Key result
In silico trial suggests hip protectors cut hip fractures up to ~74% at full compliance.
Why the study?
Conflicting conclusions have been reported regarding the efficacy of hip protectors in preventing hip fractures, potentially due to differences in compliance.
Do hip protectors reduce fracture incidence in virtual patients?
Do hip protectors reduce fracture incidence in virtual patients?
In silico modeling predicts that hip protectors can significantly reduce hip fracture incidence, with effectiveness highly dependent on compliance.
May reduce hip fractures if compliance is achieved; leaves open need for clinical trials to validate in real patients.
Osteoporosis is characterized by loss of bone mineral density and increased fracture risk. Reduction of hip fracture incidence is of major clinical importance. Hip protectors aim to attenuate the impact force transmitted to the femur upon falling, however different conclusions on their efficacy have been reported; some authors suggest this may be due to differences in compliance. The aim of this study was to apply an In Silico trial methodology to predict the effectiveness of hip protectors and its dependence on compliance. A cohort of 1044 virtual patients (Finite Element models of proximal femur) were generated. A Markov chain process was implemented to predict fracture incidence with and without hip protectors, by simulating different levels of compliance. At each simulated follow-up year, a Poisson distribution was randomly sampled to determine the number of falls sustained by each patient. Impact direction and force were stochastically sampled from a range of possible scenarios. The effect of wearing a hip protector was simulated by applying attenuation coefficients to the impact force (12.9 %, 19 % and 33.8 %, as reported for available devices). A patient was considered fractured when impact force exceeded the femur strength. Without hip protector, virtual patients experienced 66 ± 5 fractures in 10 years. Wearing the three devices, fracture incidence was reduced to 43 ± 4, 35 ± 4 and 17 ± 2 respectively, at full compliance. As expected, effectiveness was dependent on compliance. This In Silico trial technology can be applied in the future to test multiple interventions, optimise intervention strategies, improve clinical trial design and drug development.
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Oliviero et al. (2024) studied Osteoporosis (n=1,044). Hip protectors vs. Without hip protector was evaluated on Fracture incidence. In an in silico trial of 1044 virtual patients over 10 years, wearing hip protectors at full compliance reduced the number of hip fractures from 66±5 to between 43±4 and 17±2.
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