Healthcare and Rehabilitation · Jun 2026
Association between cognitive function and hip fracture among middle-aged and older Chinese adults: A prospective study using the China Health and Retirement Longitudinal Study
By Shen Y, Shi X, Wang GY et al.
Background The relationship between cognitive function and hip fracture risk among middle-aged and older adults in China remains unclear, with limited longitudinal evidence. Objective To investigate the association between cognitive function and hip fracture risk among Chinese middle-aged and elderly adults. Study design Prospective longitudinal study. Methods We analyzed 8257 participants (aged ≥45) from China Health and Retirement Longitudinal Study (CHARLS). The present analysis used Wave 3 (2015) as the study entry and followed participants through Wave 5 (2020). Cognitive function was assessed across four domains: orientation, memory, calculation and drawing. All cognitive z-scores were standardized to the metrics of Wave 3. The calculation formula involved subtracting the Wave 3 average score from each participant’s test score per wave, followed by division using the Wave 3 standard deviation. Hip fracture status served as the outcome measure. Potential confounding effects stemming from demographic attributes and other covariates were controlled for during the analysis. Longitudinal logistic regression was used to analyze the relationship between the cognitive z-scores and their dimensions and hip fracture incidence at two follow-up surveys. Results Participants (mean age 56.62 ± 8.92 years; 53.8% male) were followed for up to 5 years. Each standard deviation decrease in global cognitive z-scores was associated with increased hip fracture risk at Wave 4 (odds ratio [OR] = 0.71, 95% CI:0.57–0.89) and Wave 5 (OR = 0.72, 95% CI:0.58–0.87). Decline in orientation demonstrated consistent associations (Wave 4: OR = 0.82, 95% CI:0.70–0.96; Wave 5: OR = 0.82, 95% CI:0.68–0.99). Declines in calculation were associated with hip fracture at Wave 4 only, while declines in memory and drawing showed such an association only at Wave 5. Conclusion Independent associations exist between impaired global cognitive function, weakened orientation and increased hip fracture risk in this Chinese middle-aged and older population. These findings highlight the need to integrate cognitive assessments with fracture risk evaluations.