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. 2025 Oct;36(10):1931-1939.
doi: 10.1007/s00198-025-07573-3. Epub 2025 Jun 23.

Four-year trajectories of depressive symptoms and subsequent risk of hip fracture: evidence from China Health and Retirement Longitudinal Study

Mingming Liu  1 , Yuxiao Li  2
Affiliations

Four-year trajectories of depressive symptoms and subsequent risk of hip fracture: evidence from China Health and Retirement Longitudinal Study

Mingming Liu et al. Osteoporos Int. 2025 Oct.

Abstract

This longitudinal study examined the association between depressive symptom trajectories and the risk of hip fracture using a nationally representative dataset. The findings suggested that a high-increasing trajectory was a significant risk factor for hip fracture in females.

Purpose: Depression has been associated with increased risk of hip fracture; however, no study has specifically examined how trajectories of depressive symptoms influence hip fracture incidence. This study aimed to investigate the association between long-term depressive symptom trajectories and the 5-year risk of hip fracture, and whether this association differs by gender.

Methods: We analyzed data from 8942 individuals aged 45 and older from the China Health and Retirement Longitudinal Study (CHARLS). Depressive symptom trajectories (2011-2015) were identified using group-based trajectory modeling. Cox proportional hazards models were used to examine the association between these trajectories and the risk of hip fracture over the subsequent 5 years.

Results: Three distinct depressive symptom trajectories were identified: low-stable, moderate-stable, and high-increasing. Compared to the low-stable group, females in the high-increasing trajectory had a significantly higher risk of hip fracture (HR = 2.37, 95% CI 1.29-4.35, P < 0.01), while no significant risk increase was observed for the moderate-stable group (HR = 1.05, 95% CI 0.63-1.73, P > 0.05). This association was not found among males. Sensitivity analyses supported these findings.

Conclusions: A high-increasing depressive symptom trajectory was significantly associated with an increased risk of hip fracture, particularly among females. Prioritizing targeted interventions for individuals with this trajectory is essential to mitigate their risk.

Keywords: Middle-aged and older adults; Chinese population; Hip fracture; Trajectory of depressive symptoms.

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Conflict of interest statement

Declarations. Ethics approval: The original CHARLS was approved by the ethics review committee of Peking University, and all the participants provided signed informed consent before they were interviewed. The IRB approval number for the main household survey, including anthropometrics, is IRB00001052–11015; the IRB approval number for biomarker collection, was IRB00001052–11014. Consent for publication: We confirm that the manuscript has been read and approved by all named authors and that there are no other persons who satisfied the criteria for authorship but are not listed. We further confirm that the order of the authors listed in the manuscript has been approved by all authors. Conflict of interest: None.

References

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