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A Scoping Review of Strategies for the Prevention of Hip Fracture

A Scoping Review of Strategies for the Prevention of Hip Fracture in Elderly Nursing Home Residents. Anna Sawka, Nofisat Ismailia, Ann Cranney, Lehana Thabane, Monika Kastner, Amiram Gafni, Linda J. Woodhouse, Richard Crilly, Angela M. Cheung, Jonathan D. Adachi,

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A Scoping Review of Strategies for the Prevention of Hip Fracture

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  1. A Scoping Review of Strategies for the Prevention of Hip Fracture in Elderly Nursing Home Residents Anna Sawka, Nofisat Ismailia, Ann Cranney, Lehana Thabane, Monika Kastner, Amiram Gafni, Linda J. Woodhouse, Richard Crilly, Angela M. Cheung, Jonathan D. Adachi, Robert G. Josse and Alexandra Papaioannou PLoS ONE 5(3) e9515

  2. Background • Elderly nursing home residents are at increased risk of hip fracture. • However the efficacy of fracture prevention strategies in this population in unclear. Sawka AM et al. 2010 PLoS ONE 5(3) e9515

  3. What was the objective? • To perform a scoping review of randomized controlled trials (RCTs) of interventions tested in the long-term care (LTC) setting, examining hip fracture outcomes. • A scoping review is a series of systematic reviews. Sawka AM et al. 2010 PLoS ONE 5(3) e9515

  4. What methods were used? • Searched for citations in 6 electronic searches, supplemented by hand searches. • Review categories were: • Vitamin D or calcium • Pharmacologic therapies • Hormonal therapies • Alternative medicines • Exercise, behavioral or multimodal interventions • Hip protectors • Two reviewers independently reviewed all citations and full-text papers. • Consensus was achieved on final inclusion. 4 Sawka AM et al. 2010 PLoS ONE 5(3) e9515

  5. What were the studies’ characteristics? • 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) • 5 - hip protectors (n = 2,594). Sawka AM et al. 2010 PLoS ONE 5(3) e9515 5

  6. What were the findings? • Vitamin D, particularly vitamin D3 ≥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. • cont’d… Sawka AM et al. 2010 PLoS ONE 5(3) e9515 6

  7. What were the findings? cont’d • 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. Sawka AM et al. 2010 PLoS ONE 5(3) e9515 7

  8. What did we conclude? 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 AM et al. 2010 PLoS ONE 5(3) e9515 8

  9. Acknowledgements This work was funded by : • Canadian Institute of Health Research (Knowledge Translation – Research Synthesis Competition FRN 82616) • Osteoporosis Strategy Program of the Ontario Ministry of Health Sawka AM et al. 2010 PLoS ONE 5(3) e9515

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