Older women should be screened for fall risk frequently. Falls are preventable and screening can be as simple as asking "Have you fallen in the past year?" combined with questioning about gait or balance problems if the patient has not experienced a recent fall. A simple physician screen can drive the need for a more comprehensive fall evaluation and the appropriateness of a multifactorial fall reduction program referral. This paper describes an algorithmic management approach to fall prevention in older women with impaired muscle and mobility; assisting them in navigating and mitigating adversity on the road from menopause to frailty.