Hip protector

Hip protector

A hip protector is a specialized form of pants or underwear containing pads (either hard or soft) along the outside of each hip/leg, designed to prevent hip fractures following a fall. They are most commonly used in elderly individuals who have a high risk of falls and hip fractures (for example, due to history of a previous fall and underlying osteoporosis)Holzer G, Holzer LA. Hip protectors and prevention of hip fractures in older persons. Geriatrics. 2007 Aug;62(8):15-20. Review. PMID: 17668960] .

Most hip fractures follow an impact due to a lateral fall.Lauritzen JB. Hip fractures: incidence, risk factors, energy absorption, and prevention. "Bone". 1996;18:65S–75S. PMID 8717550] The pads are located over the trochanters, the bony extrusions of the hip region.

Hip protectors are either of the "crash helmet type" or "energy-absorbing type". The "crash helmet type" distributes impacts into the surrounding soft tissue, while the "energy-absorbing type" is made of a compressible material and diminishes the force of impact. Both of these systems aim to reduce the focused force beneath an estimated fracture threshold Holzer G, Holzer LA. Hip protectors and prevention of hip fractures in older persons. Geriatrics. 2007 Aug;62(8):15-20. Review. PMID: 17668960] Holzer LA, Holzer G. Design: A neglected factor in medicine. Mcgill J Med. 2007 Jan;10(1):3. PMID: 18523599] .

Several different commercially available hip protectors exist, such as the Safehip (Tytex A/S, Ikast, Denmark), the AHIP Protector (Astrotech, Vienna, Austria) and the KPH hip protector (HRA Pharma, Paris, France)Holzer G, Holzer LA. Hip protectors and prevention of hip fractures in older persons. Geriatrics. 2007 Aug;62(8):15-20. Review. PMID: 17668960] . The former has been used in most clinical trials.Lin JT, Lane JM. Nonpharmacologic management of osteoporosis to minimize fracture risk. "Nat Clin Pract Rheumatol". 2008 Jan;4(1):20-5. PMID 18172445] Hip protectors have the advantage of having no important adverse effects.Parker MJ, Gillespie WJ, Gillespie LD. Effectiveness of hip protectors for preventing hip fractures in elderly people: systematic review. "BMJ". 2006;332(7541):571-4. PMID 16513687 PMC|1397761]

Clinical studies of their effectiveness have shown conflicting results.Kannus P, Parkkari J, Niemi S, "et al". Prevention of hip fracture in elderly people with use of a hip protector. "N Engl J Med". 2000;343(21):1506-13. PMID 11087879] Kiel DP, Magaziner J, Zimmerman S "et al". Efficacy of a hip protector to prevent hip fracture in nursing home residents: the HIP PRO randomized controlled trial. "JAMA". 2007;298(4):413-22. PMID 17652295] A systematic review from 2006 found that that hip protectors are only marginally effective for preventing hip fracture among nursing home residents, and not effective among community dwelling elderly individuals. A recent randomized trial was discontinued because it failed to demonstrate any benefit. A Bayesian meta-analysis showed a decreased risk of hip fractures in elderly nursing home residents.Sawka AM, Boulos P, Beattie K "et al". Hip protectors decrease hip fracture risk in elderly nursing home residents: a Bayesian meta-analysis. "J Clin Epidemiol". 2007;60(4):336-44. PMID 17346606]

It should be noted, however, that acceptance and long-term compliance towards them is quite low, mainly because of discomfort, dislike of their appearance by the person wearing it, and disagreement about fracture risk.Patel S, Ogunremi L, Chinappen U. Acceptability and compliance with hip protectors in community-dwelling women at high risk of hip fracture. "Rheumatology (Oxford)". 2003;42(6):769-72. PMID 12730537]

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