Wearing a pad is better than a pin

Summarized by Robert W. Griffith, MD
January 22, 2001 (Reviewed: February 18, 2003)

As we get older, we approach the time when we face an increased risk of falling and injuring ourselves. One of the most distressing injuries that can result is a fracture of the hip. These pages have discussed various precautionary measures, such as regular exercise, a high calcium and vitamin D intake, the treatment of osteoporosis with medication, and so on. Now we can add to the list a practical step to minimize the severe consequence of a sideways fall; it involves wearing a protective shield over the bony prominence of each femur. The padded shields are worn in inside pockets of stretch underwear.

Researchers in Finland selected elderly adults (over 70) who were "at risk" - for instance, they had experienced a fall or a previous fracture, they had poor balance or poor eyesight, they had a condition such as osteoporosis, or they were taking a medication likely to cause falls. The candidates were living in, or attending, one of 22 community-based healthcare centers. Each center was assigned randomly (i.e. by chance) to be a "hip-protector unit" or a "control unit". There were two control units for each hip-protector unit.

About one third of the selected subjects in the hip protector units and one tenth of those in control units decided not to participate in the study, for a number of reasons. In order to have enough participants to be able to reach a definite conclusion about the value of hip protectors, new subjects were enrolled from the waiting lists for each unit. By the end of the enrollment period there were over 650 subjects in the hip protector group and over 1,100 control subjects.

The hip protector used was shaped to fit anatomically over the protruding bony part of the femur (the greater trochanter); it was approximately 7 ¾ inches long, 3 ½ inches wide, and 2 inches thick. It was designed so that the energy from an impact from a sideways fall was away from the bony prominence, towards the soft tissues around it.

Padded protectors, worn on each side, were found not to interfere with normal movements, and there were no side effects of note, although 15 subjects complained of skin irritation or abrasions. However, the results showed that in those assigned to use them, they were only worn about half the days in the study.

During the 18-month study, 13 subjects in the hip-protector group and 67 control subjects had a hip fracture. Analysis showed that the risk of having a fracture in the hip-protector group was less than half that in the control group - 40%, to be precise.

When just the hip-protector group was analyzed, it was found that 4 of them had hip fractures out of a total of 1,034 falls while they were wearing protectors, whereas 9 subjects in this group had fractures out of 370 falls when they were not wearing their protectors. In this group, the risk of a hip fracture while actually wearing protectors was 20% of that in the control subjects.

How relevant is this to everyday life for elderly people at risk? The scientists who did the study say that 41 people would need to use hip protectors for one year (or 8 people for 5 years) in order to prevent one hip fracture from occurring. The facts that a third of the people asked to participate refused to use hip protectors, and that those who agreed to only wore them half the time, suggest that there is still a lot of to be done.

If we are to benefit from the use of hip protectors, two things are necessary. First, the protectors must be improved so that while they still provide protection in the case of a fall, they are also attractive enough, and comfortable enough, that people will wear them every day. Second, people at risk need to be educated about the value of hip protectors, so that they will want to wear them. And, of course, the other risk-reducing steps - a proper diet, exercise, etc. - must be continued, and even intensified. Falls will still occur, and there are plenty of other bones that can be broken.

Source

• Prevention of hip fracture in elderly people with use of a hip protector. P. Kannus, J. Parkkari, S. Niemi, N Engl J Med, 2000, vol. 343, pp. 1506--1513

Related Links
Predicting fractures in patients with osteoporosis

Related Books
Falls in Older Persons : Prevention and Management

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