Clinical role, biomechanical aspects, and barriers to the use of hip protectors in fracture prevention: insights from an Italian Delphi consensus panel

Hip fractures represent a major cause of morbidity, disability and mortality among older adults. Endocrinologists, bone experts and health authorities are called to all possible efforts in order to prevent osteoporosis, sarcopenia and falls, which are all causal factors of hip fractures due to their huge impact on quality of life, short- and long-term prognosis and direct and indirect costs for health systems worldwide. Hip protectors were proposed as a non-pharmacological intervention to reduce the impact forces transmitted to the proximal femur during falls. However, their clinical use remains limited, and uncertainty persists on their indications, efficacy, and implementation in routine practice. The aim of this study was to explore expert consensus on the clinical role, indications and barriers to the use of hip protectors in older adults at risk of falls. A modified Delphi consensus study organized by Glucocorticoid Induced Osteoporosis Skeletal Endocrinology Group (GIOSEG) involved a multidisciplinary panel of Italian experts in the management of osteoporosis, fragility fractures, and fall prevention. The Delphi process consisted of two rounds of anonymous surveys in which participants rated a series of statements using a six-point Likert scale. The questionnaire covered four domains, including relevance of falls into hip fractures, clinical role of hip protectors, barriers to their use, current gaps and future perspectives. Thirty-five experts participated in the first round and thirty-three completed the second round. Consensus was reached on several key aspects of hip fracture prevention. Hip protectors were recognized as a potentially useful adjunctive intervention, particularly in older adults at very high risk of falls and fractures. Patients' adherence and device acceptability were identified as major determinants of effectiveness, while poor patients' acceptance, limited clinician awareness and lack of reimbursement were recognized as major barriers to implementation. This Italian Delphi consensus highlights the potential role of hip protectors as part of a comprehensive strategy for hip fracture prevention in high-risk older adults.