Lancet Healthy Longev. 2021 Sep;2(9):e580-e592. doi: 10.1016/S2666-7568(21)00172-0.
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.
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).
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.
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.
Bill & Melinda Gates Foundation.
骨折是一个全球性的公共卫生问题；然而，迄今为止，尚未对其发病率和负担进行全面研究。我们旨在衡量 1990 年至 2019 年骨折的全球、区域和国家发病率、患病率和伤残调整生命年（YLDs）。
我们使用 2019 年全球疾病、伤害和危险因素研究（GBD）框架，通过年龄、性别和年份，比较了 21 个 GBD 地区和 204 个国家和地区 1990 年至 2019 年骨折的全球发病率、患病率和 YLDs 的数量和年龄标准化率。我们报告了 95%置信区间（UI）的估计值。
在全球范围内，2019 年有 1.78 亿例（95% UI 1.62-1.96）新骨折（自 1990 年以来增加了 33.4% [30.1-37.0]），4.55 亿例（4.28-4.84）急性或长期骨折症状的现有病例（自 1990 年以来增加了 70.1% [67.5-72.5]），和 2580 万例（1780-3580）YLDs（自 1990 年以来增加了 65.3% [62.4-68.0]）。2019 年骨折的年龄标准化发病率为每 10 万人 2296.2 例（2091.1-2529.5）（自 1990 年以来下降了 9.6% [8.1-11.1]），5614.3 例（5286.1-5977.5）每 10 万人的现有病例（自 1990 年以来下降了 6.7% [5.7-7.6]），和每 10 万人 319.0 YLDs（220.1-442.5）（自 1990 年以来下降了 8.4% [7.2-9.5]）。2019 年，髌骨、胫骨或腓骨或踝关节的小腿骨折是最常见和负担最重的骨折，年龄标准化发病率为每 10 万人 419.9 例（345.8-512.0），年龄标准化 YLDs 率为每 10 万人 190.4 例（125.0-276.9）。2019 年，骨折发病率的年龄特异性率在年龄最大的年龄组中最高，例如，95 岁及以上人群每 10 万人中有 15381.5 例（11245.3-20651.9）新发病例。
1990 年至 2019 年，骨折的全球年龄标准化发病率、患病率和 YLDs 略有下降，但绝对数量大幅增加。老年人骨折的风险特别高，更广泛的伤害预防工作以及为老年人提供骨质疏松症筛查和治疗的机会，应该有助于减轻整体负担。
比尔和梅琳达盖茨基金会。
