Hip protectors for preventing hip fractures in older people
Abstract
Background
Hip fracture in older people usually results from a fall on the hip. Hip protectors have been advocated as a means to reduce the risk of hip fracture.
Objectives
To determine if external hip protectors reduce the incidence of hip fractures in older people following a fall.
Search methods
We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (January 2010), The Cochrane Library 2010, Issue 2, MEDLINE (1950 to November 2009), MEDLINE in‐process (30 December 2009), EMBASE (1988 to 2009 week 52), CINAHL (1982 to February 2009), BioMed Central (January 2010) and reference lists of relevant articles.
Selection criteria
All randomised or quasi‐randomised controlled trials comparing the use of hip protectors with an unprotected control group.
Data collection and analysis
Two authors independently assessed risk of bias and extracted data. We sought additional information from trialists. Data were pooled using fixed‐effect or random‐effects models as appropriate.
Main results
Pooling of data from 13 studies (11,573 participants) conducted in nursing or residential care settings found a marginally significant reduction in hip fracture risk (risk ratio (RR) 0.81, 95% confidence interval (CI) 0.66 to 0.99); statistical significance was lost following exclusion of five studies (3757 participants) assessed at high risk of bias (RR 0.93, 95% CI 0.74 to 1.18).
Pooling of data from three trials (5135 community‐dwelling participants) showed no evidence of reduction in hip fracture risk (RR 1.14, 95% CI 0.83 to 1.57).
There was no evidence of a statistically significant effect on incidence of pelvic or other fractures, or on rate of falls. No important adverse effects of the hip protectors were reported but adherence, particularly in the long term, was poor.
Authors' conclusions
The effectiveness of the provision of hip protectors in reducing the incidence of hip fracture in older people is still not clearly established, although they may reduce the rate of hip fractures if made available to frail older people in nursing care. It remains unknown from studies identified to date if these findings apply to all types of hip protectors. Some cluster‐randomised trials have been associated with high risk of bias. Poor acceptance and adherence by older people offered hip protectors have been key factors contributing to the continuing uncertainty.
PICOs
Plain language summary
Hip protectors for preventing hip fractures in older people
Hip protectors consist of plastic shields or foam pads fitted in pockets within specially designed underwear. They are worn to reduce the impact of a sideways fall on the hip, and thus reduce the risk of a hip fracture. Studies, mainly from the early 1990s, and some since then, have suggested that providing protectors to older people in nursing home care reduced their risk of fracturing their hip in a fall by more than 50%. However, a number of later studies have not confirmed that finding. Many people offered hip protectors rejected their use because they were uncomfortable to wear.
This update includes 16 studies involving a total of over 16,000 older people living in nursing care facilities or older adults living at home. Present evidence shows that there is no benefit from hip protectors for the majority of older people living in their own homes. Making hip protectors available to frail older people in nursing care facilities may reduce the risk of fractures. The size of any reduction in risk seems to be much less than was suggested by the early studies. More research and development is needed to make and test hip protectors that are more comfortable to wear.
