Association between handgrip strength weakness and asymmetry with incident hip fracture among older Chinese adults

•Handgrip strength asymmetry is frequently overlooked in the HGS assessment.•The association between HGS asymmetry and hip fracture remains unclear.•Men with both HGS weakness and asymmetry had a higher risk of hip fracture.•Combined examination of HGS weakness and asymmetry aids hip fracture prevention. To evaluate the association between handgrip strength (HGS) weakness and asymmetry with incident hip fracture among older Chinese adults. Data was obtained from the 2011 and 2015 waves of the China Health and Retirement Longitudinal Study (CHARLS). HGS weakness was defined as maximal HGS 〈 28 kg in men and < 18 kg in women. HGS asymmetry was defined as the HGS ratio < 0.9 or 〉 1.1. Participants were categorized into normal HGS, weakness only, asymmetry only, and both weakness and asymmetry. Given the sex differences in HGS, the association between HGS weakness and asymmetry was analyzed by sex using the multivariable logistic regression models. A total of 4789 participants aged ≥ 60 years old without hip fracture at baseline were included in the final analysis. Over the four-year follow-up, there were 152 (3.17 %) participants having incident hip fractures, of which 69 (2.90 %) were men and 83 (3.45 %) were women. Compared to the normal group, men with both weakness and asymmetry had a significantly higher risk of incident hip fracture in the fully adjusted model (adjusted odds ratio (OR): 2.31, 95 % confidence interval (CI):1.17–4.52). There was no significant association between HGS asymmetry and weakness with hip fracture in women. Our findings indicated that among the Chinese population, men with both HGS weakness and asymmetry were associated with increased odds of hip fracture, while no significant association was observed in women.