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. 2021 Sep;2(9):e580-e592.
doi: 10.1016/S2666-7568(21)00172-0.

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

GBD 2019 Fracture Collaborators
Collaborators

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

GBD 2019 Fracture Collaborators. Lancet Healthy Longev. 2021 Sep.

Abstract

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.

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Conflict of interest statement

I Filip reports financial support from Avicenna Medical and Clinical Research Institute. R Q Ivers reports grants from National and Medical Research Council of Australia during the conduct of the study. S L James reports employment with Genentech/Roche beginning in 2020, and project funding from Sanofi Pasteur from 2019–2020, outside the submitted work. All other authors declare no competing interests.

Figures

Figure 1
Figure 1
Age-standardised incidence of fractures for females (A) and males (B), 2019
Figure 2
Figure 2
Age-standardised incidence (A), prevalence (B), and YLDs (C) of fractures for each anatomical site, by GBD region and sex, 2019 Regions in each panel are listed from lowest (top) to highest (bottom) age-standardised rate for both sexes combined. GBD=Global Burden of Diseases, Injuries, and Risk Factors Study. YLDs=years lived with disability.
Figure 3
Figure 3
Age-specific incidence rate of fractures for each anatomical site globally, by age group and sex, 2019
See this image and copyright information in PMC

Comment in

  • The global burden of fractures.
    Cauley JA. Cauley JA. Lancet Healthy Longev. 2021 Sep;2(9):e535-e536. doi: 10.1016/S2666-7568(21)00183-5. Epub 2021 Aug 20. Lancet Healthy Longev. 2021. PMID: 36098004 No abstract available.

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