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<p>Low bone mineral density (LBMD) is a major driver of fractures and disability in women. We quantified the global LBMD burden in women from 1990 to 2021 and examined variation by age and Socio-demographic Index (SDI). Using GBD 2021 for 204 countries/territories, we estimated LBMD-attributable age-standardized mortality rate (ASMR) and age-standardized DALY rate (ASDR), assessed trends using Joinpoint regression and the estimated annual percentage change (EAPC), decomposed drivers (population growth, ageing, epidemiologic change), measured inequality (concentration index, slope index), and projected burden to 2040 with ARIMA; uncertainty intervals (UIs) refer to the 95% intervals provided by the GBD estimation process. We additionally used a frontier framework to benchmark burden against the best observed performance at comparable SDI levels and conducted out-of-sample validation for the projection models to improve interpretability for health planning. In 2021, crude DALYs were 900.32 (95% UI 742.64–1081.51) and crude mortality was 27.04 (95% UI 22.49–30.75) per 100,000 women. From 1990 to 2021, deaths rose ~ 100,000 to ~ 220,000 and DALYs ~ 45 to ~ 85&#xa0;million, largely due to population growth and ageing in low-/middle-SDI settings. Globally, ASMR was flat (AAPC = 0.26%, <i>P</i> = 0.071) but increased in high-SDI countries (AAPC = 0.51%, <i>P</i> = 0.001), where absolute levels remained low (&lt; 2 per 100,000). Low-SDI regions—particularly sub-Saharan Africa—had the highest rates (to 12.5 deaths and 280 DALYs per 100,000). Burden peaked at ages 80–94. Inequality was evident across the SDI gradient (e.g., CInd for crude DALYs rate: 0.18 in 1990 and 0.15 in 2021). Projections indicate broadly stable or modestly declining age-standardized rates, whereas the absolute burden is expected to continue rising through 2040, largely under the influence of population growth and ageing. The global age-standardized LBMD burden in women has plateaued, but stark SDI-related disparities persist. Scaling targeted screening, fracture prevention, and equitable access to effective therapies is essential to reduce inequalities and curb the growing absolute burden.</p>

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Ageing and Inequality Drive the Global Burden of Low Bone Mineral Density in Midlife and Older Women

  • 期刊论文

  • 发表日期：

    2026年3月24日

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  • Mixue Guo,
  • Meixuan Guo,
  • Mengyuan Cai,
  • Tao Sun,
  • Lichun Qiao,
  • Huqiang Dong

摘要

Low bone mineral density (LBMD) is a major driver of fractures and disability in women. We quantified the global LBMD burden in women from 1990 to 2021 and examined variation by age and Socio-demographic Index (SDI). Using GBD 2021 for 204 countries/territories, we estimated LBMD-attributable age-standardized mortality rate (ASMR) and age-standardized DALY rate (ASDR), assessed trends using Joinpoint regression and the estimated annual percentage change (EAPC), decomposed drivers (population growth, ageing, epidemiologic change), measured inequality (concentration index, slope index), and projected burden to 2040 with ARIMA; uncertainty intervals (UIs) refer to the 95% intervals provided by the GBD estimation process. We additionally used a frontier framework to benchmark burden against the best observed performance at comparable SDI levels and conducted out-of-sample validation for the projection models to improve interpretability for health planning. In 2021, crude DALYs were 900.32 (95% UI 742.64–1081.51) and crude mortality was 27.04 (95% UI 22.49–30.75) per 100,000 women. From 1990 to 2021, deaths rose ~ 100,000 to ~ 220,000 and DALYs ~ 45 to ~ 85 million, largely due to population growth and ageing in low-/middle-SDI settings. Globally, ASMR was flat (AAPC = 0.26%, P = 0.071) but increased in high-SDI countries (AAPC = 0.51%, P = 0.001), where absolute levels remained low (< 2 per 100,000). Low-SDI regions—particularly sub-Saharan Africa—had the highest rates (to 12.5 deaths and 280 DALYs per 100,000). Burden peaked at ages 80–94. Inequality was evident across the SDI gradient (e.g., CInd for crude DALYs rate: 0.18 in 1990 and 0.15 in 2021). Projections indicate broadly stable or modestly declining age-standardized rates, whereas the absolute burden is expected to continue rising through 2040, largely under the influence of population growth and ageing. The global age-standardized LBMD burden in women has plateaued, but stark SDI-related disparities persist. Scaling targeted screening, fracture prevention, and equitable access to effective therapies is essential to reduce inequalities and curb the growing absolute burden.