Case study: Tread Safely, Germany

Tread Safely (Trittsicher) was developed to improve bone health and mobility of older people in rural areas.1

Case study: Tread Safely, Germany

What does the programme involve?

Tread Safely runs falls and fracture prevention programmes. The programme, which is also known as the osteoporotic fracture prevention programme in rural areas (OFRA), comprises three elements: an assessment of bone health, including through the use of dual-energy X-ray absorptiometry (DXA) scanning; mobility exercise classes; and consultations about how to reduce the risk of falls in houses and on farms. The programme was developed following an assessment of local needs and priorities, and is implemented by an innovative collaboration of local partners.1 It was based on findings from a survey of local residents which identified loss of independence through disabling falls and accidents as a key concern.2 It is funded by a regional insurance fund and run in collaboration with two rural community organisations.

What has the programme achieved?

Since its inception in 2015, the programme has shown good signs of success:2 3

  • More than 2,300 mobility classes have been conducted, with high satisfaction rates among participants.
  • A first formative evaluation showed that more than half of participants attended all six classes and venues had good accessibility, with participants often having to travel less than 1.7km.
  • Huge demand from the local population has led to long waiting lists for the programme.

What lessons can be learnt from this programme?

The project highlights the importance of tailoring programmes for active and healthy ageing to local needs and involving local actors in implementation. Addressing the local people’s concerns and collaborating with local institutions that play an important role in community life has likely contributed to the hugely positive response and participation.2 4 As low participation rates are a key barrier to the successful implementation of health promotion programmes, this model of engagement may offer an important blueprint to adapt for use elsewhere.


The information in this case study is based on research conducted for the 2020 publication Osteoporosis and fragility fractures: a policy toolkit.
Date of preparation: October 2020.
References +
  1. Rapp K, Kampe K, Roigk P, et al. 2016. The osteoporotic fracture prevention program in rural areas (OFRA): a protocol for a cluster-randomized health care fund driven intervention in a routine health care setting. BMC musculoskeletal disorders 17(1): 458-58
  2. Becker C. 2019. Interview with Kirsten Budig at The Health Policy Partnership [telephone]. 06/11/19
  3. Bundesinitiative Sturzprävention. 2018. 3. STURZPRÄVENTIONSTAGUNG D-A-CH. Available from: [Accessed 01/09/20]
  4. Roigk P, Büchele G, Kampe K, et al. 2019. Trittsicher durchs Leben: Analyse von 1092 Bewegungskursen im ländlichen Raum. Zeitschrift für Gerontologie und Geriatrie 52(1): 68-74
  5. Deutsche Gesellschaft fuer Geriatrie e.V. 2016. PM: Kampagne „Trittsicher durchs Leben“ unterstützt ältere Menschen dabei, lange aktiv zu bleiben. Available from: [Accessed 01/09/20]