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
Wu A.-M. Bisignano C. James S.L. Abady G.G. Abedi A. Abu-Gharbieh E. Alhassan R.K. Alipour V. Arabloo J. Asaad M. Asmare W.N. Awedew A.F. Banach M. Banerjee S.K. Bijani A. Birhanu T.T.M. Bolla S.R. Cámera L.A. Chang J.-C. Cho D.Y. Chung M.Y. Couto R.A.S. Dai X. Dandona L. Dandona R. Farzadfar F. Filip I. Fischer F. Fomenkov A.A. Gill T.K. Gupta B. Haagsma J.A. Haj-Mirzaian A. Hamidi S. Hay S.I. Ilic I.M. Ilic M.D. Ivers R.Q. Jürisson M. Kalhor R. Kanchan T. Kavetskyy T. Khalilov R. Khan E.A. Khan M. Kneib C.J. Krishnamoorthy V. Kumar G.A. Kumar N. Lalloo R. Lasrado S. Lim S.S. Liu Z. Manafi A. Manafi N. Menezes R.G. Meretoja T.J. Miazgowski B. Miller T.R. Mohammad Y. Mohammadian-Hafshejani A. Mokdad A.H. Murray C.J.L. Naderi M. Naimzada M.D. Nayak V.C. Nguyen C.T. Nikbakhsh R. Olagunju A.T. Otstavnov N. Otstavnov S.S. Padubidri J.R. Pereira J. Pham H.Q. Pinheiro M. Polinder S. Pourchamani H. Rabiee N. Radfar A. Ur Rahman M.H. Rawaf D.L. Rawaf S. Saeb M.R. Samy A.M. Riera L.S. Schwebel D.C. Shahabi S. Shaikh M.A. Soheili A. Tabarés-Seisdedos R. Tovani-Palone M.R. Tran B.X. Travillian R.S. Valdez P.R. Vasankari T.J. Velazquez D.Z. Venketasubramanian N. Vu G.T. Zhang Z.-J. Vos T.
September 2021Elsevier Ltd
The Lancet Healthy Longevity
2021#2Issue 9e580 - e592 pp.
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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Department of Orthopaedics, Zhejiang Provincial Key Laboratory of Orthopaedics, The Second Affiliated Hospital and Yuying Childrens Hospital of Wenzhou Medical University, Wenzhou, China
Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, United States
Division of Plastic Surgery, University of Washington, Seattle, WA, United States
Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, United States
Department of Anesthesiology, University of Washington, Seattle, WA, United States
Personalized Healthcare, Genentech, San Francisco, CA, United States
Department of Nursing, Adigrat University, Adigrat, Ethiopia
Department of Orthopaedic Surgery, University of Southern California, Los Angeles, CA, United States
Department of Clinical Sciences, University of Sharjah, Sharjah, United Arab Emirates
Institute of Health Research, University of Health and Allied Sciences, Ho, Ghana
Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran
Department of Health Economics, Iran University of Medical Sciences, Tehran, Iran
Plastic Surgery Department, Iran University of Medical Sciences, Tehran, Iran
School of Medicine, Iran University of Medical Sciences, Tehran, Iran
Department of Plastic Surgery, University of Texas, Houston, TX, United States
Department of Nursing, Mizan-Tepi University, Mizan Teferi, Ethiopia
Department of Surgery, Addis Ababa University, Addis Ababa, Ethiopia
Department of Hypertension, Medical University of Lodz, Lodz, Poland
Polish Mothers Memorial Hospital Research Institute, Lodz, Poland
School of Health Sciences, Walden University, Minneapolis, MN, United States
Social Determinants of Health Research Center, Babol University of Medical Sciences, Babol, Iran
Planning, Monitoring and Evaluation Directorate, Amhara Public Health Institute, Bahir Dar, Ethiopia
Department of Biomedical Sciences, Nazarbayev University, Nur-Sultan City, Kazakhstan
Internal Medicine Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
Board of Directors, Argentine Society of Medicine, Buenos Aires, Argentina
Argentine Society of Medicine, Buenos Aires, Argentina
College of Medicine, National Taiwan University, Taipei, Taiwan
Department of Nursing, National Taiwan University Hospital, Taipei, Taiwan
Department of Otolaryngology, Wayne State University, Detroit, MI, United States
Department of Chemical Sciences, University of Porto, Porto, Portugal
Department of Chemistry, University of Porto, Porto, Portugal
Public Health Foundation of India, Gurugram, India
Indian Council of Medical Research, New Delhi, India
Non-communicable Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
Department of Pharmacology, Tehran University of Medical Sciences, Tehran, Iran
Psychiatry Department, Kaiser Permanente, Fontana, CA, United States
School of Health Sciences, A T Still University, Mesa, AZ, United States
Institute of Gerontological Health Services and Nursing Research, Ravensburg-Weingarten University of Applied Sciences, Weingarten, Germany
Department of Cell Biology and Biotechnology, K A Timiryazev Institute of Plant Physiology, Moscow, Russian Federation
Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
Department of Public Health, Torrens University, Melbourne, VIC, Australia
Department of Public Health, Erasmus University Medical Center, Rotterdam, Netherlands
Obesity Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
School of Health and Environmental Studies, Hamdan Bin Mohammed Smart University, Dubai, United Arab Emirates
Faculty of Medicine, University of Belgrade, Belgrade, Serbia
Department of Epidemiology, University of Kragujevac, Kragujevac, Serbia
School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, Australia
Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia
Institute for Prevention of Non-communicable Diseases, Qazvin University of Medical Sciences, Qazvin, Iran
Health Services Management Department, Qazvin University of Medical Sciences, Qazvin, Iran
Department of Forensic Medicine and Toxicology, All India Institute of Medical Sciences, Jodhpur, India
Department of Surface Engineering, The John Paul II Catholic University of Lublin, Lublin, Poland
Drohobych Ivan Franko State Pedagogical University, Drohobych, Ukraine
Department of Biophysics and Biochemistry, Baku State University, Baku, Azerbaijan
Russian Institute for Advanced Study, Moscow State Pedagogical University, Moscow, Russian Federation
Department of Epidemiology and Biostatistics, Health Services Academy, Islamabad, Pakistan
Epidemiology Department, Jazan University, Jazan, Saudi Arabia
Department of Anesthesiology, Duke University, Durham, NC, United States
Department of Orthopaedics, Medanta Hospital, Lucknow, India
School of Dentistry, The University of Queensland, Brisbane, QLD, Australia
Department of Otorhinolaryngology, Father Muller Medical College, Mangalore, India
School of Medicine, University of Manitoba, Winnipeg, MB, Canada
Forensic Medicine Division, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
Breast Surgery Unit, Helsinki University Hospital, Helsinki, Finland
University of Helsinki, Helsinki, Finland
Center for Innovation in Medical Education, Szczecin, Poland
Pomeranian Medical University, Szczecin, Poland
Pacific Institute for Research and Evaluation, Calverton, MD, United States
School of Public Health, Curtin University, Perth, WA, Australia
Internal Medicine Department, King Saud University, Riyadh, Saudi Arabia
Department of Epidemiology and Biostatistics, Shahrekord University of Medical Sciences, Shahrekord, Iran
Clinical Research Development Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
Clinical Research Development Centre, Kermanshah University of Medical Sciences, Kermanshah, Iran
Laboratory of Public Health Indicators Analysis and Health Digitalization, Moscow Institute of Physics and Technology, Dolgoprudny, Russian Federation
Experimental Surgery and Oncology Laboratory, Kursk State Medical University, Kursk, Russian Federation
Department of Forensic Medicine and Toxicology, Manipal Academy of Higher Education, Manipal, India
Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India
Institute for Global Health Innovations, Duy Tan University, Hanoi, Viet Nam
Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
Department of Psychiatry, University of Lagos, Lagos, Nigeria
Department of Project Management, National Research University Higher School of Economics, Moscow, Russian Federation
Department of Orthopedics, Yenepoya Medical College, Mangalore, India
Department of Chemistry, Sharif University of Technology, Tehran, Iran
College of Medicine, University of Central Florida, Orlando, FL, United States
Department of Community Medicine, Maharishi Markandeshwar Medical College and Hospital, Solan, India
WHO Collaborating Centre for Public Health Education and Training, Imperial College London, London, United Kingdom
Department of Primary Care and Public Health, Imperial College London, London, United Kingdom
University College London Hospitals, London, United Kingdom
Academic Public Health England, Public Health England, London, United Kingdom
CentraleSupélec, University of Lorraine, Metz, France
Department of Entomology, Ain Shams University, Cairo, Egypt
Rheumatology Department, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom
Institute of Bone and Joint Research, University of Sydney, Sydney, NSW, Australia
Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, United States
Health Policy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
Karachi, Pakistan
Nursing Care Research Center, Semnan University of Medical Sciences, Semnan, Iran
Department of Medicine, University of Valencia, Valencia, Spain
Carlos III Health Institute, Biomedical Research Networking Center for Mental Health Network (CiberSAM), Madrid, Spain
Department of Pathology and Legal Medicine, University of São Paulo, Ribeirão Preto, Brazil
Modestum, London, United Kingdom
Department of Health Economics, Hanoi Medical University, Hanoi, Viet Nam
Velez Sarsfield Hospital, Buenos Aires, Argentina
UKK Institute, Tampere, Finland
Faculty of Veterinary Medicine and Zootechnics, Autonomous University of Sinaloa, Culiacán Rosales, Mexico
Raffles Neuroscience Centre, Raffles Hospital, Singapore, Singapore
Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
Center of Excellence in Behavioral Medicine, Nguyen Tat Thanh University, Ho Chi Minh City, Viet Nam
School of Medicine, Wuhan University, Wuhan, China
Department of Orthopaedics
Institute for Health Metrics and Evaluation
Division of Plastic Surgery
Department of Health Metrics Sciences
Department of Anesthesiology
Personalized Healthcare
Department of Nursing
Department of Orthopaedic Surgery
Department of Clinical Sciences
Institute of Health Research
Health Management and Economics Research Center
Department of Health Economics
Plastic Surgery Department
School of Medicine
Department of Plastic Surgery
Department of Nursing
Department of Surgery
Department of Hypertension
Polish Mothers Memorial Hospital Research Institute
School of Health Sciences
Social Determinants of Health Research Center
Planning
Department of Biomedical Sciences
Internal Medicine Department
Board of Directors
Argentine Society of Medicine
College of Medicine
Department of Nursing
Department of Otolaryngology
Department of Chemical Sciences
Department of Chemistry
Public Health Foundation of India
Indian Council of Medical Research
Non-communicable Diseases Research Center
Department of Pharmacology
Psychiatry Department
School of Health Sciences
Institute of Gerontological Health Services and Nursing Research
Department of Cell Biology and Biotechnology
Adelaide Medical School
Department of Public Health
Department of Public Health
Obesity Research Center
School of Health and Environmental Studies
Faculty of Medicine
Department of Epidemiology
School of Public Health and Community Medicine
Institute of Family Medicine and Public Health
Institute for Prevention of Non-communicable Diseases
Health Services Management Department
Department of Forensic Medicine and Toxicology
Department of Surface Engineering
Drohobych Ivan Franko State Pedagogical University
Department of Biophysics and Biochemistry
Russian Institute for Advanced Study
Department of Epidemiology and Biostatistics
Epidemiology Department
Department of Anesthesiology
Department of Orthopaedics
School of Dentistry
Department of Otorhinolaryngology
School of Medicine
Forensic Medicine Division
Breast Surgery Unit
University of Helsinki
Center for Innovation in Medical Education
Pomeranian Medical University
Pacific Institute for Research and Evaluation
School of Public Health
Internal Medicine Department
Department of Epidemiology and Biostatistics
Clinical Research Development Center
Clinical Research Development Centre
Laboratory of Public Health Indicators Analysis and Health Digitalization
Experimental Surgery and Oncology Laboratory
Department of Forensic Medicine and Toxicology
Kasturba Medical College
Institute for Global Health Innovations
Department of Psychiatry and Behavioural Neurosciences
Department of Psychiatry
Department of Project Management
Department of Orthopedics
Department of Chemistry
College of Medicine
Department of Community Medicine
WHO Collaborating Centre for Public Health Education and Training
Department of Primary Care and Public Health
University College London Hospitals
Academic Public Health England
CentraleSupélec
Department of Entomology
Rheumatology Department
Institute of Bone and Joint Research
Department of Psychology
Health Policy Research Center
Karachi
Nursing Care Research Center
Department of Medicine
Carlos III Health Institute
Department of Pathology and Legal Medicine
Modestum
Department of Health Economics
Velez Sarsfield Hospital
UKK Institute
Faculty of Veterinary Medicine and Zootechnics
Raffles Neuroscience Centre
Yong Loo Lin School of Medicine
Center of Excellence in Behavioral Medicine
School of Medicine
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