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External hip protectors are effective for the elderly with higher-than-average risk factors for hip fractures

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Abstract

Summary

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.

Introduction

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.

Methods

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.

Results

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%.

Conclusion

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

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Acknowledgements

This study was supported by grants from the Health and Labour Sciences Research Grants for Comprehensive Research on Aging and Health (TK and KT), Japan and the Research Society for Metabolic Bone Diseases (TK), Japan. We are indebted to the local research coordinators and caregivers at participating facilities for their help, recognition and dedication in conducting the trial. We also wish to thank Tadao Tsuboyama, Kazuki Sakamoto, Motohiro Fujii and Hideaki Ishibashi for their help in collecting data and Tomoko Watanabe for her special efforts as a research nurse in recruiting subjects, conducting interviews and communicating with caregivers.

Conflicts of interest

None.

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Authors and Affiliations

  1. Department of Rheumatosurgery, Osaka City University Medical School, Osaka, Japan

    T. Koike

  2. Department of Orthopaedic Surgery, Osaka City University Medical School, Osaka, Japan

    Y. Orito, H. Toyoda, M. Tada, R. Sugama, M. Hoshino, Y. Nakao & K. Takaoka

  3. Department of Orthopaedic Surgery, Shinshu University School of Medicine, Matsumoto, Japan

    S. Kobayashi

  4. Department of Public Health, Osaka City University Medical School, Osaka, Japan

    K. Kondo & Y. Hirota

  5. Abenoku Asahimachi 1-4-3, Osaka, 545-8585, Japan

    T. Koike

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  1. T. Koike
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  2. Y. Orito
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  3. H. Toyoda
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  4. M. Tada
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Correspondence to T. Koike.

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Koike, T., Orito, Y., Toyoda, H. et al. External hip protectors are effective for the elderly with higher-than-average risk factors for hip fractures. Osteoporos Int 20, 1613–1620 (2009). https://doi.org/10.1007/s00198-008-0824-7

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  • DOI: https://doi.org/10.1007/s00198-008-0824-7

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