Hip protectors for preventing hip fractures in the elderly.

Abstract

Hip fracture in the elderly usually results from a fall on the hip. Hip protectors have been advocated as a means to reduce the risk of sustaining a hip fracture. To determine if external hip protectors reduce the incidence of hip fractures in elderly persons following a fall. We searched the Cochrane Musculoskeletal Injuries Group trials register (February 2004), the Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 1, 2004), MEDLINE (1966 to February Week 2 2004), EMBASE (1988 to 2004 Week 08), CINAHL (1982 to February Week 2 2004), other databases and reference lists of relevant articles. We also contacted trialists. All randomised or quasi-randomised controlled trials comparing the use of hip protectors with a control group. Two reviewers independently assessed trial quality and extracted data. We sought additional information from all trialists. An additional trial with 4169 participants was included in this update, giving a total of 14 included trials. One, which was a study of compliance (adherence) lasting 12 weeks, contributed no fracture outcome data. Five studies involving 4316 participants were cluster randomised by care unit, nursing home or nursing home ward rather than by the individual. Each of these studies reported a reduced incidence of hip fractures within those units allocated to receive the protectors. Because the majority of these trials had not been analysed to allow for clustering, pooling of their results was not undertaken. Pooling of data from five individually randomised trials conducted in nursing/residential care settings (1426 participants) showed no significant reduction in hip fracture incidence (hip protectors 37/822, controls 40/604, relative risk (RR) 0.83, 95% confidence interval (CI) 0.54 to 1.29). Three individually randomised trials of 5135 community dwelling participants, reported no reduction in hip fracture incidence with the hip protectors (RR 1.16, 95% CI 0.85 to 1.59). No important adverse effects of the hip protectors were reported but compliance, particularly in the long term, was poor. There is no evidence of effectiveness of hip protectors from studies in which randomisation was by individual patient within an institution, or for those living in their own homes. Data from cluster randomised studies indicate that, for those living in institutional care with a high background incidence of hip fracture, a programme of providing hip protectors appears to reduce the incidence of hip fractures. Acceptability by users of the protectors remains a problem, due to discomfort and practicality.