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Osteoporosis International

, Volume 16, Issue 12, pp 1461–1474 | Cite as

Do hip protectors decrease the risk of hip fracture in institutional and community-dwelling elderly? A systematic review and meta-analysis of randomized controlled trials

  • Anna M. Sawka
  • Pauline Boulos
  • Karen Beattie
  • Lehana Thabane
  • Alexandra Papaioannou
  • Amiram Gafni
  • Ann Cranney
  • Nicole Zytaruk
  • David A. Hanley
  • Jonathan D. Adachi
Review

Abstract

Hip fractures are an important cause of morbidity and mortality in the elderly. Hip protectors are padded undergarments designed to decrease the impact of a fall on the hip. We systematically reviewed randomized controlled trials of hip protectors to determine if they reduce hip fractures in the elderly. Analyses were pooled according to participant residence—community or institutional (the latter, included nursing homes, residential group homes or seniors’ hostels). We included individually randomized and statistically adjusted cluster randomized trials. Seven trials of 12- to 28-month duration were included. The Safehip brand of hip protector was used in most studies. Compliance rates in the treatment groups varied from 31 to 68%. In four trials including a total of 5,696 community-dwelling seniors, the hip fracture rates in control groups ranged from 1.1 to 7.4%, and the pooled risk difference with hip protector allocation was 0% [95% confidence intervals (CI), −1%, +1%), with a relative risk of 1.07 (0.81, 1.42). In three trials including 1,188 institutionalized elderly participants, hip fracture rates in the control groups varied from 8 to 19.4%, and the pooled risk difference for sustaining one or more hip fractures with hip protector allocation was −3.7% (95% CI, −7.4%, 0.1%), with a relative risk of 0.56 (0.31, 1.01) (with statistically significant heterogeneity of treatment effect). In a post-hoc subgroup analysis of two trials comprised of exclusively nursing home residents, the risk difference with hip protector allocation was −4.4% (−8.09, −0.76) with a relative risk of 0.50 (0.28, 0.91) ( n =1,014). Thus, there is little evidence to support the use of hip protectors outside the nursing home setting. The potential benefit of hip protectors in reducing hip fractures in nursing home residents requires further confirmation.

Keywords

Hip fracture Hip protectors Meta-analysis Osteoporosis Elderly 

Abbreviations

ICC

intra-cluster correlation coefficient

VIF

variance inflation factor

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Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2005

Authors and Affiliations

  • Anna M. Sawka
    • 1
    • 2
  • Pauline Boulos
    • 2
    • 3
  • Karen Beattie
    • 4
  • Lehana Thabane
    • 5
    • 6
  • Alexandra Papaioannou
    • 7
  • Amiram Gafni
    • 5
  • Ann Cranney
    • 8
  • Nicole Zytaruk
    • 5
    • 9
  • David A. Hanley
    • 10
  • Jonathan D. Adachi
    • 3
  1. 1.Division of Endocrinology and Department of MedicineSt. Joseph’s Healthcare and McMaster UniversityHamiltonCanada
  2. 2.Faculty of Health SciencesMcMaster UniversityHamiltonCanada
  3. 3.Division of Rheumatology and Department of MedicineSt. Joseph’s Healthcare and McMaster UniversityHamiltonCanada
  4. 4.Faculty of Health SciencesMcMaster UniversityHamiltonCanada
  5. 5.Department of Clinical Epidemiology and BiostatisticsMcMaster UniversityHamiltonCanada
  6. 6.Centre for Evaluation of MedicinesSt. Joseph’s HealthcareHamiltonCanada
  7. 7.Division of Geriatrics and Department of MedicineHamilton Health Sciences and McMaster UniversityHamiltonCanada
  8. 8.Division of Rheumatology and Department of MedicineUniversity of OttawaOttawaCanada
  9. 9.Osteoporosis Society of CanadaHamiltonCanada
  10. 10.Division of Endocrinology and MetabolismUniversity of CalgaryCalgaryCanada

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