Epidemiology and disease burden of fractures in Asia, 1990–2021: An analysis for the Global Burden of Disease Study 2021

Background: Fractures are a significant global public health concern, imposing a substantial economic burden, particularly among the elderly. However, research on the fracture burden in Asia remains limited, highlighting the need for comprehensive and up-to-date studies to support the effective planning and allocation of healthcare resources across the region. Methods: Using the Global Burden of Disease (GBD) 2021 database, we analyzed the age-standardized rates (ASRs) of incidence (ASIR), prevalence (ASPR), and years lived with disability (YLDs) (ASYR) associated with fracture burden across Asia. Our study explored trends over time, variations by age, sex, and country, and examined the correlation between fracture burden and the sociodemographic index (SDI). Results: In 2021, fractures in Asia caused 91.3 million (95 % uncertainty interval, 83.65-99.47) incident cases, 232.71 million (95 % UI, (215.57-250.39) prevalent cases, and 12.97 million (95 % UI, 8.89-17.82) YLDs, with age-standardized rates of 1968.49 (95 % UI, 1799.15-2147.14) for incidence (ASIR), 4683.96 (95 % UI, 4347.58-5036.61) for prevalence (ASPR), and 261.72 (95 % UI, 179.43-358.94) for YLDs (ASYR) per 100,000 population. Despite a higher absolute burden, Asian age-standardized rates of fracture were slightly lower than the global average. For ASYR, the most burdensome fractures were those of the patella, tibia/fibula/ankle, hip, and pelvis. Between 1990 and 2021, fracture incident cases, prevalent cases, and YLDs in Asia increased markedly. Age and sex differences were observed, with the elderly experiencing the highest fracture burden, particularly for hip fractures in women. While men had a higher overall fracture burden, women faced a greater fracture disease burden in the elderly population. Geographically, High-income Asia Pacific and Central Asia exhibited the highest age-standardized YLD rates, while South and East Asia had the largest number of fractures and YLDs. Conclusions: Our study provides an in-depth analysis of the fracture burden in Asia. From 1990 to 2021, the overall age-standardized fracture burden in Asia showed a gradual decline, yet the burden of hip fractures continued to increase. Asia holds the highest absolute number of fracture burden globally, with East Asia and South Asia being the primary regions contributing to this burden. The fracture burden increases with age in Asia, and women experience a higher fracture burden than men in older age groups. Strengthening surveillance and targeted prevention is essential to reduce the future fracture burden. The translational potential of this article: Fracture is a kind of health problem with high incidence and serious disease burden in Asia. Although overall burden of disease for fractures in Asia from 1990 to 2021 was decreasing, the burden of hip fracture disease in Asia has continued to rise from 1990 to 2021 in terms of incidence and prevalence. Males had a higher fracture burden than females in Asia, yet females had a higher fracture disease burden in the elderly population in 2021.