A Cochrane review included 19 studies with a total of over 17 000 older people living in nursing care facilities or older adults living at home. Pooling of data from trials conducted in nursing or residential care settings showed a marginally statistically significant reduction in hip fracture risk (RR 0.82, 95% CI 0.67 to 1.00; 14 studies, n=11 808). Among community dwelling participants, provision of hip protectors showed no reduction in hip fracture incidence (RR 1.15, 95% CI 0.84 to 1.58; 3 studies, n=5 614). There is probably little to no effect on falls (rate ratio 1.02, 95% CI 0.9 to 1.16) or fractures other than of the hip or pelvis (rate ratio 0.87, 95% CI 0.71 to 1.07). However, the risk ratio for pelvic fractures is RR 1.27 (95% CI 0.78 to 2.08); this is an absolute effect of one more person (95% CI 1 fewer to 5 more) per 1000 having a pelvic fracture when provided with hip protectors. The incidence of adverse events while wearing hip protectors, including skin irritation, ranged from 0% to 5%. Adherence, particularly in the long term, was poor.
A systematic reviewComment: The quality of evidence is downgraded by study quality (inadequate or unclear allocation concealment) and by inconsistency (variability in results across studies).