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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 Publisher



Hsieh E ; Bryazka D ; Ong KL ; Rhinehart PA ; Cousin E ; Hagins H ; Cooper C ; Cross M ; Culbreth GT ; Dreinhoefer KE ; Halbout P ; Kopec JA ; Nicholson SI ; Prietoalhambra D Show All Authors
Authors
  1. Hsieh E
  2. Bryazka D
  3. Ong KL
  4. Rhinehart PA
  5. Cousin E
  6. Hagins H
  7. Cooper C
  8. Cross M
  9. Culbreth GT
  10. Dreinhoefer KE
  11. Halbout P
  12. Kopec JA
  13. Nicholson SI
  14. Prietoalhambra D
  15. Woolf AD
  16. Vos T
  17. Abate YH
  18. Abdelsalam S
  19. Abdoun M
  20. Abouzid M
  21. Abugharbieh E
  22. Aburuz S
  23. Adepoju AV
  24. Adnani QES
  25. Ahmad A
  26. Ahmed H
  27. Ahmed LA
  28. Al Hasan SM
  29. Alalwan TA
  30. Alamer RM
  31. Alemi H
  32. Ali A
  33. Alworafi YM
  34. Amani R
  35. Anil A
  36. Arabloo J
  37. Aravkin AY
  38. Areda D
  39. Aregawi BB
  40. Asghari Jafarabadi M
  41. Athari SS
  42. Azadnajafabad S
  43. Azzam AY
  44. Badiye AD
  45. Bagheri N
  46. Bagherieh S
  47. Balogun SA
  48. Banach M
  49. Barati S
  50. Bhardwaj P
  51. Bhaskar S
  52. Bhatti GK
  53. Bustanji Y
  54. Calina D
  55. Chattu VK
  56. Chekol Abebe E
  57. Chu DT
  58. Criqui MH
  59. Cruzmartins N
  60. Dadras O
  61. Dai X
  62. Dai Z
  63. Darvishi Cheshmeh Soltani R
  64. Dashti M
  65. Dejenie TA
  66. Del Bo C
  67. Denovagutierrez E
  68. Devanbu VGC
  69. Dewan SMR
  70. Dhulipala VR
  71. Ekholuenetale M
  72. Elmonem MA
  73. Etaee F
  74. Fagbamigbe AF
  75. Fakhradiyev IR
  76. Fatehizadeh A
  77. Feizkhah A
  78. Fekadu G
  79. Regassa BR
  80. Fischer F
  81. Gaipov A
  82. Galluzzo L
  83. Gebrehiwot M
  84. Ghadirian F
  85. Gill TK
  86. Gohari K
  87. Golchin A
  88. Gupta B
  89. Gupta S
  90. Hadi NR
  91. Hajmirzaian A
  92. Hanif A
  93. Harlianto NI
  94. Hasan I
  95. Hasnain MS
  96. Hassan A
  97. Hay SI
  98. He J
  99. Heidari G
  100. Hezam K
  101. Hiraike Y
  102. Hoogar P
  103. Hu C
  104. Ibitoye SE
  105. Iranmehr A
  106. Ismail NE
  107. Iwagami M
  108. Jafarikhounigh A
  109. Jakovljevic M
  110. Jamshidi E
  111. Jayapal SK
  112. Jayaram S
  113. Jemere DM
  114. Jeong GH
  115. Joseph N
  116. Joshua CE
  117. Jurisson M
  118. Kadashetti V
  119. Kalra S
  120. Khafaie MA
  121. Khajuria H
  122. Khan MAB
  123. Khanali J
  124. Khanmohammadi S
  125. Khatatbeh MM
  126. Khateri S
  127. Kim MS
  128. Korzh O
  129. Krishan K
  130. Kulimbet M
  131. Kulkarni V
  132. Kurniasari MD
  133. Lahariya C
  134. Laksono T
  135. Landires I
  136. Latief K
  137. Le TTT
  138. Lee M
  139. Lee WC
  140. Llanaj E
  141. Malhotra K
  142. Malik AA
  143. Martorell M
  144. Maugeri A
  145. Meles HN
  146. Merati M
  147. Meretoja TJ
  148. Mestrovic T
  149. Mirahmadi A
  150. Mohamed NS
  151. Mohammadianhafshejani A
  152. Mokdad AH
  153. Monasta L
  154. Moradi Y
  155. Morovatdar N
  156. Morrison SD
  157. Mostafavi E
  158. Mousavi P
  159. Mubarik S
  160. Murray CJL
  161. Muthu S
  162. Naghavi M
  163. Naghavi P
  164. Natto ZS
  165. Nayak BP
  166. Nematollahi MH
  167. Nguyen DH
  168. Nguyen HQ
  169. Nguyen VT
  170. Niazi RK
  171. Noman EA
  172. Nurrika D
  173. Okonji OC
  174. Ordak M
  175. Osman WMS
  176. Ostadi Y
  177. Padronmonedero A
  178. Pardhan S
  179. Parija PP
  180. Parikh RR
  181. Patel J
  182. Petermannrocha FE
  183. Pham HT
  184. Prates EJS
  185. Qattea I
  186. Rahimi M
  187. Rahimimovaghar V
  188. Rahman M
  189. Rahmati M
  190. Raimondo I
  191. Ramasamy SK
  192. Rashedi S
  193. Rashidi MM
  194. Rawaf S
  195. Redwan EM
  196. Rezaei N
  197. Saad AMA
  198. Saeed U
  199. Saghazadeh A
  200. Saheb Sharifaskari F
  201. Sahebkar A
  202. Saki M
  203. Sakshaug JW
  204. Saleh MA
  205. Samodra YL
  206. Samy AM
  207. Sanmarchi F
  208. Saqib MAN
  209. Schuermans A
  210. Sethi Y
  211. Seylani A
  212. Shahwan MJ
  213. Sham S
  214. Shannawaz M
  215. Sharfaei S
  216. Sharma M
  217. Shorofi SA
  218. Siddig EE
  219. Silva LMLR
  220. Singh JA
  221. Singh P
  222. Soleimani H
  223. Swain CK
  224. Tabatabai S
  225. Tamuzi JL
  226. Tavakoli Oliaee R
  227. Tavangar SM
  228. Teramoto M
  229. Terefa DR
  230. Ticoalu JHV
  231. Vaithinathan AG
  232. Vasankari TJ
  233. Vaziri S
  234. Wang F
  235. Wang S
  236. Xia J
  237. Yonemoto N
  238. Yu C
  239. Zahir M
  240. Zhao H
  241. Zielinska M
  242. Zitoun OA
  243. March LM
  244. Sanchezriera L

Source: The Lancet Rheumatology Published:2025


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/cm2). 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 in-hospital 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, 8·32 million (95% UI 5·58–10·84) YLDs, 17·2 million (14·1–20·2) 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 91·8% (88·5–95·1), 89·8% (81·5–99·0), and 127·1% (108·5–144·5), 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 76·2% (95% UI 74·2–78·3) of YLDs, 65·2% (62·9–67·6) of DALYs, and 71·0% (67·4–72·8) of deaths attributable to low bone mineral density, and road injuries largely accounted for the remaining amount: 12·4% (11·1–13·6) of YLDs, 24·6% (22·5–27·1) of DALYs, and 23·1% (21·6–26·2) of deaths. As a proportion of all fall-related burden, low bone mineral density accounted for 26·6% (23·2–28·7) of YLDs, 25·6% (22·1–27·4) of DALYs, and 40·6% (35·4–44·0) of deaths in 2020. Of all road injury-related burden, 12·6% (10·8–13·5) of YLDs, 6·3% (5·4–6·9) of DALYs, and 8·9% (7·6–9·6) 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 leading cause of DALYs attributable to low bone mineral density in those aged 40–44 years and the leading cause of deaths attributable to low bone mineral density in those aged 40–54 years. In older age groups among both men and women, falls were the leading cause of the burden attributable to low bone mineral density. Interpretation Low bone mineral density is a crucial modifiable risk factor for fractures, which are an important cause of morbidity and mortality particularly in ageing populations. This analysis highlights low bone mineral density as a cause of health loss not just from falls, but also from road injuries. Funding Gates Foundation. © 2025 Elsevier B.V., All rights reserved.