls [1].

The level of BMD is an indicator for fracture risk in osteoporosis. There is a negative correlation between BMD and fracture risk: the lower the BMD the higher the fracture risk being substantified by the EPIDOS study and a study of Keegan et al. [3, 19].

Since over 70 % of the people suffering from a proximal humerus fracture are 60 years and older, a correlation of the age and fracture risk can be assumed [18]. This might be due to an age-depending distribution of the bone mass with a peak being reached in females at the age of thirty. From the beginning of the menopause the bone mass decreases continuously in most of the women [20]. Taking this into consideration the chances for proximal humerus fractures, even in low-energy injuries are increased whereas usually a high-energy injury is essential to cause such fractures in healthy bone [18].

Besides the risk of falling increases as well with increasing age leading especially in combination with low BMD to a higher fracture risk per se [15, 21].

As described above the chance to suffer from an osteoporosis related fracture is several times higher in women compared to men. On the one hand, the postmenopausal changes, on the other hand the overall lower bone mineral density are responsible for this fact. Due to the increasing age of the population the percentage of men developing osteoportic fractures increases as well since men lose about 1 % of their bone mass starting at the age of sixty with a raised conspicuously fracture risk [15, 22].