Osteoporosis International

, Volume 20, Issue 9, pp 1613–1620

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
Original Article



In our 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 body-mass 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. We randomly assigned 76 homes with 672 ambulatory but frail elderly women. 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.


Female Hip fracture Hip protector Osteoporosis RCT Risk factor 


  1. 1.
    Kannus P, Niemi S, Palvanen M et al (1997) Fall-induced injuries among elderly people. Lancet 350:1174PubMedCrossRefGoogle Scholar
  2. 2.
    Wolf SL, Barnhart HX, Kutner NG et al (1996) Reducing frailty and falls in older persons: an investigation of Tai Chi and computerized balance training. Atlanta FICSIT Group. Frailty and Injuries: Cooperative Studies of Intervention Techniques. J Am Geriatr Soc 44:489–497PubMedGoogle Scholar
  3. 3.
    Bischoff-Ferrari HA, Dawson-Hughes B, Willett WC et al (2004) Effect of Vitamin D on falls: a meta-analysis. JAMA 291:1999–2006PubMedCrossRefGoogle Scholar
  4. 4.
    Parkkari J, Kannus P, Palvanen M et al (1999) Majority of hip fractures occur as a result of a fall and impact on the greater trochanter of the femur: a prospective controlled hip fracture study with 206 consecutive patients. Calcif Tissue Int 65:183–187PubMedCrossRefGoogle Scholar
  5. 5.
    Colon-Emeric CS, Datta SK, Matchar DB (2003) An economic analysis of external hip protector use in ambulatory nursing facility residents. Age Ageing 32:47–52PubMedCrossRefGoogle Scholar
  6. 6.
    Singh S, Sun H, Anis AH (2004) Cost-effectiveness of hip protectors in the prevention of osteoporosis related hip fractures in elderly nursing home residents. J Rheumatol 31:1607–1613PubMedGoogle Scholar
  7. 7.
    Parker MJ, Gillespie WJ, Gillespie LD (2005) Hip protectors for preventing hip fractures in older people. Cochrane Database Syst Rev CD001255Google Scholar
  8. 8.
    Chan DK, Hillier G, Coore M et al (2000) Effectiveness and acceptability of a newly designed hip protector: a pilot study. Arch Gerontol Geriatr 30:25–34PubMedCrossRefGoogle Scholar
  9. 9.
    Harada A, Mizuno M, Takemura M et al (2001) Hip fracture prevention trial using hip protectors in Japanese nursing homes. Osteoporos Int 12:215–221PubMedCrossRefGoogle Scholar
  10. 10.
    Jantti P, Aho HJ, maki-Jokela L (1996) Protector trousers in prevention of hip fractures. Suomen Lookorilehti 51:3387–3389 [in Finnish]Google Scholar
  11. 11.
    Kannus P, Parkkari J, Niemi S et al (2000) Prevention of hip fracture in elderly people with use of a hip protector. N Engl J Med 343:1506–1513PubMedCrossRefGoogle Scholar
  12. 12.
    Lauritzen JB, Petersen MM, Lund B (1993) Effect of external hip protectors on hip fractures. Lancet 341:11–13PubMedCrossRefGoogle Scholar
  13. 13.
    Ekman A, Mallmin H, Michaelsson K et al (1997) External hip protectors to prevent osteoporotic hip fractures. Lancet 350:563–564PubMedCrossRefGoogle Scholar
  14. 14.
    Meyer G, Warnke A, Bender R et al (2003) Effect on hip fractures of increased use of hip protectors in nursing homes: cluster randomised controlled trial. BMJ 326:76PubMedCrossRefGoogle Scholar
  15. 15.
    Birks YF, Hildreth R, Campbell P et al (2003) Randomised controlled trial of hip protectors for the prevention of second hip fractures. Age Ageing 32:442–444PubMedCrossRefGoogle Scholar
  16. 16.
    Birks YF, Porthouse J, Addie C et al (2004) Randomized controlled trial of hip protectors among women living in the community. Osteoporos Int 15:701–706PubMedCrossRefGoogle Scholar
  17. 17.
    Cameron ID, Cumming RG, Kurrle SE et al (2003) A randomised trial of hip protector use by frail older women living in their own homes. Inj Prev 9:138–141PubMedCrossRefGoogle Scholar
  18. 18.
    Cameron ID, Venman J, Kurrle SE et al (2001) Hip protectors in aged-care facilities: a randomized trial of use by individual higher-risk residents. Age Ageing 30:477–481PubMedCrossRefGoogle Scholar
  19. 19.
    Hubacher M, Wettstein A (2001) Acceptance of hip protectors for hip fracture prevention in nursing homes. Osteoporos Int 12:794–799PubMedCrossRefGoogle Scholar
  20. 20.
    Kiel DP, Magaziner J, Zimmerman S et al (2007) Efficacy of a hip protector to prevent hip fracture in nursing home residents: the HIP PRO randomized controlled trial. JAMA 298:413–422PubMedCrossRefGoogle Scholar
  21. 21.
    O’Halloran PD, Cran GW, Beringer TR et al (2004) A cluster randomised controlled trial to evaluate a policy of making hip protectors available to residents of nursing homes. Age Ageing 33:582–588PubMedCrossRefGoogle Scholar
  22. 22.
    van Schoor NM, Smit JH, Twisk JW et al (2003) Prevention of hip fractures by external hip protectors: a randomized controlled trial. JAMA 289:1957–1962PubMedCrossRefGoogle Scholar
  23. 23.
    Parker MJ, Gillespie WJ, Gillespie LD (2006) Effectiveness of hip protectors for preventing hip fractures in elderly people: systematic review. BMJ 332:571–574PubMedCrossRefGoogle Scholar
  24. 24.
    van Schoor NM, Deville WL, Bouter LM et al (2002) Acceptance and compliance with external hip protectors: a systematic review of the literature. Osteoporos Int 13:917–924PubMedCrossRefGoogle Scholar
  25. 25.
    Cummings SR, Nevitt MC, Browner WS et al (1995) Risk factors for hip fracture in white women. Study of Osteoporotic Fractures Research Group. N Engl J Med 332:767–773PubMedCrossRefGoogle Scholar
  26. 26.
    Fujiwara S, Kasagi F, Yamada M et al (1997) Risk factors for hip fracture in a Japanese cohort. J Bone Miner Res 12:998–1004PubMedCrossRefGoogle Scholar
  27. 27.
    Takaishi Y, Okamoto Y, Ikeo T et al (2005) Correlations between periodontitis and loss of mandibular bone in relation to systemic bone changes in postmenopausal Japanese women. Osteoporos Int 16:1875–1882PubMedCrossRefGoogle Scholar
  28. 28.
    Tombaugh TN, McIntyre NJ (1992) The mini-mental state examination: a comprehensive review. J Am Geriatr Soc 40:922–935PubMedGoogle Scholar
  29. 29.
    Cummings SR, Nevitt MC (1989) A hypothesis: the causes of hip fractures. J Gerontol 44:M107–M111PubMedGoogle Scholar
  30. 30.
    Hahn S, Puffer S, Torgerson DJ et al (2005) Methodological bias in cluster randomised trials. BMC Med Res Methodol 5:10PubMedCrossRefGoogle Scholar
  31. 31.
    Cameron ID, Stafford B, Cumming RG et al (2000) Hip protectors improve falls self-efficacy. Age Ageing 29:57–62PubMedCrossRefGoogle Scholar

Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2008

Authors and Affiliations

  • T. Koike
    • 1
    • 5
  • Y. Orito
    • 2
  • H. Toyoda
    • 2
  • M. Tada
    • 2
  • R. Sugama
    • 2
  • M. Hoshino
    • 2
  • Y. Nakao
    • 2
  • S. Kobayashi
    • 3
  • K. Kondo
    • 4
  • Y. Hirota
    • 4
  • K. Takaoka
    • 2
  1. 1.Department of RheumatosurgeryOsaka City University Medical SchoolOsakaJapan
  2. 2.Department of Orthopaedic SurgeryOsaka City University Medical SchoolOsakaJapan
  3. 3.Department of Orthopaedic SurgeryShinshu University School of MedicineMatsumotoJapan
  4. 4.Department of Public HealthOsaka City University Medical SchoolOsakaJapan
  5. 5.OsakaJapan

Personalised recommendations