Global and regional estimates of hip fracture burden associated with type 1 diabetes from 1990 to 2021

Abstract Aim To assess the global and regional burden of hip fractures associated with type 1 diabetes (T1D) from 1990 to 2021. Materials and Methods The population attributable fraction was calculated by combining the published risk ratio with T1D prevalence (age ≥ 20 years) from the Global Burden of Disease study to estimate the T1D‐associated hip‐fracture burden. Trends were assessed using the age‐standardized incidence rate (ASIR) and estimated annual percentage change (EAPC). Results The global incidence of T1D‐related hip fractures was 290 180 in 2021 with an ASIR of 3.96 (95% confidence interval: 1.92‐5.87) per 100 000 population and a male‐to‐female ratio of 0.54. At the super‐regional level, the highest incidence (204 610) and ASIR (13.09 per 100 000 population; 6.40‐25.53) were observed in high‐income regions, in particular in Australasia and Western Europe. Notably, Australasia exhibited the highest EAPC, 2.90% in T1D‐associated ASIR, followed by East Asia (2.73%). The incidence among those aged 45‐64 years grew significantly in 14 regions over the past decade. Nationally, the ASIR increased in 166 countries from 1990 to 2021. Conclusions High‐income regions experienced the greatest burden of T1D‐associated hip fracture, while Australasia and East Asia witnessed the largest increase over the last 32 years. Prioritizing the promotion of T1D treatment and hip‐fracture screening for middle‐aged females living with T1D is crucial in these regions.