Lifetime occupational physical demand and risk of hip fracture in older adults: A retrospective cohort study

Hip fractures in the elderly, especially among the Chinese population, are among the most serious complications of osteoporosis. As age increases, the incidence of these fractures rises. In this study, we seek to identify a range of lifetime occupational physical-demand factors that may serve as potential indicators of hip-fracture risk in Chinese individuals aged 65 years and older. Our aim is to inform preventive strategies and occupational health policies by enhancing understanding of how long-term physical work demands contribute to fracture risk across the aging population. This study employed a retrospective cohort design and was conducted at the Affiliated Hospital of Yan'an University. We included patients who underwent surgical treatment for intertrochanteric fractures or femoral neck fractures between January 2017 and December 2021. The study followed the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) guidelines to enhance transparency and methodological reporting. A total of 434 patients were included in this study, comprising 95 with light, 297 with moderate, and 42 with heavy occupational physical demand. Unadjusted multivariate logistic analysis revealed that moderate occupational physical demand was associated with a decreased risk of hip fracture (OR = 3.57, 95% CI: 2.01-6.33, P <.0001; compared to heavy occupational physical demand). Adjusted multivariate logistic model Ⅰ showed that moderate occupational physical demand (OR = 3.35, 95% CI: 1.75-6.44. P = .0003; compared to heavy occupational physical demand) remained associated with hip fracture. Fully adjusted multivariate logistic model Ⅱ also showed that moderate occupational physical demand (OR = 2.83, 95% CI: 1.51-5.97, P = .0032; compared to heavy occupational physical demand) remained associated with hip fracture. Compared to heavy physical demand, moderate occupational physical demand might be associated with a higher risk of hip fracture among older adults.