A scoping review of strategies for the prevention of hip fracture in elderly nursing home residents.
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.
Sawka
Anna M
AM
Division of Endocrinology, Department of Medicine, University Health Network, Toronto, Ontario, Canada. sawkaam@yahoo.com
Ismaila
Nofisat
N
Cranney
Ann
A
Thabane
Lehana
L
Kastner
Monika
M
Gafni
Amiram
A
Woodhouse
Linda J
LJ
Crilly
Richard
R
Cheung
Angela M
AM
Adachi
Jonathan D
JD
Josse
Robert G
RG
Papaioannou
Alexandra
A
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
D014807:Vitamin D; D005459:Fluorides; D019386:Alendronate