China’s Hip Fracture Toll in Older Adults More Than Quintupled Over Three Decades

A new modelling analysis of Global Burden of Disease 2023 data shows that hip fractures among adults aged 60 and older in China have risen steeply over the past three decades, with the annual number of new cases climbing from roughly 563,000 in 1990 to more than 3.2 million by 2023. The crude incidence rate, which counts new fractures per 100,000 people without adjusting for age, nearly doubled over the same period, from 556.87 to 1,088.96 per 100,000.

The study, conducted by a team led by Zeqian Zhang and Jinxian Zhao, went beyond simple case counts to ask how much of the observed increase reflects changes in fracture risk versus the shifting age structure of China’s population. Using Kitagawa decomposition, the researchers found that about 33 percent of the crude rise in incidence could be attributed to age composition alone, the fact that older adults now make up a larger share of the population. The remaining increase reflects higher fracture rates within age groups: the internally age-standardized incidence rate, which holds the age distribution constant, still rose by 58.46 percent between 1990 and 2023.

The picture for disability burden is somewhat different. Absolute years lived with disability, a measure that combines the number of cases with the severity and duration of resulting disability, grew from 201,151 to 595,147 over the study period. Yet when adjusted for age composition, the YLD rate declined by 10.74 percent. This divergence means that although more people are fracturing hips and experiencing disability as a result, the per-capita disability rate relative to the ageing population has eased over the three decades covered by the analysis.

Looking forward, the team evaluated three forecasting approaches: log-linear models, generalized additive models (GAMs), and ARIMA time-series models. They tested each using sequential held-out and rolling-origin analyses, methods that simulate how a model would have performed if used in real time with only past data available. ARIMA proved most accurate over short horizons, but the GAM achieved the lowest error over the five-to-ten-year windows most relevant for healthcare planning, with a root-mean-square error of 820.30 overall. Among adults aged 80 and older, the highest-burden group, the GAM’s RMSE was 1,118.88 with a mean absolute percentage error of 12.46 percent. An autoregressive-adjusted GAM was run as a sensitivity check. On the strength of these results, the researchers selected the GAM to project incidence from 2024 to 2035.

The projections reveal a striking sex and age gradient. By 2035, the model forecasts the highest fracture rate among women aged 95 and older, reaching 14,266.00 per 100,000, roughly double the projected rate of 7,052.89 per 100,000 for men of the same age.

Not all age groups face rising rates, however. The projections indicate that incidence will decline among adults aged 60 to 69, while the steepest increases occur in the oldest age brackets. This age-specific heterogeneity matters for planners: the burden is not simply growing uniformly, but shifting toward the oldest groups, who require the most intensive surgical, rehabilitation, and long-term care resources.

To ground the national estimates in local reality, the researchers performed an exploratory comparison against hospital records from 2019 to 2025, examining the overlap with the GBD series from 2019 to 2023. They found that the hospital case mix skews younger than the national GBD age distribution. The authors present this comparison as complementary local context rather than a validation of the national figures.

As a modelling study based on GBD estimates, the analysis projects future incidence along the modelled trajectories of observed age-specific rates and population structure. The findings point to escalating demand for hip surgery, post-fracture rehabilitation, and long-term care through the mid-2030s. The authors argue that the projected concentration of cases among the oldest women, together with the projected declines at younger ages, supports targeted prevention strategies and capacity planning aimed at the groups where future burden will be greatest.

The study was published open access in BMC Geriatrics on 24 October 2026 as part of the Global Burden of Disease 2023 cycle of analyses.

Subject of Research: Hip fracture incidence, disability burden, and projections to 2035 among older adults in China

Article Title: Hip fracture burden and projected incidence among older adults in China to 2035: a GBD 2023 modelling study with exploratory hospital case-mix comparison

Article References: Zhang, Z., Zhao, J., Lei, J., Yu, S., Chen, S., Chen, Y., & Li, C. (2026). Hip fracture burden and projected incidence among older adults in China to 2035: a GBD 2023 modelling study with exploratory hospital case-mix comparison. BMC Geriatrics. https://doi.org/10.1186/s12877-026-08527-y

Image Credits: AI Generated

DOI: 10.1186/s12877-026-08527-y

Keywords: hip fracture, China, GBD 2023, ageing population, forecasting, generalized additive model, ARIMA, years lived with disability, incidence projection, healthcare planning, BMC Geriatrics, fracture