Risk-stratified Lifetime Risk and Incidence of Hip Fracture and Falls in Middle-aged and Elderly Chinese Population: The China Health and Retirement Longitudinal Study

Overview

Journal J Orthop Translat

Publisher Elsevier

Date 2025 Feb 3

PMID 39895863

Authors

Guangyuan Du

Zijuan Fan

Kenan Fan

Haifeng Liu

Jing Zhang

Dijun Li

Lei Yan

Jingwei Jiu

Ruoqi Li

Xiaoke Li

Songyan Li

Ligan Jia

Huachen Liu

Yijia Ren

Xuanbo Liu

Jiao Jiao Li

Bin Wang

Affiliations

Soon will be listed here.

Abstract

Background: Hip fracture (HF) is one of the most prevalent orthopedic conditions among the elderly, with falls being the primary risk factor for HF. With the surge of aged population, China is facing great challenges from HF and falls. However, a comprehensive long-term observation of risk factors affecting HF and falls and their association are little reported at a national level.

Methods: The longitudinal cohort was established using the China Health and Retirement Longitudinal Study (CHARLS) data from 2011 to 2018. The incidence density and multi-risk-stratified lifetime risk (up to 90 years of age) of falls and HF were studied at index ages of 50, 60, and 70, as well as the lifetime risk stratified by six regions in China, based on the modified Kaplan-Meier method with Statistical Analysis System (SAS).

Results: This study identified 17 705 subjects aged 50-89. The incidence density of falls was 65.07 and 47.53 per 1000 person-years in women and men, respectively. The incidence density of HF was also higher in women at 5.58 per 1000 person-years than in men at 4.88. By age 50, the lifetime risk of experiencing a HF was 18.58 % for women and 13.72 % for men. Vision and hearing abilities were significantly related to the lifetime risk of both falls and HF. Obesity-related factors presented age-relevant relationships with lifelong risks. Lack of naps, poor lower limb strength, and physical capabilities were indicative of HF risk. The north-western region of China had the lowest lifetime risk of falls but highest risk of HF, while other regions showed a consistent trend between falls and HF.

Conclusion: The aging population worldwide faces a considerable risk of falls and HF. Several risk factors were identified in this study using a Chinese population, relating to disease history, lifestyle habits, health status and physical function, and the risks differed among six regions in China. Future precautionary management programs, as well as patient self-awareness are necessary for improving the prevention of falls and HF to reduce their incidence in the aging population.

The Translational Potential Of This Article: With the greatest aged population worldwide, China faces the unparalleled challenge on public health. The study poses the lifetime risk of hip fracture and falls stratified by multiple risk factors in people from 45 to 90 in a national scale, which would shed a light on the early and continuous prevention of such injury.

References

Pellegrino A, Tiidus P, Vandenboom R . Mechanisms of Estrogen Influence on Skeletal Muscle: Mass, Regeneration, and Mitochondrial Function. Sports Med. 2022; 52(12):2853-2869. DOI: 10.1007/s40279-022-01733-9. View

Han H, Chen S, Wang X, Jin J, Li X, Li Z . Association between muscle strength and mass and bone mineral density in the US general population: data from NHANES 1999-2002. J Orthop Surg Res. 2023; 18(1):397. PMC: 10233893. DOI: 10.1186/s13018-023-03877-4. View

Pinar-Gutierrez A, Garcia-Fontana C, Garcia-Fontana B, Munoz-Torres M . Obesity and Bone Health: A Complex Relationship. Int J Mol Sci. 2022; 23(15). PMC: 9368241. DOI: 10.3390/ijms23158303. View

Schwartz A, Kelsey J, Sidney S, Grisso J . Characteristics of falls and risk of hip fracture in elderly men. Osteoporos Int. 1998; 8(3):240-6. DOI: 10.1007/s001980050060. View

Garber C, Blissmer B, Deschenes M, Franklin B, LaMonte M, Lee I . American College of Sports Medicine position stand. Quantity and quality of exercise for developing and maintaining cardiorespiratory, musculoskeletal, and neuromotor fitness in apparently healthy adults: guidance for prescribing exercise. Med Sci Sports Exerc. 2011; 43(7):1334-59. DOI: 10.1249/MSS.0b013e318213fefb. View

Tandon P, Montano-Loza A, Lai J, Dasarathy S, Merli M . Sarcopenia and frailty in decompensated cirrhosis. J Hepatol. 2021; 75 Suppl 1:S147-S162. PMC: 9125684. DOI: 10.1016/j.jhep.2021.01.025. View

Zhu X, Liu K, Yuan C, Xia J, Qian Y, Xu L . General and abdominal obesity operate differently as influencing factors of fracture risk in old adults. iScience. 2022; 25(6):104466. PMC: 9167983. DOI: 10.1016/j.isci.2022.104466. View

Vantyghem M, Danel T, Marcelli-Tourvieille S, Moriau J, Leclerc L, Cardot-Bauters C . Calcitonin levels do not decrease with weaning in chronic alcoholism. Thyroid. 2007; 17(3):213-7. DOI: 10.1089/thy.2006.0216. View

Zheng R, Zhang S, Zeng H, Wang S, Sun K, Chen R . Cancer incidence and mortality in China, 2016. J Natl Cancer Cent. 2024; 2(1):1-9. PMC: 11256658. DOI: 10.1016/j.jncc.2022.02.002. View

10.

Kanis J, Johnell O, Oden A, Johansson H, McCloskey E . FRAX and the assessment of fracture probability in men and women from the UK. Osteoporos Int. 2008; 19(4):385-97. PMC: 2267485. DOI: 10.1007/s00198-007-0543-5. View

11.

Peeters C, Visser E, van de Ree C, Gosens T, Den Oudsten B, de Vries J . Quality of life after hip fracture in the elderly: A systematic literature review. Injury. 2016; 47(7):1369-82. DOI: 10.1016/j.injury.2016.04.018. View

12.

Karampampa K, Ahlbom A, Michaelsson K, Andersson T, Drefahl S, Modig K . Declining incidence trends for hip fractures have not been accompanied by improvements in lifetime risk or post-fracture survival--A nationwide study of the Swedish population 60 years and older. Bone. 2015; 78:55-61. DOI: 10.1016/j.bone.2015.04.032. View

13.

Beiser A, DAgostino Sr R, Seshadri S, Sullivan L, Wolf P . Computing estimates of incidence, including lifetime risk: Alzheimer's disease in the Framingham Study. The Practical Incidence Estimators (PIE) macro. Stat Med. 2000; 19(11-12):1495-522. DOI: 10.1002/(sici)1097-0258(20000615/30)19:11/12<1495::aid-sim441>3.0.co;2-e. View

14.

Veronese N, Maggi S . Epidemiology and social costs of hip fracture. Injury. 2018; 49(8):1458-1460. DOI: 10.1016/j.injury.2018.04.015. View

15.

Chen W, Lv H, Liu S, Liu B, Zhu Y, Chen X . National incidence of traumatic fractures in China: a retrospective survey of 512 187 individuals. Lancet Glob Health. 2017; 5(8):e807-e817. DOI: 10.1016/S2214-109X(17)30222-X. View

16.

Griggs R, Kingston W, Jozefowicz R, Herr B, Forbes G, Halliday D . Effect of testosterone on muscle mass and muscle protein synthesis. J Appl Physiol (1985). 1989; 66(1):498-503. DOI: 10.1152/jappl.1989.66.1.498. View

17.

Zhou M, Wang H, Zeng X, Yin P, Zhu J, Chen W . Mortality, morbidity, and risk factors in China and its provinces, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2019; 394(10204):1145-1158. PMC: 6891889. DOI: 10.1016/S0140-6736(19)30427-1. View

18.

Wang Y, Luo Y, Mhalgi A, Ren W, Wu L . Association of Self-Reported Sleep Characteristics and Hip Fracture: Observational and Mendelian Randomization Studies. Healthcare (Basel). 2023; 11(7). PMC: 10094697. DOI: 10.3390/healthcare11070926. View

19.

Hagino H, Furukawa K, Fujiwara S, Okano T, Katagiri H, Yamamoto K . Recent trends in the incidence and lifetime risk of hip fracture in Tottori, Japan. Osteoporos Int. 2008; 20(4):543-8. DOI: 10.1007/s00198-008-0685-0. View

20.

Bhandari M, Swiontkowski M . Management of Acute Hip Fracture. N Engl J Med. 2017; 377(21):2053-2062. DOI: 10.1056/NEJMcp1611090. View