Randomized controlled trial of hip protectors among women living in the community

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Abstract
Objective: To asess whether hip protectors used among women living in the community in the United Kingdom and at high risk of hip fracture, lead to a reduction in hip fracture. Design: Pragmatic randomized controlled trial (RCT). Setting: Primary care with participants being recruited largely from general practitioners’ patient lists. Participants: Women aged 70 years and over with one or more risk factors for hip fracture (i.e., low body weight, current smoker, a prior fracture, family history of hip fracture). Intervention: Three pairs of hip protectors of the “shell” type mailed to participants with instructions on how to use them. Main outcome measure: Reduction in hip fractures. Results: 1,388 and 2,781 women aged 70 years or over were randomized to be given three pairs of hip protectors or act as controls, respectively. We followed up both groups of women for a minimum of 24 months (maximum 42 months, median 28). Compliance was poor with only 31% of participants reporting that they wore the hip protectors on a daily basis at 12 months. Intention-to-treat analysis showed that there was no statistically significant difference in the unadjusted odds ratios (ORs) of sustaining a hip fracture between the groups (OR=1.19; 95% confidence interval, 0.80 to 1.78, p=0.40). Adjustment for important covariates did not materially change these findings (OR=1.17; 95% CI, 0.78 to 1.75). Comparing the rate of hip fracture between those women who regularly wore the devices and the control group yielded an OR of 1.12 (95% CI, 0.58 to 2.03; p=0.83). Conclusion: This study is the largest RCT of hip protectors to date and provides no evidence of an effect of hip protectors among women living independently and at high risk of fracture.