Ding Qianqian, Zhou Bei, Leung Jason, Kwok Timothy, Su Yi
Department of Epidemiology and Biostatistics, School of Public Health, Hunan Normal University, 371 Tongzipo Road, Changsha, 410013, China.
Key Laboratory of Molecular Epidemiology of Hunan Province, Hunan Normal University, 371 Tongzipo Road, Changsha, 410013, China.
Osteoporos Int. 2025 Jun 17. doi: 10.1007/s00198-025-07570-6.
This study examined the global burden of fractures, low bone mineral density (BMD), and high body mass index (BMI) across various age groups, periods, and cohorts, revealing significant health inequalities and the need for targeted interventions.
To analyze globally long-term trends in fractures, low BMD, and high BMI, and to examine effects of age, cohort, period, and health inequalities.
The estimated annual percentage change (EAPC) in age-standardized rates (ASR) of prevalence, Disability-Adjusted Life Years (DALYs) or Years Lived with Disability (YLDs) were utilized to estimate the trends, and health inequality indices were applied to assess the socioeconomic disparities, in 204 countries or territories from 1990 to 2021. The age-period-cohort model was used to assess the independent effects of age, period, and cohort.
From 1990 to 2021, fracture prevalence and the DALYs attributable to low BMD generally declined (EAPC for fracture prevalence: -0.53%; EAPC for DALYs attributable to low BMD: -0.90%), while the DALYs attributable to high BMI increased (EAPC: 0.66%). The disease burden attributable to fractures, low BMD, and high BMI generally increased with age. Globally, there was a pattern of rising and then declining risk of fractures and low BMD in successively younger birth cohorts, alongside an increasing risk of high BMI. Significant Socio-demographic Index (SDI)-related inequalities in burdens of fractures, low BMD, and high BMI were observed, with inequalities quantified by the slope index of inequality (SII) in 2021 showing values of 267, -53, and -119, respectively.
Global trends in burden of fractures, low BMD, and high BMI varied across different age groups, periods, cohorts, and varied SDI regions.
本研究调查了不同年龄组、时期和队列中骨折、低骨矿物质密度（BMD）和高体重指数（BMI）的全球负担，揭示了显著的健康不平等现象以及进行有针对性干预的必要性。
分析全球范围内骨折、低BMD和高BMI的长期趋势，并研究年龄、队列、时期和健康不平等的影响。
利用年龄标准化患病率、伤残调整生命年（DALY）或残疾生活年数（YLD）率的估计年度百分比变化（EAPC）来估计趋势，并应用健康不平等指数评估1990年至2021年期间204个国家或地区的社会经济差异。采用年龄-时期-队列模型评估年龄、时期和队列的独立影响。
1990年至2021年，骨折患病率以及低BMD所致的DALY总体呈下降趋势（骨折患病率的EAPC为-0.53%；低BMD所致DALY的EAPC为-0.90%），而高BMI所致的DALY则有所增加（EAPC为0.66%）。骨折、低BMD和高BMI所致的疾病负担通常随年龄增长而增加。在全球范围内，相继出生的较年轻队列中骨折和低BMD的风险呈现先上升后下降的模式，同时高BMI的风险不断增加。观察到骨折、低BMD和高BMI负担存在与社会人口指数（SDI）相关的显著不平等，2021年通过不平等斜率指数（SII）量化的不平等程度分别为267、-53和-119。
骨折、低BMD和高BMI负担的全球趋势在不同年龄组、时期、队列以及不同SDI地区存在差异。
