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August 20, 2003

External Hip Protectors and Risk of Hip FractureExternal Hip Protectors and Risk of Hip Fracture

Author Affiliations

Letters Section Editor: Stephen J. Lurie, MD, PhD, Senior Editor.

JAMA. 2003;290(7):883. doi:10.1001/jama.290.7.883-a

To the Editor: The negative results in the study by Ms van Schoor and colleagues1 underscore the importance of adherence in measuring the effectiveness of hip protectors.

Although the authors extended the follow-up duration to address the inadequate number of study participants, a larger issue arises from the authors' ambitious risk reduction estimate of 75% that they used to compute the power of their study. Such a risk reduction exceeds that reported in the largest trials to date, and results from these studies also had wide confidence intervals.24 Such studies generally have found that external hip protectors reduce the risk of fracture, but that poor adherence undermines their effectiveness. It is not clear that the measure of compliance in this study was comparable with that of other studies, and both recall bias and provision of socially acceptable responses may have overestimated true compliance in those who fell.

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