Hip protectors

• a systematic review of randomised trials previoiusly investigated the effectiveness of hip protectors (1)
  • five trials totalling 1681 elderly participants at risk of hip fracture were included in that review
  • study authors concluded that hip protectors seemed to reduce the risk of a hip fracture after a fall in elderly residents of nursing homes
• a more recent systematic review by the same authors has shown no evidence for effectiveness for of hip protectors in those patients living at home (2). Also the review only revealed marginal evidence of efficacy for the use of hip protectors in elderly residents in nursing or residential care settings (2):
  • data from 11 trials carried out in nursing or residential care settings, including six cluster randomised studies, showed evidence of a marginally statistically significant reduction in incidence of hip fracture (relative risk 0.77, 95% confidence interval 0.62 to 0.97)
  • pooling of data from three individually randomised trials of 5135 community dwelling participants showed no reduction in hip fracture incidence with provision of hip protectors (1.16, 0.85 to 1.59)
  • no evidence was found of any significant effect of hip protectors on incidence of pelvic or other fractures. No important adverse effects of hip protectors were reported, but compliance, particularly in the long term, was poor
  • the study authors concluded that accumulating evidence indicates that hip protectors are an ineffective intervention for those living at home and that their effectiveness in an institutional setting is uncertain

It is likely that the use of such devices will be limited by patients finding these bulky, uncomfortable devices unacceptable.

In conclusion:

• no evidence that hip protectors reduce hip fracture risk in community-dwelling elderly, but some evidence that they may be effective in extended care settings (4)

Reference:

1. Parker MJ, Gillespie LD, Gillespie WJ. Hip protectors for preventing hip fractures in the elderly. Cochrane Database Syst Rev 1999;(3): CD001255.
2. Parker MJ et al. Effectiveness of hip protectors for preventing hip fractures in elderly people: systematic review. BMJ 2006;332:571-4.
3. Osteoporosis Clinical guidelines for prevention and treatment. Update on pharmacological interventions and an algorithm for management. Royal College of Physicians, Bone and Tooth Society of Great Britain July 2000.
4. ARC.Hands On 2007;11:1-6.