In an attempt to account for the effects of compliance or noncompliance, the authors also calculated the rate of fractures among subjects in the hip-protector group according to whether they were wearing or not wearing hip protectors when they fell. They found that the rate of hip fracture per fall was 84 percent lower when the hip protectors were being worn. The latter calculation is only an estimate, because this subgroup analysis was not randomized and because many other variables may have differed between those wearing and those not wearing the protectors. Nonetheless, this study provides strong and timely confirmation of the efficacy of hip protectors in subjects at high risk for hip fractures. Although calculations of cost effectiveness were not performed, the cost of a hip protector must be small compared with the cost associated with a hip fracture, and according to the authors' calculations of the number needed to treat, only 41 persons need be offered a hip protector to prevent one hip fracture during the course of one year.
Every study has limitations.
Dropouts and intercurrent deaths plagued this study, as they do almost every long-term study involving frail, elderly people. Finally, as reported previously, it has been notoriously difficult to convince people to wear these protectors, although with improving attention to comfort and with more solid data demonstrating efficacy, compliance should improve. Hip protectors offer a powerful new method for reducing the risk of hip fracture. Future research should focus on ways to improve the acceptability of hip protectors and on better defining the subgroups that can derive particular benefit from their use. All rights reserved.