Health Outcomes and Care Needs After Osteoporotic Fractures in Rural Chinese Older Adults: Policy Implications

Qian ZhuCaixia Ran^*

• The Central Hospital of EnshiTujia and Miao Autonomous Prefecture, Enshi, China

AbstractBackground: Osteoporotic fractures pose a significant public health challenge among the elderly in rural settings with limited healthcare access. This study investigated the burden of osteoporotic fractures, associated care needs, and influencing factors in rural China.Methodology: A cross-sectional study was conducted from March 2022 to December 2024, involving elderly individuals aged ≥60 years from rural regions of Enshi Prefecture, Hubei Province, as well as Shandong, Henan, Yunnan, and Gansu provinces in China. Participants were recruited via community health centers, with eligibility confirmed through medical records for osteoporosis or osteoporotic fracture history. A validated 33-item questionnaire assessed demographics, family support, health status, healthcare access, and policy awareness, with logistic regression analyzing factors associated with receiving help after fractures, adjusting for confounders.Results: Among a total of 3,600 participants, 58.7% reported osteoporotic fractures, with 50.2% experiencing life impact, strongly linked to recent falls (93.2%, p < 0.001). Socioeconomic disparities were evident, with insured individuals (OR 2.18, 95% CI 1.95–2.40, p < 0.001) and homeowners (OR 2.65, 95% CI 2.40–2.90, p < 0.001) more likely to receive help after fractures. low policy awareness — defined as < 3 correct answers on a (0–6) Rural Health-Policy Knowledge Index — (OR 0.22, 95% CI 0.15–0.30, p < 0.001), and a high need for government support (90.1%) highlighted barriers to care. Medical interventions, including supplement use (OR 5.07, 95% CI 4.80–5.35, p < 0.001) and osteoporosis treatment (OR 4.51, 95% CI 4.32–4.73, p < 0.001), were significantly associated with increased odds of receiving help following osteoporotic fractures. Family support dynamics showed variability, with children helping after fracture reducing formal care access (OR 0.79, 95% CI 0.65–0.95, p = 0.013).Conclusion: Osteoporotic fractures impose a substantial burden on rural Chinese elderly, exacerbated by socioeconomic disparities and low policy awareness. Enhancing insurance coverage, health education, and access to medical interventions is critical to address care inequities and improve outcomes.