Age- and Site-Specific Ecological Concordance Between Bone Fractures and Alzheimer’s Disease and Other Dementias: A Global Burden Analysis with Hospital-Based Contextualization

Peidong Zhang, Deng Chen, Jialiu Luo, Shunyao Chen, Zhiqiang Lin, Shuaipeng Gu, Teding Chang, Zhaohui Tang, Cong ZhangDepartment of Trauma Surgery, Emergency Surgery & Surgical Critical, Tongji Trauma Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, People’s Republic of ChinaCorrespondence: Cong Zhang, Email tjzhangc@hust.edu.cnBackground: Bone fractures and Alzheimer’s disease and other dementias (ADD) are major ageing-related conditions, but their population-level co-burden and ecological concordance remain incompletely characterized.Methods: We analyzed Global Burden of Disease estimates from 1990 to 2023 to characterize global, age-specific, country-level, and site-specific patterns of bone fractures and ADD. Pearson and Spearman ecological correlations and lagged analyses were performed across age groups, countries, and Socio-demographic Index strata. Separately, a hospital-based descriptive analysis of patients with recorded ADD diagnoses from 2015 to 2025 was conducted to provide clinical context and was not designed to validate the ecological findings.Results: Fracture and ADD incidence showed stronger ecological concordance in older age groups. The strongest unadjusted lagged ecological association was observed at approximately 3 years (r=0.930 (95% CI, 0.927– 0.933; unadjusted P< 2.2× 10− 16)). Hip, sternum/rib, and pelvic fractures showed positive site-specific correlations with lagged ADD incidence (r=0.62,0.59, and 0.58, respectively; all P< 0.001). In the hospital-based cohort, 896 patients with recorded ADD diagnoses were included, of whom 342 (38.2%) had documented fracture records. Among these patients, fracture records preceded the first recorded ADD diagnosis in 195 cases (57.1%). Because no non-ADD comparison group was included, these findings were descriptive only.Conclusion: Fracture burden and ADD burden show age-dependent, site-specific, and lagged ecological concordance. In the hospital-based descriptive cohort, fracture records were frequently documented before the recorded dementia diagnosis date. These findings should be interpreted as hypothesis-generating and support future individual-level longitudinal studies to determine whether fragility fractures can serve as markers for subsequent cognitive decline.Keywords: Alzheimer’s disease, dementia, bone fractures, fragility fracture, Global Burden of Disease, ecological association