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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

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.

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.

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.

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%.

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

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