(2025) The global, regional, and national burden attributable to low bone mineral density, 1990-2020: an analysis of a modifiable risk factor from the Global Burden of Disease Study 2021. Lancet Rheumatology. E873-E894. ISSN 2665-9913
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Abstract
Background Fractures related to osteoporosis and low bone mineral density lead to substantial morbidity, mortality, and cost to individuals and health systems. Here we present the most up-to-date global, regional, and national estimates of the contribution of low bone mineral density to the burden of fractures from falls and additional categories of injuries from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021.Methods The burden of low bone mineral density was estimated from 1990 to 2020 in terms of years lived with disability (YLDs), disability-adjusted life years (DALYs), and deaths, for individuals aged 40 years and older, using data from population-based studies from 48 countries or territories (169 unique sources). Mean standardised femoral neck bone mineral density values were estimated by GBD location, age, and sex by meta-regression. Based on a separate meta-analysis of population-based studies from nine countries (12 unique sources), we also estimated the pooled relative risk of fractures per unit decrease in bone mineral density (g/cm(2)). The population-attributable fraction for low bone mineral density was calculated by comparing the observed distributions of standardised femoral neck bone mineral density to an age-specific and sex-specific counterfactual distribution, defined as the 99th percentile of five rounds of the National Health and Nutrition Examination Survey in the USA, by 5-year age group and sex. Hospital and emergency department data were used to derive the incidence of fractures for six categories of injury (road injuries, other transport injuries, falls, non-venomous animal contact, exposure to mechanical forces, and physical interpersonal violence) using ICD codes. Deaths due to fractures were estimated as the proportion of inhospital deaths due to the specified injury causes for which a fracture (nature of injury code) was more severe than the cause of injury code. YLDs and DALYs attributable to low bone mineral density by cause of injury were also determined according to previous GBD methods.Findings In 2020, 8 center dot 32 million (95 UI 5 center dot 58-10 center dot 84) YLDs, 17 center dot 2 million (14 center dot 1-20 center dot 2) DALYs, and 477 000 (411 000-536 000) deaths were attributable to low bone mineral density globally in individuals aged 40 years and older. Between 1990 and 2020, global YLDs, DALYs, and deaths attributable to low bone mineral density increased by 91 center dot 8 (88 center dot 5-95 center dot 1), 89 center dot 8 (81 center dot 5-99 center dot 0), and 127 center dot 1 (108 center dot 5-144 center dot 5), respectively. Over this period, the age-standardised global rates of YLDs, DALYs, and deaths attributable to low bone mineral density showed modest decreases. In 2020, falls accounted for 76 center dot 2 (95 UI 74 center dot 2-78 center dot 3) of YLDs, 65 center dot 2 (62 center dot 9-67 center dot 6) of DALYs, and 71 center dot 0 (67 center dot 4-72 center dot 8) of deaths attributable to low bone mineral density, and road injuries largely accounted for the remaining amount: 12 center dot 4 (11 center dot 1-13 center dot 6) of YLDs, 24 center dot 6 (22 center dot 5-27 center dot 1) of DALYs, and 23 center dot 1 (21 center dot 6-26 center dot 2) of deaths. As a proportion of all fall-related burden, low bone mineral density accounted for 26 center dot 6 (23 center dot 2-28 center dot 7) of YLDs, 25 center dot 6 (22 center dot 1-27 center dot 4) of DALYs, and 40 center dot 6 (35 center dot 4-44 center dot 0) of deaths in 2020. Of all road injury-related burden, 12 center dot 6 (10 center dot 8-13 center dot 5) of YLDs, 6 center dot 3 (5 center dot 4-6 center dot 9) of DALYs, and 8 center dot 9 (7 center dot 6-9 center dot 6) of deaths were attributable to low bone mineral density. In men, road injuries accounted for the largest proportion of DALYs attributable to low bone mineral density in those aged 40-59 years and the largest proportion of deaths in those aged 40-64 years. In women, road injuries were the leadin
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| Keywords: | osteoporotic fractures cost-effectiveness fragility fracture hip fracture men women prevention mortality injuries care ) Shahid Beheshti University Medical Sciences Shahid Beheshti University Medical Sciences Shahid Beheshti University Medical Sciences Shahid Beheshti University Medical Sciences Shahid Beheshti University Medical Sciences Shahid Beheshti University Medical Sciences Adelaide University University of Adelaide Tarbiat Modares University Urmia University of Medical Sciences Urmia University of Medical Sciences Torrens University Australia University of Kufa Harvard University Harvard University Medical Affiliates Massachusetts General Hospital Harvard University Harvard University Medical Affiliates Massachusetts General Hospital Sakarya University Utrecht University Utrecht University Medical Center Utrecht University Utrecht University Medical Center University of Dhaka Marwadi University Taiz University Taiz University Nankai University University of Tokyo Tsinghua University AIMST University University of Tsukuba University of London London School of Hygiene & Tropical Medicine Shaanxi University of Technology Johns Hopkins University Flinders University Flinders University Gyeongsang National University Manipal University College Malaysia Manipal Academy of Higher Education (MAHE) University of Tartu Krishna Vishwa Vidyapeeth Ahvaz Jundishapur University of Medical Sciences (AJUMS) Ahvaz Jundishapur University of Medical Sciences (AJUMS) Ahvaz Jundishapur University of Medical Sciences (AJUMS) Amity University Noida Amity University Noida Kurdistan University of Medical Sciences Kurdistan University of Medical Sciences Harvard University Massachusetts Institute of Technology (MIT) Broad Institute Kharkiv National Medical University Panjab University Asfendiyarov Kazakh National Medical University Queensland Health Universitas Kristen Satya Wacana Taipei Medical University Taipei Medical University National Cheng Kung University Ministerio de Salud de la Republica de Panama University of Indonesia Hochiminh City University of Medicine & Pharmacy Hochiminh City University of Medicine & Pharmacy Ajou University University of Texas System University of Texas Medical Branch Galveston Leibniz Association Deutsches Institut fur Ernahrungsforschung Potsdam-Rehbrucke (DIfE) German Center for Diabetes Research (DZD) Rama University University of Birmingham King Abdulaziz University King Abdulaziz University Universidad de Concepcion Universidad de Concepcion University of Catania University of Helsinki Helsinki University Central Hospital University of Helsinki University North - Croatia Shahrekord University Medical Sciences IRCCS Burlo Garofolo Mashhad University of Medical Sciences Mashhad University of Medical Sciences University of Washington University of Washington Seattle Stanford Medicine Stanford University Stanford University Stanford Medicine University of Groningen Wuhan University Karpagam Academy of Higher Education (KAHE) University of Illinois System University of Illinois Urbana-Champaign Harvard University Harvard University Harvard University Medical Affiliates Beth Israel Deaconess Medical Center Kerman University of Medical Sciences Hanoi Medical University University of Oxford International Islamic University, Pakistan University of the Western Cape Medical University of Warsaw Medical University of Warsaw Khalifa University of Science & Technology Anglia Ruskin University University of Minnesota System University of Minnesota Twin Cities University of Edinburgh University Diego Portales University of Glasgow Universidade Federal de Minas Gerais University System of Ohio Case Western Reserve University University of Rajshahi Aix-Marseille Universite University of Sassari Stanford University Stanford Medicine Harvard University Harvard Medical School Harvard University Medical Affiliates Brigham & Women's Hospital Imperial College London Public Health England King Abdulaziz University Egyptian Knowledge Bank (EKB) Zagazig University Saveetha Institute of Medical & Technical Rheumatology |
| Page Range: | E873-E894 |
| Journal or Publication Title: | Lancet Rheumatology |
| Journal Index: | ISI |
| Volume: | 7 |
| Number: | 12 |
| Identification Number: | https://doi.org/10.1016/s2665-9913(25)00105-5 |
| ISSN: | 2665-9913 |
| Depositing User: | خانم ناهید ضیائی |
| URI: | http://eprints.mui.ac.ir/id/eprint/32630 |
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