The global burden of fractures and its underlying etiologies: results from and further analysis of the Global Burden of Disease Study 2021

Abstract

Summary

Fractures can result in decreased quality of life and care requirements, all of which significantly affect patients and their families. Our results revealed that the global incident, prevalent, and YLDs cases of fractures have risen in both sexes. Policies that prioritize avoiding fractures at different anatomical sites should be developed.

Background

Fractures are a major contributor of disease burden and are predicted to rise significantly in the years to come. The purpose of this study was to estimate the global burden of fractures and analyze the changes of etiologies of fractures between 1990 and 2021.

Methods

Based on the information collected from the Global Burden of Disease (GBD) 2021, this study analyzed both the number and age-standardized rate of incidence, prevalence, and years lived with disability (YLD) of fractures between 1990 and 2021 by sex, age group, anatomical site, GBD region, SDI region, and country. We used estimated annual percentage changes (EAPC) to calculate the trends of the age-standardized rate over the past 30 years.

Results

In 2021, the number of new cases of fractures was 172.79 million (95%UI 158.38–187.65), with 77.66 million (95%UI 70.53–85.15) cases in females and 95.12 million (95%UI 87.69–102.67) cases in males. The prevalent cases were 453.31 million (95%UI 421.17–486.12) globally. In addition, fractures caused 25.18 million (95%UI 17.28–34.62) YLDs among all ages in 2021, displaying an increasing trend with an EAPC of 1.1. However, there was a general decline in the age-standardized incidence rate (ASIR), age-standardized prevalence rate (ASPR), and age-standardized years lived with disability rate (ASYR) of fractures from 1990 to 2021. The ASIR, ASPR, and ASYR of fracture in 2021 were 2172.52 cases (95%UI 1995.20–2364.46) per 100,000 population, 5397.67 cases 95%UI (5022.63, 5787.16) per 100,000 population, and 300.19 cases (95%UI 205.86–412.53) per 100,000 population. Compared with other countries and territories, New Zealand (6197.81 cases (5391.24–7068.78) per 100,000 population) had the highest ASIR of fractures in 2021, followed by the Republic of Slovenia (5996.53 cases (5367.82–6640.29) per 100,000 population) and Australia 5420.39 cases (4684.64–6301.56) per 100,000 population). Even while we observed that males had more incident, prevalent, and YLDs cases of fractures than females; and higher ASIR, ASPR, and ASYR, it may not apply to fractures at different anatomical sites, such as fracture of hip and fracture of radius and/or ulna. Furthermore, our study revealed that ASIR, ASPR, and ASYR for females were higher than males after the ages of 55–59, 85–89, and 70–74, although the ASPR and ASYR rose with age for both females and males. Falls were the leading ASYR level 3 cause of fractures worldwide, but with a downward trend; road injuries and exposure to mechanical forces were the second and third main causes of fractures.

Conclusions

Given the rising tendency of incidence, prevalence, and YLDs cases over the past 30 years, bone fractures continue to be a major global burden. In addition, despite the downward trend in ASIR, ASPR, and ASYR of fractures in the high SDI region, it consistently ranked first among the five SDI regions. Increased awareness should be paid to women after the ages of 55 to 59 to lower the incidence rate of fractures. Anti-osteoporotic medication, improving lifestyle habits and multiple-component fall prevention strategies should be considered while making policy.