To the Editor: Ms van Schoor and colleagues1 found that external hip protectors did not decrease the risk of hip fractures among elderly individuals with low bone density and at high risk for fractures. Other studies, however, have found that hip protectors are effective when properly worn.2 - 4 We believe that the ethical principle of beneficence demands that research studies should be aimed at improving adherence with use of external hip protectors, which is critical to their effectiveness.5 - 6 In the study by van Schoor et al, adherence was assessed in a minimal way by random site visits at 1, 6, and 12 months. Furthermore, of the 18 hip fractures in the intervention group, 78% occurred when patients were not wearing hip protectors. Similarly, 77% of the intervention group had either ceased wearing the hip protectors or were lost to follow-up at 12 months.
We are also concerned that the authors relied on "participant-kept calendars" to measure the occurrence of falls. In addition to the usual limitations of self-report, these calendars are likely to be even more unreliable given that 77% of the intervention group and 75% of the control group had cognitive impairment.
Finally, the authors did not assess the durability of the hip protectors with repeated laundering and impacts throughout the 12 months of the trial. Some changes in the protective properties of hip protectors may occur during 1 year of use. This may explain why they were found to be ineffective even in the participants who did use them regularly.
Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal
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