Rising burden of fall-induced hip fractures in China: accelerating male-specific trends and persistent gender disparities from Global Burden of Disease 2021

Objective: To develop effective strategies for addressing hip fractures caused by falls in China, a comprehensive assessment of the disease burden is essential. Methods: Data on the characteristics of fall-related hip fractures in China—including incidence, prevalence, years lived with disability (YLDs), and their age-standardized rates—were obtained from the Global Burden of Disease 2021 study. Joinpoint regression analysis was used to examine the changes in disease burden; decomposition analysis was applied to quantify the contributions of aging, population growth, and epidemiological factors to burden changes; and autoregressive integrated moving average model was employed to forecast the burden through 2036. Results: In 2021, there were 2.537 million new cases of fall-related hip fractures in China (ASIR = 144.12 per 100 000), with a higher burden among females (age-standardized incidence rate [ASIR]: 158.47 vs. 117.93 per 100 000 for males). From 1990 to 2021, the total number of incident cases increased by 386.1%, and the ASIR rose by 83.43%, with a marked acceleration after 2010 (age–period–cohort = 6.72%). The age–period–cohort model indicated a stronger period effect in males (net drift 0.74% per year vs. 0.5% per year in females), and an exponential increase in age effect among those aged 65 years and above. Decomposition analysis revealed epidemiological factors contributed 56.6%-75.3% to incidence/prevalence, while aging accounted for 57.4%-165.2% of YLDs growth. Autoregressive integrated moving average projections suggest that by 2036, the ASIR will decline to 109.85 per 100 000, but the age-standardized prevalence rate in males will rise by 2.01%. Conclusion: The burden of hip fractures due to falls in China continues to intensify, with a higher incidence in females but a more rapid long-term increase in males. Integrated fall prevention strategies are urgently needed to address the challenges posed by an aging population.   Cite this article as: Xu D, Lu Z, Yan H, Yang Z. Rising burden of fall-induced hip fractures in China: accelerating male-specific trends and persistent gender disparities from GBD 2021. Acta Orthop Traumatol Turc. 2026; 60(2), 0673, doi: 10.5152/j.aott.2026.25673.