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External hip protectors have been around for at least 15 years, and studies have already tried to find out which ones (if any) help prevent hip fractures in older people. The results have been inconsistent, contradictory, and generally disappointing. Even people with the highest risk of fracture did not benefit from a unilateral protector in a recent randomised trial of more than 1000 nursing home residents with a mean age of 85. Almost four fifths of participants were womenwomen.
The negative result was so emphatic that the authors stopped the trial early. In all analyses, fractures were more common in protected than unprotected hips, although the difference was not statistically significant. In the subgroup that wore the protector most reliably, the incidence of fractures was 15/284 hip years of observation for protected hips and 10/284 hip years of observation for unprotected hips (P=0.42)
The device used in this trial worked well in simulated biomechanical tests, and the authors aren't sure why it failed to prevent fractures in the real world. Different designs might work better, and they urgently need testing, says an editorial (p 454). In the meantime, healthcare professionals must cope without hard and fast evidence to inform their practice.