Stressful life events and hip fracture risk in older Chinese adults: a prospective cohort study

Background Stressful life events (SLEs) are established precursors to adverse geriatric outcomes; however, their association with hip fracture risk and underlying mechanisms remain unclear. This study evaluated the association between SLEs and incident hip fracture among Chinese older adults, specifically examining depressive symptoms as a potential intermediary pathway. Methods In this prospective cohort study, we utilized data from 3,706 participants (aged ≥ 65 years) from the China Health and Retirement Longitudinal Study (CHARLS, 2011–2020). SLEs were quantified across five key adulthood domains. Incident hip fractures were ascertained through standardized self-reports. Time-to-event outcomes were analyzed using multivariable Cox regression and exploratory mediation analysis for depressive symptoms. Results Over a 9-year follow-up, 218 (5.9%) participants sustained a hip fracture. Cumulative SLEs exhibited a dose-dependent association with fracture risk (HR = 1.32; 95% CI: 1.13–1.54 per additional event). Compared with no SLEs, adjusted HRs were 1.57 (95% CI: 1.07–2.31) for one event and 2.14 (95% CI: 1.43–3.20) for ≥ 2 events. In an exploratory mediation analysis, depressive symptoms accounted for 11.4% of the association. Conclusions Cumulative SLEs are associated with hip fracture risk in a dose-dependent manner among older Chinese adults, with depressive symptoms potentially serving as an intermediary pathway. These findings support the consideration of integrating psychosocial assessments into fracture prevention strategies. Clinical trial number Not applicable.