Editor—I write with reference to the systematic review by Parker et al.1 Adherence is certainly an issue, and needs to be addressed organisationally as well as at the level of the individual. However, given that many of those people seen as possible beneficiaries are cognitively or physically impaired and living in institutions, I think the question of consent is also an issue. I guess most BMJ readers would prefer not to wear special pants for the last 20 or so years of their lives, even if avoiding a hip fracture could be guaranteed. Avoiding a fall is better than wearing a hip protector (most falls don't result in a hip fracture, but they are all very unpleasant for the faller) so hip protectors should not be seen as a substitute for a falls prevention programme.
McCrea in his rapid response to Parker et al suggests that hip fracture is caused by the joint and musculature being brought to the end of its range of movement, but the evidence points to the impact of a fall as the usual cause.2-5
Competing interests: None declared.
References
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