Association between estimated pulse wave velocity and hip fracture in middle-aged and older adults: A prospective cohort study in China.

Abstract

Hip fractures represent a significant public health challenge among middle-aged and older adults, with substantial implications for health and quality of life. This study aimed to investigate the association between estimated pulse wave velocity (ePWV) and hip fracture risk, with a comprehensive analysis of both overall and female population cohorts. Utilizing data from the China Health and Retirement Longitudinal Study (CHARLS), this prospective cohort study included 11,024 participants aged 45 and older, with a 9-year follow-up period (2011-2020). The research employed Cox proportional hazards models to analyze the overall population and a specific female subgroup. The female subgroup analysis uniquely adjusted for menopausal status to provide a nuanced assessment of ePWV's relationship with hip fracture risk. Restricted cubic spline (RCS) analysis and threshold analysis were conducted to explore nonlinear associations between ePWV and hip fracture risk. During the follow-up period, 471 hip fractures were documented. In the overall population, each increment in ePWV quartile was associated with a significant 32 % increase in hip fracture risk (Hazard Ratio [HR]: 1.32, 95 % Confidence Interval [CI]: 1.18-1.49, p < 0.001). The female subgroup analysis, after adjusting for menopausal status, revealed a 29 % increased hip fracture risk per ePWV quartile increment (HR: 1.29, 95 % CI: 1.09-1.53, p < 0.05). Nonlinear analysis identified a critical threshold at 11.18 m/s, beyond which hip fracture risk significantly increased [HR (95%CI): 1.28 (1.12-1.47)]. The ePWV significantly correlates with hip fracture risk in middle-aged and older Chinese adults, offering novel insights into the relationship between arterial stiffness and fracture vulnerability. Future research should validate these findings and explore vascular health-based strategies for hip fracture prevention.