title: A scoping review of strategies for the prevention of hip fracture in elderly nursing home residents.
abstract: BACKGROUND
  Elderly nursing home residents are at increased risk of hip fracture; however, the efficacy of fracture prevention strategies in this population is unclear.
  
  
  OBJECTIVE
  We performed a scoping review of randomized controlled trials of interventions tested in the long-term care (LTC) setting, examining hip fracture outcomes.
  
  
  METHODS
  We searched for citations in 6 respective electronic searches, supplemented by hand searches. Two reviewers independently reviewed all citations and full-text papers; consensus was achieved on final inclusion. Data was abstracted in duplicate.
  
  
  RESULTS
  We reviewed 22,349 abstracts or citations and 949 full-text papers. Data from 20 trials were included: 7--vitamin D (n = 12,875 participants), 2--sunlight exposure (n = 522), 1--alendronate (n = 327), 1--fluoride (n = 460), 4--exercise or multimodal interventions (n = 8,165), and 5--hip protectors (n = 2,594). Vitamin D, particularly vitamin D(3) > or = 800 IU orally daily, reduced hip fracture risk. Hip protectors reduced hip fractures in included studies, although a recent large study not meeting inclusion criteria was negative. Fluoride and sunlight exposure did not significantly reduce hip fractures. Falls were reduced in three studies of exercise or multimodal interventions, with one study suggesting reduced hip fractures in a secondary analysis. A staff education and risk assessment strategy did not significantly reduce falls or hip fractures. In a study underpowered for fracture outcomes, alendronate did not significantly reduce hip fractures in LTC.
  
  
  CONCLUSIONS
  The intervention with the strongest evidence for reduction of hip fractures in LTC is Vitamin D supplementation; more research on other interventions is needed.
authors.affiliation: Division of Endocrinology, Department of Medicine, University Health Network, Toronto, Ontario, Canada. sawkaam@yahoo.com
authors.forename: Anna M
authors.initials: AM
authors.lastname: Sawka
authors.forename: Nofisat
authors.initials: N
authors.lastname: Ismaila
authors.forename: Ann
authors.initials: A
authors.lastname: Cranney
authors.forename: Lehana
authors.initials: L
authors.lastname: Thabane
authors.forename: Monika
authors.initials: M
authors.lastname: Kastner
authors.forename: Amiram
authors.initials: A
authors.lastname: Gafni
authors.forename: Linda J
authors.initials: LJ
authors.lastname: Woodhouse
authors.forename: Richard
authors.initials: R
authors.lastname: Crilly
authors.forename: Angela M
authors.initials: AM
authors.lastname: Cheung
authors.forename: Jonathan D
authors.initials: JD
authors.lastname: Adachi
authors.forename: Robert G
authors.initials: RG
authors.lastname: Josse
authors.forename: Alexandra
authors.initials: A
authors.lastname: Papaioannou
mesh_terms: D000368:Aged; D019386:Alendronate / Q000378:metabolism; D015444:Exercise; D005459:Fluorides / Q000494:pharmacology; D006620:Hip Fractures / Q000517:prevention & control*; D006801:Humans; D008134:Long-Term Care / Q000379:methods*; D009735:Nursing Homes; D016032:Randomized Controlled Trials as Topic; D012306:Risk; D013472:Sunlight; D014807:Vitamin D / Q000378:metabolism
chemical_list: D014807:Vitamin D; D005459:Fluorides; D019386:Alendronate