Protector De Cadera

T he New England

Journal o f M edicine
© Co py r ig ht , 2 0 0 0 , by t he Ma s s ac h u s e t t s Me d ic a l S o c ie t y

N O V E M B E R 2 3, 2000

V O L U ME 3 4 3

N UMB ER 21

P REVENTION OF HIP FRACTURE IN ELDERLY PEOPLE
WITH USE OF A HIP PROTECTOR
PEKKA KANNUS, M.D., PH.D., JARI PARKKARI, M.D., PH.D., SEPPO NIEMI, MATTI PASANEN, M.SC., MIKA PALVANEN, M.D.,
MARKKU JÄRVINEN,M.D., PH.D., AND ILKKA VUORI, M.D., PH.D.

ABSTRACT
Background Hip fractures are common in frail elderly adults worldwide. We investigated the effect of
an anatomically designed external hip protector on the
risk of these age-related fractures.
Methods We randomly assigned 1801 ambulatory
but frail elderly adults (1409 women and 392 men;
mean age, 82 years), in a 1:2 ratio, either to agroup
that wore a hip protector or to a control group. Fractures of the hip and all other fractures were recorded
until the end of the first full month after 62 hip fractures had occurred in the control group. The risk of
fracture in the two groups was compared, and in the
hip-protector group the risk of fracture was also analyzed according to whether the protector had been
in use at the timeof a fall.
Results During follow-up, 13 subjects in the hip-protector group had a hip fracture, as compared with 67
subjects in the control group. The respective rates of
hip fracture were 21.3 and 46.0 per 1000 person-years
(relative hazard in the hip-protector group, 0.4; 95 percent confidence interval, 0.2 to 0.8; P=0.008). The risk
of pelvic fracture was slightly but not significantlylower in the hip-protector group than in the control group
(2 subjects and 12 subjects, respectively, had pelvic
fracture) (relative hazard, 0.4; 95 percent confidence
interval, 0.1 to 1.8; P»0.05). The risk of other fractures
was similar in the two groups. In the hip-protector
group, four subjects had a hip fracture (among 1034
falls) while wearing the protector, and nine subjects
had a hipfracture (among 370 falls) while not wearing the protector (relative hazard, 0.2; 95 percent confidence interval, 0.05 to 0.5; P=0.002).
Conclusions The risk of hip fracture can be reduced
in frail elderly adults by the use of an anatomically
designed external hip protector. (N Engl J Med 2000;
343:1506-13.)
©2000, Massachusetts Medical Society.

1506 ·

H

IP fractures are a major causeof disability,
functional impairment, and death in elderly people.1-6 Furthermore, the frequency of hip fractures is likely to increase because the number and mean age of elderly adults are
increasing and because, in many countries, the ageadjusted incidence (that is, the average individual risk)
of hip fracture is also increasing.4,7,8
The alarming increase in the frequency of hip fracturehas resulted in the development of various methods for the prevention of fractures, including exercise,
calcium and vitamin D supplementation, specific drugs
to prevent or treat osteoporosis, and multifaceted interventions to modify the risk of falling.9-15 However,
since in most cases of hip fracture the immediate cause
of the fracture is a sideways fall with direct impact on
the greatertrochanter of the proximal femur,16-20 a logical option, but one that has as yet been poorly studied, is to use a device to protect the hips, so that at the
time of a fall the force and energy of the impact are
attenuated and shunted away from the greater trochanter, preventing fracture.
We undertook this study to determine whether an
external hip protector would be effective in preventing
hipfractures among elderly adults.
M ETHODS
Study Design
We studied elderly adults from 22 community-based health care
centers in the southern and central parts of Finland. Each center
had treatment units (geriatric long-stay facilities or outpatient care
units for supported living at home) for the care of elderly people
at high risk for hip fracture and other fractures induced by falls....