Hip Protectors Fall Short

They don't reduce fractures among the elderly

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HealthDay Reporter

TUESDAY, April 15, 2003 (HealthDayNews) -- The shock-absorbing underwear called hip protectors fail to prevent hip fractures in the elderly.

That's the conclusion of a new Dutch study that was immediately criticized by an American bone expert who says the protectors are effective and the study's methodology is flawed.

The value of hip protectors is part of a life-and-death debate. More than 300,000 Americans suffer hip fractures each year, most of them 65 and older. And 15 percent to 30 percent of those people will die within one year from complications due to surgery or prolonged immobility, experts say.

The new study is the latest in a series of trials that have produced mostly positive findings about the protectors' worth, says Natasja M. van Schoor, a researcher at the Vrije Universiteit Medical Center in Amsterdam. She's also the lead author of the latest study, which appears in the April 16 issue of the Journal of the American Medical Association.

Most previous studies have shown the protectors -- usually plastic shields or foam pads held in place with specially designed underwear -- can help prevent fractures, van Schoor acknowledges. For example, a study of German nursing home residents reported earlier this year a more than 40 percent reduction in fractures among those who wore hip protectors. And an ongoing analysis of randomized trials worldwide by Dr. M.J. Parker of Peterborough District Hospital in Cambridgeshire, England, found a two-thirds reduction of fractures for hip-protector wearers.

However, the trials were of "low to moderate quality," says a summary of Parker's ongoing analysis, and "results from six ongoing trials may clarify this situation."

The Dutch study is one of those trials. It selected 561 older Amsterdam residents who had a high risk of hip fractures, with 276 wearing the protectors and 285 going without. During the next 70 weeks, 18 of the people assigned to the hip-protector group suffered fractures, compared to 20 of those assigned to the other group, a negligible difference.

Dr. Gerard T. Varlotta, an associate professor of medicine at New York University School of Medicine's Rusk Institute of Rehabilitation Medicine, says the study's findings are meaningless because the researchers "are making assumptions that are not justified."

You can't accuse hip protectors of being failures, Varlotta says, because "the study had a very high noncompliance rate. Of the 18 people who had fractures, only four were wearing hip protectors at the time. How can those fractures be included in the hip-protector category?"

And the type of hip protector used in the study was not optimum, Varlotta adds. It is designed to absorb shock, while most fractures are caused by torque, he says -- sudden stress on the hip from an unexpected movement.

But van Schoor says, "I do not think that the results of our study are applicable only to our hip protector. It is possible that hip protectors are effective in reducing hip fractures when the compliance is optimized. However, I do not think they are as effective as suggested in the earlier studies."

While the debate and the studies go on, van Schoor and Varlotta offer advice about preventing hip fractures.

If you have a hip protector, wear it 24 hours a day, says van Schoor, because four fractures in the study's protector-wearing group occurred during the night. "Other effective interventions include biphosphonates [prescription drugs that build bone strength] and the combination of calcium and vitamin D," she says.

Additional bone-building measures include not smoking and limiting alcohol consumption to modest levels, Varlotta says. An exercise program, even a moderate one, can help. So can paying attention to your living arrangements. Small throw rugs, electric cords and newly waxed floors are hazards to be avoided. And the bathroom, with its smooth, hard surfaces and water, is the most dangerous room in the house.

Also, wear sensible shoes. "One 90-year-old patient of mine insisted on wearing high heels to our appointments," Varlotta says.

Finally, have a support system of people you can call if an accident happens, and consider a medic alert device. Some people who fall lie on the floor for hours or days because they can't reach a phone.

More information

For more information on hip protectors, visit Johns Hopkins Health After 50. For more on hip fractures among older adults, check with the National Center for Injury Prevention and Control.

SOURCES: Natasja M. van Schoor, M.Sc., Vrije Universiteit Medical Center, Amsterdam, the Netherlands; Gerard T. Varlotta, M.D., New York University School of Medicine's Rusk Institute of Rehabilitation Medicine, New York City; April 16, 2003, Journal of the American Medical Association

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