ArticleBMC geriatrics2026
Association of serum creatinine-to-cystatin C ratio with incident hip fracture in community-dwelling older adults: a prospective cohort study from the China Health and Retirement Longitudinal Study (CHARLS).
Article in BMC geriatrics, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundThe serum creatinine-to-cystatin C ratio (CCR) is a promising biomarker of muscle mass, yet its prospective link with hip fracture in Asian older adults remains unclear.
methodsWe included 2,636 participants aged ≥ 65 from the China Health and Retirement Longitudinal Study (CHARLS, 2011–2020). CCR was derived from serum creatinine and cystatin C. Incident hip fractures were self-reported in follow-up interviews. We used cause-specific Cox models and Fine–Gray subdistribution hazard models, treating death as a competing risk.
resultsThe mean CCR was 0.73 ± 0.19 (mean ± SD). During a median follow-up of 9 years, we identified 155 incident hip fracture events and 784 deaths. Higher CCR was consistently and inversely associated with hip fracture risk in a graded manner. Specifically, in fully adjusted cause‑specific Cox models, each 0.1‑unit increase in CCR was associated with a 12% reduction in the instantaneous hazard of hip fracture (HR = 0.88; 95% CI: 0.79–0.99). Participants in the highest CCR quartile had a 56% lower hazard compared with those in the lowest quartile (HR = 0.44; 95% CI: 0.25–0.77). Fine–Gray subdistribution models, which estimate effects on the cumulative incidence function accounting for death as a competing event, yielded estimates of similar direction and magnitude (per 0.1-unit increase: SHR = 0.88; 95% CI: 0.79–0.99; highest vs. lowest quartile: SHR = 0.44; 95% CI: 0.25–0.78). The inverse association was approximately linear and robust across sensitivity analyses. While generally consistent in most prespecified subgroups, sex-stratified analysis revealed a pronounced association in females (per 0.1-unit increase: HR = 0.83, 95% CI: 0.70–0.98) but not in males (HR = 1.00, 95% CI: 0.84–1.18). The interaction by sex was not statistically significant (P = 0.12), and limited power precludes definitive interpretation of effect modification.
conclusionsIn this nationally representative prospective cohort of older Chinese adults, a higher CCR was observed to be associated with a lower risk of incident hip fracture, even after accounting for competing mortality. CCR may serve as an associative biomarker, pending external validation and cost-effectiveness evaluation.
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