April 15, 2003 -- Fall-related hip fractures are a leading cause of death and disability among older adults, and the problem is expected to get much worse as the population ages. The World Health Organization predicts a rise in hip fractures from 1.7 million worldwide in 1990 to 6.26 million by 2050.
Roughly a decade ago, external hip protectors were introduced to reduce fall-related hip fractures in frail elderly people who are most at risk. Early research showed them to be effective, but new findings from a large European study disagree. Institutionalized patients in this most recent study who wore the padded devices had a similar number of hip fractures as patients who did not.
"Our study finds protectors to be less useful than they were originally thought to be," doctoral candidate and lead researcher Natasja M. van Schoor, MSc, tells WebMD. "But that doesn't mean they have no value and that they should not be used."
In the U.S. alone, some 350,000 hospital admissions each year are due to hip fractures, and 90% of these fractures are caused by falls. Nearly one in four patients die within a year of their fracture because of injury-related complications and almost half will require some type of institutionalized care.
Van Schoor and colleagues at Vrije University Medical Center included 561 elderly people at high risk for hip fractures in their study. All were living in nursing homes or assisted living facilities. Half the participants were asked to wear padded hip protectors and the other half did not wear them.
Both groups were followed for roughly a year and a half, during which time there were 18 hip fractures in the hip protector group and 20 fractures among those who did not wear hip protectors. Similar amounts of falls occurred in both groups. The findings are published in the April 16 issue of TheJournal of the American Medical Association.
As in other studies, compliance was a major issue in the intervention group. Hip protectors are supposed to be worn both day and night, but fewer than 16% of the study participants wore them while sleeping. In the intervention group, four of the 18 fractures occurred in patients who wore their hip protectors at the time.
"In this study, compliance was moderate to good during the day but poor at night," van Schoor says. "I do think many patients find them uncomfortable to sleep in, and this is a problem."
Orthopaedic surgeon Mark Wellisch, MD, says he is not surprised that the devices, which are not widely used in the United States, performed poorly in the latest study.
"I don't really see how this type of padding is going to keep someone from breaking a hip when they fall," the Encino, Calif., doctor tells WebMD. "The impact of a fall is just too great."
He says elderly people who are at risk for fractures, but still relatively healthy, can derive great benefit from bone-building drugs and the right kind of exercise. The Chinese discipline tai chi is especially good, he says, because it promotes better balance without putting strain on the joints.