Prevention of Hip Fractures by External Hip Protectors

Abstract

ContextSeveral randomized controlled trials have been performed to examine the effectiveness of external hip protectors in reducing the incidence of hip fractures, but the results are controversial.ObjectiveTo examine the effectiveness of hip protectors in reducing the incidence of hip fractures in an elderly high-risk population.Design, Setting, and ParticipantsRandomized controlled trial of elderly persons aged 70 years or older, who have low bone density, and are at high risk for falls. Participants lived in apartment houses for the elderly, homes for the elderly, and nursing homes in Amsterdam and surrounding areas in the Netherlands. They were enrolled in the study between March 1999 and March 2001; the mean follow-up was 69.6 weeks. Of the 830 persons who were screened, 561 persons were enrolled.InterventionExternal hip protector. Both groups received written information on bone health and risk factors for falls.Main Outcome MeasureTime to first hip fracture. Survival analysis was used to include all participants for the time they participated.ResultsIn the intervention group, 18 hip fractures occurred vs 20 in the control group. Four hip fractures in the intervention group occurred while an individual was wearing a hip protector. At least 4 hip fractures in the intervention group occurred late at night or early in the morning. Both in univariate analysis (log-rank P = .86) and in multivariate analysis (hazard ratio [HR], 1.05; 95% confidence interval [CI], 0.55-2.03), no statistically significant difference between the intervention group and control group was found with regard to time to first hip fracture. In addition, the per protocol analysis in compliant participants did not show a statistically significant difference between the groups (HR, 0.77; 95% CI, 0.25-2.38).ConclusionThe hip protector studied was not effective in preventing hip fractures.

Cost-effectiveness of hip protectors in frail institutionalized elderly

“…This is a large randomized controlled trial (n=561) in which individual randomization was used to assign persons to the intervention or control group. However, in this study, the hip protectors were not effective in reducing the incidence of hip fractures [6]. These results were confirmed by a recent update of the Cochrane review of Parker et al [7].…”

“…Although the statistical power to detect a clinically significant difference in the incidence of hip fractures was good [6], this study may have lacked statistical power to detect clinically relevant differences in costs due to the low number of events. Another limitation of our study is that we did not include the costs of the screening for hip fracture risk and the costs of implementing the intervention.…”

“…There was no statistically significant difference in the incidence of hip fractures (log rank P-value=0.86). In the intervention group, 18 persons fractured a hip versus 19 persons in the control group [6]. In the control group, one person fractured two hips, making a total of 38 hip fractures in the study.…”

“…low bone density and/or a high fall risk. The contents of the screening method and the inclusion and exclusion criteria are described elsewhere [6]. The Ethical Review Board of the VU University Medical Center approved the study and all respondents (or their proxies in case of cognitive impairment) gave informed consent.…”

Hip protectors decrease hip fracture risk in elderly nursing home residents: a Bayesian meta-analysis

“…Finally, we have used this approach to highlight the effectiveness of hip protectors in decreasing the risk of hip fractures in a vulnerable, often ignored population with a significant burden of disease. Process of exclusion of studies from the systematic review [26][27][28][29][30][31][32][33][34][35][36]. Table 1 Assessment of the methodologic features of included studies The unit of randomization was not clearly described in the primary publication.…”