The Global Burden of Osteoporosis, Low Bone Mass, and Its Related Fracture in 204 Countries and Territories, 1990-2019

Abstract

Background: Low bone mineral density (LBMD), including osteoporosis and low bone mass, has becoming a serious public health concern. We aimed to estimate the disease burden of LBMD and its related fractures in 204 countries and territories over the past 30 years.

Methods: We collected detailed information and performed a secondary analysis for LBMD and its related fractures from the Global Burden of Disease Study 2019. Numbers and age-standardized rates related to LBMD of disability-adjusted life-years (DALYs) and deaths in 204 countries and territories were compared by age, gender, socio-demographic index (SDI), and location.

Results: Global deaths and DALYs number attributable to LBMD increased from 207 367 and 8 588 936 in 1990 to 437 884 and 16 647 466 in 2019, with a raise of 111.16% and 93.82%, respectively. DALYs and deaths number of LBMD-related fractures increased 121.07% and 148.65% from 4 436 789 and 121248 in 1990 to 9 808 464 and 301 482 in 2019. In 2019, the five countries with the highest disease burden of DALYs number in LBMD-related fractures were India (2 510 288), China (1 839 375), United States of America (819 445), Japan (323 094), and Germany (297 944), accounting for 25.59%, 18.75%, 8.35%, 3.29%, and 3.04%. There was a quadratic correlation between socio-demographic index (SDI) and burden of LBMD-related fractures: DALYs rate was 179.985-420.435SDI+417.936SDI²(R^{2 =} 0.188, p<0.001); Deaths rate was 7.879-13.416SDI+8.839 SDI²(R^{2 =} 0.101, p<0.001).

Conclusions: The global burden of DALYs and deaths associated with LBMD and its related fractures has increased significantly since 1990. There were differences in disease burden between regions and countries. These estimations could be useful in priority setting, policy-making, and resource allocation in osteoporosis prevention and treatment.

Keywords: death; disability-adjusted life years (DALYs); fracture; global burden; low bone mineral density; osteoporosis.

Figure 1

Trend of LBMD and its related fractures at the global level from 1990 to 2019. (A) Trends in numbers and age-standardised rates of DALYs of LBMD at the global level,1990-2019; (B) Trends in numbers and age-standardised rates of deaths of LBMD at the global level, 1990-2019; (C) Composition of different causes at the risk of LBMD by DALYs at the global level, 1990-2019; (D) Trends in numbers and age-standardized rates of DALYs of fractures at LBMD risk at the global level, 1990-2019.DALYs, Disability-adjusted life years; LBMD, Low bone mineral Density; Error bars indicate the 95% uncertainty interval (UI) for numbers and rates.

Figure 2

Global burden of LBMD and its related fractures by age groups in 2019. (A) DALYs number of LBMD at the global level, 2019; (B) DALYs number of fractures at LBMD risk at the global level, 2019; (C) Deaths number of fractures at LBMD risk at the global level, 2019; (D) Age-specific numbers and rates of fractures prevalent cases by gender, 2019. DALYs, Disability-adjusted life years; LBMD, Low bone mineral density; Error bars indicate the 95% uncertainty interval (UI) for numbers.

Figure 3

Global map of health burden of LBMD related fractures in 2019. (A) DALYs number; (B) Death number. DALYs, Disability-adjusted life years; LBMD, Low bone mineral density.

Figure 4

The association between SDI and burden of LBMD related fractures. (A) Trends in DALYS number of fractures at LBMD by SDI quintiles in both sexes,1990-2019; (B) Trends in DALYS rate of fractures at LBMD by SDI quintiles in both sexes,1990-2019; (C) Association between DALYs rate and SDI in both sex in 2019; (D) Association between deaths rate and SDI in both sex in 2019; (E) Association between DALYs number and SDI in both sex in 2019; (F) Association between deaths number and SDI in both sex in 2019; SDI, Socio-demographic Index.