Attributable disease burden of low bone mineral density related fractures in people over 50 years old from 1990 to 2023 in China_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

LAI Zepeng ¹ , WU Yunxiao ¹ ^{共同第一作者} , JIANG Juxi ¹ , SHU Xiang ¹ ,  ZENG Ziqian ^1,2 ,  CHEN Weizhong ^1,2

1. School of Public Health, Chengdu Medical College, Chengdu Sichuan, 610500, P. R. China;
2. Key Laboratory of Intelligent Medical Care and Elderly Health Management, Chengdu Sichuan, 610500, P. R. China;

Corresponding author：

ZENG Ziqian, Email: zengziqian@cmc.edu.cn; CHEN Weizhong, Email: wejone@126.com

Keywords：

Fracture; low bone mineral density; fall; disease burden; the elderly; trend analysis

DOI：

10.7507/1002-1892.202507110

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Objective To estimate the population attributable disease burden (PAD) of low bone mineral density (LBMD) related fractures among Chinese people over 50 years old from 1990 to 2023, using data from the Global Burden of Disease Study 2023 (GBD 2023), and to provide evidence for prevention strategies and health resource allocation. Methods Based on the GBD 2023, the LBMD summary exposure values (SEV), fracture incidence, years lived with disability (YLDs), and LBMD-related falls YLDs of Chinese people over 50 years old from 1990 to 2023 were extracted. PAD was calculated with population attributable fraction (PAF), and an entropy-weight method was applied to evaluate the contribution of individual fracture sites. Temporal trends and sex differences were examined with Joinpoint regression. Results From 1990 to 2023, the age-standardized SEV of LBMD in people over 50 years old showed an overall decline [average annual percent change (AAPC)=−0.564%]. Age-standardized fracture incidence, fracture YLDs rate, and LBMD-related falls YLDs rate all exhibited W-shaped upward trends (AAPC=1.045%, 0.296%, and 0.724%, respectively). PAF-based estimates indicated that LBMD-attributable fracture incidence likewise increased in a “W-shaped” manner (AAPC=0.558%), whereas the corresponding YLDs rate showed an overall W-shaped decline (AAPC=−0.193%). In international comparison, China and the global average displayed broadly concordant directions of change, with greater volatility in China and a progressive narrowing of the gap after 2015. Regarding sex differences, fracture YLDs rates were consistently higher in the males, whereas the other burden indicators were higher in the females; the temporal patterns were similar in both sexes. Entropy weight method identified hip fractures as contributing most to incidence (weight 0.133), and pelvic fractures as the largest contributor to YLDs rate (weight 0.115). Conclusion Since 1990, the LBMD attributable fracture burden in China’s older population has risen, with female and hip or pelvic fractures bearing the heaviest load. Strengthened osteoporosis screening, improved insurance coverage, and targeted health education are urgently needed to curb further increases in disease burden.

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5.	Cauley JA. Public health impact of osteoporosis. J Gerontol A Biol Sci Med Sci, 2013, 68(10): 1243-1251.
6.	Liu Y, Huang X, Tang K, et al. Prevalence of osteoporosis and associated factors among Chinese adults: a systematic review and modelling study. J Glob Health, 2025, 15: 04009. doi: 10.7189/jogh.15.04009.
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10.	Larocque SC, Kerstetter JE, Cauley JA, et al. Dietary protein and vitamin D intake and risk of falls: A secondary analysis of postmenopausal women from the study of osteoporotic fractures. J Nutr Gerontol Geriatr, 2015, 34(3): 305-318.
11.	刘刚, 杨明辉, 张京, 等. 北京地区老年髋部骨折的流行病学分布特点: 多中心2 071例患者分析. 中华创伤骨科杂志, 2022, 24(9): 759-765.
12.	Shen Y, Huang X, Wu J, et al. The global burden of osteoporosis, low bone mass, and its related fracture in 204 countries and territories, 1990-2019. Front Endocrinol (Lausanne), 2022, 13: 882241. doi: 10.3389/fendo.2022.882241.
13.	World Health Organization. Comparative quantification of health risks: global and regional burden of disease attributable to selected major risk factors [EB/OL]. (2004-10-18) [2025-07-27]. https://www.who.int/publications/i/item/9241580313.
14.	Martinez R, Muñoz-Venturelli P, Ordunez P, et al. Risk and impact of stroke across 38 countries and territories of the Americas from 1990 to 2021: a population-based trends analysis from the Global Burden of Disease Study 2021. Lancet Reg Health Am, 2025, 43: 101017. doi: 10.1016/j.lana.2025.101017.
15.	GBD 2019 Risk Factors Collaborators. Global burden of 87 risk factors in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet, 2020, 396(10258): 1223-1249.
16.	GBD 2021 Low Bone Mineral Density Collaborators. 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. Supplementary Appendix 1 (mmc1) [EB/OL]. (2025-09-16) [2025-09-20]. https://doi.org/10.1016/S2665-9913(25)00105-5.
17.	Johnell O, Kanis JA, Oden A, et al. Predictive value of BMD for hip and other fractures. J Bone Miner Res, 2005, 20(7): 1185-1194.
18.	Panahi N, Saeedi Moghaddam S, Fahimfar N, et al. Trend in global burden attributable to low bone mineral density in different WHO regions: 2000 and beyond, results from the Global Burden of Disease (GBD) study 2019. Endocr Connect, 2023, 12(10): e230160. doi: 10.1530/EC-23-0160.
19.	Tian C, Shi L, Wang J, et al. Global, regional, and national burdens of hip fractures in elderly individuals from 1990 to 2021 and predictions up to 2050: A systematic analysis of the Global Burden of Disease Study 2021. Arch Gerontol Geriatr, 2025, 133: 105832. doi: 10.1016/j.archger.2025.105832.
20.	Zeng Q, Li N, Wang Q, et al. The prevalence of osteoporosis in China, a nationwide, multicenter DXA survey. J Bone Miner Res, 2019, 34(10): 1789-1797.
21.	尹英超, 董琪, 贾会扬, 等. 《骨质疏松性骨折诊疗指南(2022)》解读. 河北医科大学学报, 2024, 45(8): 869-872.
22.	Fu Y, Ba L, Lü N, et al. Burden of falls attributable to low bone mineral density among people aged 60 years and over in China from 1990 to 2019. Front Public Health, 2023, 11: 1204497. doi: 10.3389/fpubh.2023.1204497.
23.	何海洋, 杨嘉玲, 雷迅. 绝经后女性骨质疏松症患病率及影响因素的Meta分析. 中国全科医学, 2024, 27(11): 1370-1379.

1. 国家统计局. 第七次全国人口普查公报(第三号)—地区人口情况[EB/OL]. (2021-05-11) [2025-07-27]. https://www.stats.gov.cn/sj/tjgb/rkpcgb/qgrkpcgb/202302/t20230206_1902003.html.
2. No authors listed]. Consensus development conference: diagnosis, prophylaxis, and treatment of osteoporosis. Am J Med, 1993, 94(6): 646-650.
3. Van Oostwaard M. Osteoporosis and the nature of fragility fracture: An overview//Hertz K, Santy-Tomlinson J. Fragility fracture nursing. Cham: Springer International Publishing, 2018: 1-13.
4. Tang N, Gao L, Song J, et al. Risk analysis for subsequent fracture of osteoporotic fractures in Chinese women over age 60: a nationwide cross-sectional study. Scientific Reports, 2024, 14: 13319. doi: 10.1038/s41598-024-64170-w.
5. Cauley JA. Public health impact of osteoporosis. J Gerontol A Biol Sci Med Sci, 2013, 68(10): 1243-1251.
6. Liu Y, Huang X, Tang K, et al. Prevalence of osteoporosis and associated factors among Chinese adults: a systematic review and modelling study. J Glob Health, 2025, 15: 04009. doi: 10.7189/jogh.15.04009.
7. Global Burden of Disease Collaborative Network. GBD Results [EB/OL]. Institute for Health Metrics and Evaluation (IHME). (2025-10-12) [2025-10-22]. https://vizhub.healthdata.org/gbd-results.
8. GBD 2023 Disease and Injury and Risk Factor Collaborators. Burden of 375 diseases and injuries, risk-attributable burden of 88 risk factors, and healthy life expectancy in 204 countries and territories, including 660 subnational locations, 1990-2023: a systematic analysis for the Global Burden of Disease Study 2023. Lancet, 2025, 406(10513): 1873-1922.
9. GBD 2021 Risk Factors Collaborators. Global burden and strength of evidence for 88 risk factors in 204 countries and 811 subnational locations, 1990-2021: a systematic analysis for the Global Burden of Disease Study 2021. Lancet, 2024, 403(10440): 2162-2203.
10. Larocque SC, Kerstetter JE, Cauley JA, et al. Dietary protein and vitamin D intake and risk of falls: A secondary analysis of postmenopausal women from the study of osteoporotic fractures. J Nutr Gerontol Geriatr, 2015, 34(3): 305-318.
11. 刘刚, 杨明辉, 张京, 等. 北京地区老年髋部骨折的流行病学分布特点: 多中心2 071例患者分析. 中华创伤骨科杂志, 2022, 24(9): 759-765.
12. Shen Y, Huang X, Wu J, et al. The global burden of osteoporosis, low bone mass, and its related fracture in 204 countries and territories, 1990-2019. Front Endocrinol (Lausanne), 2022, 13: 882241. doi: 10.3389/fendo.2022.882241.
13. World Health Organization. Comparative quantification of health risks: global and regional burden of disease attributable to selected major risk factors [EB/OL]. (2004-10-18) [2025-07-27]. https://www.who.int/publications/i/item/9241580313.
14. Martinez R, Muñoz-Venturelli P, Ordunez P, et al. Risk and impact of stroke across 38 countries and territories of the Americas from 1990 to 2021: a population-based trends analysis from the Global Burden of Disease Study 2021. Lancet Reg Health Am, 2025, 43: 101017. doi: 10.1016/j.lana.2025.101017.
15. GBD 2019 Risk Factors Collaborators. Global burden of 87 risk factors in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet, 2020, 396(10258): 1223-1249.
16. GBD 2021 Low Bone Mineral Density Collaborators. 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. Supplementary Appendix 1 (mmc1) [EB/OL]. (2025-09-16) [2025-09-20]. https://doi.org/10.1016/S2665-9913(25)00105-5.
17. Johnell O, Kanis JA, Oden A, et al. Predictive value of BMD for hip and other fractures. J Bone Miner Res, 2005, 20(7): 1185-1194.
18. Panahi N, Saeedi Moghaddam S, Fahimfar N, et al. Trend in global burden attributable to low bone mineral density in different WHO regions: 2000 and beyond, results from the Global Burden of Disease (GBD) study 2019. Endocr Connect, 2023, 12(10): e230160. doi: 10.1530/EC-23-0160.
19. Tian C, Shi L, Wang J, et al. Global, regional, and national burdens of hip fractures in elderly individuals from 1990 to 2021 and predictions up to 2050: A systematic analysis of the Global Burden of Disease Study 2021. Arch Gerontol Geriatr, 2025, 133: 105832. doi: 10.1016/j.archger.2025.105832.
20. Zeng Q, Li N, Wang Q, et al. The prevalence of osteoporosis in China, a nationwide, multicenter DXA survey. J Bone Miner Res, 2019, 34(10): 1789-1797.
21. 尹英超, 董琪, 贾会扬, 等. 《骨质疏松性骨折诊疗指南(2022)》解读. 河北医科大学学报, 2024, 45(8): 869-872.
22. Fu Y, Ba L, Lü N, et al. Burden of falls attributable to low bone mineral density among people aged 60 years and over in China from 1990 to 2019. Front Public Health, 2023, 11: 1204497. doi: 10.3389/fpubh.2023.1204497.
23. 何海洋, 杨嘉玲, 雷迅. 绝经后女性骨质疏松症患病率及影响因素的Meta分析. 中国全科医学, 2024, 27(11): 1370-1379.

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