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External hip protectors are effective for the elderly with higher-than-average risk factors for hip fractures

T. Koike & Y. Orito & H. Toyoda &M. Tada & R. Sugama & M. Hoshino & Y. Nakao & S. Kobayashi & K. Kondo & Y. Hirota & K. Takaoka, 
International Osteoporosis Foundation and National Osteoporosis Foundation 2008

Summary
In this cluster randomised controlled trial for efficacy of hip protector with 672 ambulatory elderly women, a hip protector was more effective for prevention of hip fractures in residents with fall history (n=202; hazard ratio (HR), 0.375; 95%CI, 0.14-0.98; p=0.05) and bodymass index (BMI)≤19.0 (n=206; HR, 0.37; 95%CI, 0.14-0.95; p=0.04) by a Cox proportional hazards regression model.

Introduction
Hip fractures result from both osteoporosis and falling. A potentially cost-effective method of preventing hip fractures involves the use of hip protectors but recent studies have revealed the uncertain effectiveness of hip protectors even in institutional settings.

Methods 
This study was a cluster randomised controlled trial with nursing homes. 76 homes with 672 ambulatory but frail elderly women were randomly assigned. Several risk factors were assessed at baseline and incorporated into a Cox proportional hazards regression model. UMIN Clinical Trials Registry number is UMIN000000467. Research period was between January 2004 and March 2006.

Results 
In the intervention group, 19 hip fractures occurred (54.0/1,000 person-years), whereas 39 hip fractures occurred in the control group (78.8/1,000 person-years). Hazard ratio of hip fracture in the intervention group was 0.56 (95%CI, 0.31-1.03; p=0.06) after adjusting for risk factors. In subgroup analysis, hip protectors were more effective for prevention of hip fractures in residents with fall history (n= 202; HR, 0.375; 95%CI, 0.14-0.98; p=0.05) and BMI≤19.0 (n=206; HR, 0.37; 95%CI, 0.14-0.95; p=0.04). Overall compliance with use of hip protectors was 79.7%.

Conclusion 
Risk of hip fracture can be reduced by hip protectors among elderly women with fall history and low BMI.

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