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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

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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.

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Abbreviations

ICC:

intra-cluster correlation coefficient

VIF:

variance inflation factor

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Authors and Affiliations

  1. Division of Endocrinology and Department of Medicine, St. Joseph’s Healthcare and McMaster University, Hamilton, Ontario, Canada

    Anna M. Sawka

  2. Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada

    Anna M. Sawka & Pauline Boulos

  3. Division of Rheumatology and Department of Medicine, St. Joseph’s Healthcare and McMaster University, Hamilton, Ontario, Canada

    Pauline Boulos & Jonathan D. Adachi

  4. Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada

    Karen Beattie

  5. Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada

    Lehana Thabane, Amiram Gafni & Nicole Zytaruk

  6. Centre for Evaluation of Medicines, St. Joseph’s Healthcare, Hamilton, Ontario, Canada

    Lehana Thabane

  7. Division of Geriatrics and Department of Medicine, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada

    Alexandra Papaioannou

  8. Division of Rheumatology and Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada

    Ann Cranney

  9. Osteoporosis Society of Canada, Hamilton, Ontario, Canada

    Nicole Zytaruk

  10. Division of Endocrinology and Metabolism, University of Calgary, Calgary, Alberta, Canada

    David A. Hanley

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  1. Anna M. Sawka
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Correspondence to Anna M. Sawka.

Appendix

Appendix

The following describes the electronic search strategy for relevant trials. An electronic search was conducted without language restrictions in the following databases in September 2004: Ovid Medline (1966 to 2004), Medline in Process, Cochrane Database for Systematic Reviews, American College of Physicians Journal Club Online (1991 to 2004), Cochrane Clinical Trials Registry, Database of Abstracts and Reviews, EMBASE (1980 to 2004), CINAHL (1982 to September, 2004) and AARP Ageline (1978 to August, 2004). The search strategy included the MESH headings for “Orthotic Devices” or “Protective Devices” or “Protective Clothing” or the root of the text word “hip protector.” This category was then matched with the MESH heading of “Fractures” or the root of the textword “fracture,” as well as the MESH heading “Hip” or the root of the textword “hip.”

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Sawka, A.M., Boulos, P., Beattie, K. et al. 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. Osteoporos Int 16, 1461–1474 (2005). https://doi.org/10.1007/s00198-005-1932-2

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