Hip Protectors to Prevent Fracture
Do hip protectors prevent hip fractures? As I'm sure you know, a fractured hip, especially in elderly individuals, can be a devastating or even life-threatening event. Thus, anything that can help prevent hip fractures is beneficial. Certainly the commonly-held beliefs for helping to prevent fractures includes such things as regular weight-bearing exercise, proper diet to include adequate calcium, vitamin D and other necessary vitamins and minerals, avoidance of excess alcohol, not smoking, etc. But, do hip protectors also help prevent fractures or are they a waste of time and money? And if they help, who do they help? I hope to shed some light on this topic by a review of some of the more recent literature on this topic.
A Cochrane Database of Systematic Reviews article. This article is by Parker MJ, Gillespie LD and Gillespie WJ in Cochrane Database Syste Rev. 2003;(3):CD001255, entitled Hip protectors for preventing hip fractures in the elderly. PMID: 12917903. The objective was to determine if external hip protectors reduce the incidence of hip fractures in elderly persons after a fall. The article is basically a review of all the pertinent literature in the medical literature on this subject. After this review, the authors concluded: "There is no evidence of effectiveness of hip protectors from studies in which randomization was by individual patient within an institution, or for those living in their own homes. Data from cluster randomized studies indicates that, for those living in institutional care with a high background incidence of hip fracture, a program of providing hip protectors appears to reduce the incidence of hip fractures. Acceptability by users of the protectors remains a problem due to discomfort and practicality. Cost effectiveness remains unclear." So, there doesn't seem to be a strong set of studies to indicate that hip protectors are truly effective at preventing fractures. And, if they are effective, it would appear to be mainly for individuals living in homes for the elderly, possibly because they are more likely to wear the devices due to constant oversight by staff members. There also doesn't seem to be studies to indicate that the cost of the devices is warranted by their effectiveness. I'm not going to present an exhaustive evaluation of the literature, but will mention a few studies with conflicting findings to describe the problem.
Some potential problems with hip protector studies. There are several factors that could influence the outcome of hip protector studies: 1) Compliance, that is, do they wear the protectors all the time during the study and how do you verify that? 2) What was the baseline bone mineral density (BMD) of the group studied? That could be very important because if there are significant differences in BMD among members of the group it could affect the outcome. Remember that a large portion of hip fractures are purported to occur before the fall in individuals with severe osteoporosis. Certainly a hip protector will be of no benefit for such a person. 3) "Fall" is a term that encompasses a wide range of possible events. That is, a person could fall from a six-foot ladder, from their knees to the ground, or anything in between. So, it is important to specify the severity of the fall to truly understand if the hip protector could have been beneficial.
The findings of some studies. In a study done in the U.K. using the Safehip hip protectors, there was no benefit found when testing to see if they could prevent a second fracture in women living in the community. See Age Ageing. 2003;32(4):442-4, Birks YF and others, PMID: 12851191. An Australian study testing the effectiveness of hip protectors on frail women living in their own homes found no effectiveness from wearing the protectors. This appeared related to incomplete compliance by study participants and the small population studied didn't allow adequate statistical power. See: Inj Prev. 2003 Jun;9(2):138-41, Cameron ID and others, PMID: 12810740. Elderly instutionalized individuals, however, did appear to benefit from hip protectors as noted in a Canadian meta-analysis. These authors note: "The economic analysis found that the use of hip protectors is expected to be both effective and cost saving." They also state, "There is sufficient clinical and economic evidence to support the use of hip protectors for institutional dwelling elderly." See: Osteoporos Int. 2003 Mar;14(3):243-50, Waldegger, L and others, PMID: 12730792. But, in a study done in Amsterdam on elderly persons aged 70 years or older living in apartment houses for the elderly, homes for the elderly and nursing homes, there was no benefit from hip protectors. See: JAMA. 2003 Apr 16;289(15):1957-62, vanSchoor NM and others, PMID: 12697798. An American study using high-risk ambulatory residents of a long-term care facility found high compliance when using the hip protectors. However the cost was a potential problem and the authors felt that third-party payers would need to pay for the protectors. The cost per individual was approximately $166, including the cost of staff time. Unfortunately, there was no concomitant study of fracture prevention during the study to truly allow a cost-benefit analysis. See: J. Am Med Dir Assoc. 2003 Sep-Oct;4(5):245-50, Burl JB and others, PMID: 12959651.
Summary. First, here is a Website where it is possible to purchase several varieties of hip protectors: http://www.hip-protector.com/. Just realize that there is conflicting evidence as to whether they will help you or not. It appears that the greatest potential benefit from hip protectors is in the elderly institutionalized population that is at high risk of a hip fracture. Individuals will probably have to buy their own protectors since they most likely will not be provided by insurance of any kind. And, it would be easier to justify the expense if studies showed a strong correlation between wearing the protectors and reduced hip fracture risk--which is not the case yet. Additionally it would be beneficial to know how hip protectors compare to such things as exercise programs, diet changes, medications, etc. So, we appear to be a long way from knowing the final answer on this subject.