Research Article| Volume 146, P26-33, April 2021

Physical performance and risk of hip fracture in community-dwelling elderly people in China: A 4-year longitudinal cohort study


      • The relationship between physical performance and hip fracture is point out.
      • Participants with hip fractures had poorer physical performance than those without hip fractures.
      • After adjustment for potential confounding factors, a significant risk gradient for hip fracture was associated with the SPPB score and repeated chair stands.
      • No modification effect of cognition function was found on the relationship between physical performance and hip fracture.



      This study aims to evaluate the association between the risk of hip fracture and score on the Short Physical Performance Battery (SPPB) and handgrip strength in community-dwelling elderly people in China.


      A total of 5,958 community-dwelling Chinese people aged 60 years or more from the China Health and Retirement Longitudinal Study (CHARLS) were surveyed in 2011 (baseline) and followed through to 2016. Score on the SPPB (which comprises tests of balance, walking speed, and repeated chair stands) and handgrip strength were determined at baseline. Binary logistic regression models were used to estimate the risk ratio (RR) and 95 % CI.


      During an average of approximately 4 years of follow-up, 180 (3.0 %) participants experienced incident hip fracture. After multivariate adjustment, the overall SPPB score and repeated chair stands alone distinguished a gradient of hip fracture risks. The risk of hip fracture was 1.65-fold higher in poor SPPB performers (score 0−6) than in good SPPB performers (score 10−12). Participants unable to complete repeated chair stands, and those who took ≥16.7 s or 13.7–16.6 s to complete them, had a higher risk than those who took ≤ 11.1 s to complete them, with RRs of 2.45, 2.12, and 1.93, respectively. Participants unable to complete the balance tests had a higher hip fracture risk than those with scores of 4, with an RR of 2.16. Walking speed and handgrip strength were not associated with increased hip fracture risk.


      Among community-dwelling elderly Chinese people, overall SPPB score, as well as performance on repeated chair stands and balance tests within the SPPB, were significantly and independently associated with increased hip fracture risk. These indicators could be used to predict hip fracture in clinical settings.


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