Global, regional, and national burden of fractures in the elderly, 1990–2021: a systematic analysis based on GBD 2021

BACKGROUND: With the intensification of global population aging, fractures in the elderly have become a significant public health concern. Although the incidence of fractures has declined in some regions, the overall global burden of fractures among the elderly continues to rise. METHODS: We described the number of incident cases, prevalent cases, years lived with disability (YLDs), and their age-standardized rates of fractures among the elderly from 1990 to 2021, and assessed long-term trends using the estimated annual percentage change (EAPC). The study also analyzed the age and regional distribution characteristics of fractures by anatomical site and evaluated sex differences in disease burden. RESULTS: From 1990 to 2021, the number of new fracture cases in the elderly worldwide increased by 134.5%, prevalent cases rose by 95.8%, and YLDs grew by 90.9%. Although the incidence rate slightly increased, both prevalence and YLD rates showed a downward trend. Hip fractures were the most common type of incident fracture among older adults, while fractures of the patella, tibia, fibula, and ankle had the most significant health impact. The major contributors to fracture burden in older adults are falls, road-related trauma, and exposure to mechanical forces. The incidence of fractures among older women was significantly higher than that of men, with pronounced sex differences. The burden of fractures in older adults showed a decreasing trend in high-income countries, whereas incidence rates continued to rise in low- and middle-income countries. As of 2021, Andorra had the highest age-standardized burden of fractures among older adults. Furthermore, from 1990 to 2021, Qatar and the United Arab Emirates exhibited the fastest growth in incident and prevalent fracture cases, as well as YLDs. CONCLUSION: Although some regions have implemented effective fracture prevention and treatment measures, the global burden of fractures among the elderly continues to rise, particularly in low- and middle-income countries.