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Meta-Analysis
. 2014 Mar 31;2014(3):CD001255.
doi: 10.1002/14651858.CD001255.pub5.

Hip protectors for preventing hip fractures in older people

Nancy Santesso  1 , Alonso Carrasco-Labra, Romina Brignardello-Petersen
Affiliations
Meta-Analysis

Hip protectors for preventing hip fractures in older people

Nancy Santesso et al. Cochrane Database Syst Rev. .

Abstract

Background: Older people living in nursing care facilities or older adults living at home are at high risk of falling and a hip fracture may occur after a fall. Hip protectors have been advocated as a means to reduce the risk of hip fracture. Hip protectors are plastic shields (hard) or foam pads (soft), usually fitted in pockets in specially designed underwear.This is an update of a Cochrane review first published in 1999, and updated several times, most recently in 2010.

Objectives: To determine if the provision of external hip protectors (sometimes referred to as hip pads or hip protector pads) reduces the risk of fracturing the hip in older people.

Search methods: We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (December 2012), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2012, Issue 12), MEDLINE (1950 to week 3 November 2012), MEDLINE In-Process (18 December 2012), EMBASE (1988 to 2012 Week 50), CINAHL (1982 to December 2012), BioMed Central (January 2010), trial registers and reference lists of relevant articles.

Selection criteria: All randomised or quasi-randomised controlled trials comparing an intervention group provided with hip protectors with a control group not provided with hip protectors.

Data collection and analysis: Two review 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: This review includes 19 studies, nine of which were cluster randomised. These included approximately 17,000 people (mean age range 78 to 86 years). Most studies were overall at low risk of bias for fracture outcomes. Trials tested hard or soft hip protectors enclosed in special underwear in 18 studies.Pooling of data from 14 studies (11,808 participants) conducted in nursing or residential care settings found moderate quality evidence for a small reduction in hip fracture risk (risk ratio (RR) 0.82, 95% confidence interval (CI) 0.67 to 1.00); the absolute effect is 11 fewer people (95% CI, from 20 fewer to 0) per 1000 having a hip fracture when provided with hip protectors.There is moderate quality evidence when pooling data from five trials in the community (5614 participants) that shows little or no effect in hip fracture risk (RR 1.15, 95% CI 0.84 to 1.58); the absolute effect is two more people (95% CI 2 fewer to 6 more) per 1000 people having a hip fracture when provided with hip protectors.There is probably little to no effect on falls (rate ratio 1.02, 95% CI 0.9 to 1.16) or fractures other than of the hip or pelvis (rate ratio 0.87, 95% CI 0.71 to 1.07). However, the risk ratio for pelvic fractures is RR 1.27 (95% CI 0.78 to 2.08); this is an absolute effect of one more person (95% CI 1 fewer to 5 more) per 1000 having a pelvic fracture when provided with hip protectors.The incidence of adverse events while wearing hip protectors, including skin irritation, ranged from 0% to 5%. Adherence, particularly in the long term, was poor.

Authors' conclusions: Hip protectors probably reduce the risk of hip fractures if made available to older people in nursing care or residential care settings, without increasing the frequency of falls. However, hip protectors may slightly increase the small risk of pelvic fractures. Poor acceptance and adherence by older people offered hip protectors is a barrier to their use. Better understanding is needed of the personal and design factors that may influence acceptance and adherence.

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Conflict of interest statement

None known

Figures

1
1
Study flow diagram
2
2
Risk of bias summary: review authors' judgements about each risk of bias item for each included study
3
3
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies
1.1
1.1. Analysis
Comparison 1 Provision of hip protectors, Outcome 1 Hip fracture: risk ratio; institutional residence.
1.2
1.2. Analysis
Comparison 1 Provision of hip protectors, Outcome 2 Hip fracture: risk ratio; community residence.
1.3
1.3. Analysis
Comparison 1 Provision of hip protectors, Outcome 3 Pelvic fracture: risk ratio.
1.4
1.4. Analysis
Comparison 1 Provision of hip protectors, Outcome 4 Other fractures (excluding pelvis): rate ratio.
1.5
1.5. Analysis
Comparison 1 Provision of hip protectors, Outcome 5 Pelvic and other fractures: rate ratio.
1.6
1.6. Analysis
Comparison 1 Provision of hip protectors, Outcome 6 Falls per person year; rate ratio.
See this image and copyright information in PMC

Update of

References

References to studies included in this review

Birks 2003 {published and unpublished data}
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Cameron 2003 {published and unpublished data}
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Cameron 2011a {published data only}
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    1. Schaafsma FG, Kurrle SE, Quine S, Lockwood K, Cameron ID. Wearing hip protectors does not reduce health‐related quality of life in older people. Age and Ageing 2012;41(1):121‐5. - PubMed
Cameron 2011b {published data only}
    1. Cameron I. Improving adherence with the use of hip protectors amongst older people. Australian New Zealand Clinical Trials Registry. http://www.anzctr.org.au/trial_view.aspx?ID=82121 (accessed 15 Feb 2009). [ACTR number: ACTRN12607000352404]
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    1. Schaafsma FG, Kurrle SE, Quine S, Lockwood K, Cameron ID. Wearing hip protectors does not reduce health‐related quality of life in older people. Age and Ageing 2012;41(1):121‐5. - PubMed
Chan 2000 {published and unpublished data}
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Ekman 1997 {published data only}
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Kannus 2000 {published and unpublished data}
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Kiel 2007 {published data only}
    1. Barton BA, Birge SJ, Magaziner J, Zimmerman S, Ball L, Brown KM, et al. The Hip Impact Protection Project: design and methods. Clinical Trials 2008;5(4):347‐55. [MEDLINE: ] - PMC - PubMed
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Koike 2009 {published data only}
    1. Koike T. Cluster randomised controlled trial of hip protectors for the prevention of hip fractures among women in nursing homes. http://apps.who.int/trialsearch/Trial.aspx?TrialID=JPRN‐UMIN000000467 (accessed 16 May 2010). [Japan Primary Registries Network: JPRN‐UMIN000000467]
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Lauritzen 1993 {published and unpublished data}
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Meyer 2003 {published and unpublished data}
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O'Halloran 2004 {published and unpublished data}
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Van Schoor 2003 {published data only}
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References to studies excluded from this review

Becker 2003 {published data only}
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Bentzen 2008 {published data only}
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Colon‐Emeric 2007 {published data only}
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Cox 2008 {published data only}
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Cryer 2006 {published data only}
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Forsen 2003 {published data only}
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Garfinkel 2008 {published data only}
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Haines 2004 {published data only}
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Heikinheimo 2004 {published data only}
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Huang 2006 {published data only}
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Maki‐Jokela 2002 {published data only}
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O'Halloran 2005 {published data only}
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Ross 1992 {published data only}
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Thompson 2005 {published data only}
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Villar 1998 {published data only}
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Ward 2010 {published data only}
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Woo 2003 {published data only}
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Wortberg 1998 {published data only}
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References to studies awaiting assessment

Frohnhofen 2010 {published data only}
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References to ongoing studies

Tangtrakulwanich {published data only}
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Additional references

Bauchner 2012
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Bouxsein 2007
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Cameron 2010
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