Global, Regional, and National Burden of Low Bone Mineral Density From 1990 to 2019: Results From the Global Burden of Disease Study 2019

Abstract

Objective: We aim to explore the global spatial prevalence and temporal trends of the burden of low bone mineral density (LBMD) worldwide, due to a lack of related studies.

Design: Cross-sectional study.

Methods: We used data from the Global Burden of Disease Study 2019 to conduct this study. LBMD in the GBD study includes both osteopenia and osteoporosis. The estimation for the prevalence, measured by the summary exposure value (SEV), and burden of LBMD was made in DisMod-MR 2.1, a Bayesian meta-regression tool. Correlation analysis was performed using the Spearman rank order correlation methods. The temporal trends were represented by the estimated annual percentage change (EAPC).

Results: In 2019, there were 438 thousand deaths and 16.6 million DALYs attributable to LBMD, increasing by 111.1% and 93.8% respectively, compared to that in 1990. From 1990 to 2019, the prevalence of LBMD has decreased worldwide, but has increased in high-income North America. Some countries, such as the United States, Australia, Canada, and China had increased disability and mortality rates of LBMD with time. Countries with low socio-demographic index (SDI) had higher incidence and mortality rate than those with high SDI. The prevalence of LBMD was lower in males, but the attributable disability and mortality were higher in males in all years from 1990 to 2019.

Conclusion: With population aging, countries worldwide, especially those with low-SDI, will face increasing challenges in reducing the burden attributable to LBMD and osteoporosis. The treatment of osteoporosis has been overlooked in men for a long time. Effective measures are warranted to control the prevalence and burden of LBMD.

Keywords: GBD 2019; burden; disability-adjusted life year; low bone mineral density; mortality; osteoporosis.

Figure 1

Global exposure to low bone mineral density. (A) Age standardized SEV of low bone mineral density, for both sexes in 204 countries and territories in 2019. (B) The EAPC in age standardized SEV of low bone mineral density, for both sexes from 1990 to 2019, in 204 countries and territories. SEV, summary exposure value; EAPC, estimated annual percentage change.

Figure 2

Global age standardized mortality rate to low bone mineral density. (A) The all-cause ASMR per 100,000 associated with low bone mineral density, for both sexes in 204 countries and territories in 2019. (B) The EAPC of ASMR of low bone mineral density, for both sexes from 1990 to 2019, in 204 countries and territories. ASMR, age standardized mortaility rate; EAPC, estimated annual percentage change.

Figure 3

Global age standardized DALY rate of low bone mineral density. (A) The all-cause ASDR per 100,000 associated with low bone mineral density, for both sexes in 204 countries and territories in 2019. (B) The EAPC of ASDR of low bone mineral density, for both sexes from 1990 to 2019, in 204 countries and territories. DALY, disease adjusted life year. ASDR, age standardized DALY rate; EAPC, estimated annual percentage change.

Figure 4

The exposure and burden of LBMD by SDI. (A, C, E) The age standardized SEV, ASMR and ASDR of LBMD in different SDI regions from 1990 to 2019. Results are showed for both sexes worldwide. (B, D, F) The correlation between SEV and SDI (B), ASMR and SDI (D), ASDR and SDI (F). Rho indicates the value of the Spearman rank order correlation tests. SEV, summary exposure value; ASMR, age standardized mortaility rate; DALY, disease adjusted life year. ASDR, age standardized DALY rate.

Figure 5

The exposure and burden of LBMD by age and sex. (A-C) The all-cause age standardized SEV, ASMR and ASDR of LBMD worldwide from 1990 to 2019. (D-F) The SEV (D), mortality rate (E), and disability rate (F) in different age groups. SEV, summary exposure value; ASMR, age standardized mortaility rate; DALY, disease adjusted life year. ASDR, age standardized DALY rate.