Global, regional, and national burden of bone fractures in 204 countries and territories, 1990–2019: a systematic analysis from the Global Burden of Disease Study 2019

Ai-Min Wu, Catherine Bisignano, Spencer L James, Gdiom Gebreheat Abady, Aidin Abedi, Eman Abu-Gharbieh, Robert Kaba Alhassan, Vahid Alipour, Jalal Arabloo, Malke Asaad, Wondwossen Niguse Asmare, Atalel Fentahun Awedew, Maciej Banach, Srikanta K Banerjee, Ali Bijani, Tesega Tesega Mengistu Birhanu, Srinivasa Rao Bolla, Luis Alberto Cámera, Jung-Chen Chang, Daniel Youngwhan ChoMichael T Chung, Rosa A S Couto, Xiaochen Dai, Lalit Dandona, Rakhi Dandona, Farshad Farzadfar, Irina Filip, Florian Fischer, Artem Alekseevich Fomenkov, Tiffany K Gill, Bhawna Gupta, Juanita A Haagsma, Arvin Haj-Mirzaian, Samer Hamidi, Simon I Hay, Irena M Ilic, Milena D Ilic, Rebecca Q Ivers, Mikk Jürisson, Rohollah Kalhor, Tanuj Kanchan, Taras Kavetskyy, Rovshan Khalilov, Ejaz Ahmad Khan, Maseer Khan, Cameron J Kneib, Vijay Krishnamoorthy, G Anil Kumar, Narinder Kumar, Ratilal Lalloo, Savita Lasrado, Stephen S Lim, Zichen Liu, Ali Manafi, Navid Manafi, Ritesh G Menezes, Tuomo J Meretoja, Bartosz Miazgowski, Ted R Miller, Yousef Mohammad, Abdollah Mohammadian-Hafshejani, Ali H Mokdad, Christopher J L Murray, Mehdi Naderi, Mukhammad David Naimzada, Vinod C Nayak, Cuong Tat Nguyen, Rajan Nikbakhsh, Andrew T Olagunju, Nikita Otstavnov, Stanislav S Otstavnov, Jagadish Rao Padubidri, Jeevan Pereira, Hai Quang Pham, Marina Pinheiro, Suzanne Polinder, Hadis Pourchamani, Navid Rabiee, Amir Radfar, Mohammad Hifz Ur Rahman, David Laith Rawaf, Salman Rawaf, Mohammad Reza Saeb, Abdallah M Samy, Lidia Sanchez Riera, David C Schwebel, Saeed Shahabi, Masood Ali Shaikh, Amin Soheili, Rafael Tabarés-Seisdedos, Marcos Roberto Tovani-Palone, Bach Xuan Tran, Ravensara S Travillian, Pascual R Valdez, Tommi Juhani Vasankari, Diana Zuleika Velazquez, Narayanaswamy Venketasubramanian, Giang Thu Vu, Zhi-Jiang Zhang, Theo Vos

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Abstract

Summary Background Bone fractures are a global public health issue; however, to date, no comprehensive study of their incidence and burden has been done. We aimed to measure the global, regional, and national incidence, prevalence, and years lived with disability (YLDs) of fractures from 1990 to 2019. Methods Using the framework of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, we compared numbers and age-standardised rates of global incidence, prevalence, and YLDs of fractures across the 21 GBD regions and 204 countries and territories, by age, sex, and year, from 1990 to 2019. We report estimates with 95% uncertainty intervals (UIs). Findings Globally, in 2019, there were 178 million (95% UI 162–196) new fractures (an increase of 33·4% [30·1–37·0] since 1990), 455 million (428–484) prevalent cases of acute or long-term symptoms of a fracture (an increase of 70·1% [67·5–72·5] since 1990), and 25·8 million (17·8–35·8) YLDs (an increase of 65·3% [62·4–68·0] since 1990). The age-standardised rates of fractures in 2019 were 2296·2 incident cases (2091·1–2529·5) per 100 000 population (a decrease of 9·6% [8·1–11·1] since 1990), 5614·3 prevalent cases (5286·1–5977·5) per 100 000 population (a decrease of 6·7% [5·7–7·6] since 1990), and 319·0 YLDs (220·1–442·5) per 100 000 population (a decrease of 8·4% [7·2–9·5] since 1990). Lower leg fractures of the patella, tibia or fibula, or ankle were the most common and burdensome fracture in 2019, with an age-standardised incidence rate of 419·9 cases (345·8–512·0) per 100 000 population and an age-standardised rate of YLDs of 190·4 (125·0–276·9) per 100 000 population. In 2019, age-specific rates of fracture incidence were highest in the oldest age groups, with, for instance, 15 381·5 incident cases (11 245·3–20 651·9) per 100 000 population in those aged 95 years and older. Interpretation The global age-standardised rates of incidence, prevalence, and YLDs for fractures decreased slightly from 1990 to 2019, but the absolute counts increased substantially. Older people have a particularly high risk of fractures, and more widespread injury-prevention efforts and access to screening and treatment of osteoporosis for older individuals should help to reduce the overall burden. Funding Bill & Melinda Gates Foundation.
Original languageEnglish
JournalThe Lancet Healthy Longevity
DOIs
Publication statusPublished - 2021

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