{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,10]],"date-time":"2026-11-10T07:00:06Z","timestamp":1794294006748,"version":"4.9.0"},"reference-count":53,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2022,5,20]],"date-time":"2022-05-20T00:00:00Z","timestamp":1653004800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Endocrinol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Low bone mineral density (LBMD), including osteoporosis and low bone mass, has becoming a serious public health concern. We aimed to estimate the disease burden of LBMD and its related fractures in 204 countries and territories over the past 30 years.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We collected detailed information and performed a secondary analysis for LBMD and its related fractures from the Global Burden of Disease Study 2019. Numbers and age-standardized rates related to LBMD of disability-adjusted life-years (DALYs) and deaths in 204 countries and territories were compared by age, gender, socio-demographic index (SDI), and location.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Global deaths and DALYs number attributable to LBMD increased from 207 367 and 8 588 936 in 1990 to 437 884 and 16 647 466 in 2019, with a raise of 111.16% and 93.82%, respectively. DALYs and deaths number of LBMD-related fractures increased 121.07% and 148.65% from 4 436 789 and 121248 in 1990 to 9 808 464 and 301 482 in 2019. In 2019, the five countries with the highest disease burden of DALYs number in LBMD-related fractures were India (2 510 288), China (1 839 375), United States of America (819 445), Japan (323 094), and Germany (297 944), accounting for 25.59%, 18.75%, 8.35%, 3.29%, and 3.04%. There was a quadratic correlation between socio-demographic index (SDI) and burden of LBMD-related fractures: DALYs rate was 179.985-420.435SDI+417.936SDI\n                      <jats:sup>2<\/jats:sup>\n                      (R\n                      <jats:sup>2 =<\/jats:sup>\n                      0.188, p&amp;lt;0.001); Deaths rate was 7.879-13.416SDI+8.839 SDI\n                      <jats:sup>2<\/jats:sup>\n                      (R\n                      <jats:sup>2 =<\/jats:sup>\n                      0.101, p&amp;lt;0.001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The global burden of DALYs and deaths associated with LBMD and its related fractures has increased significantly since 1990. There were differences in disease burden between regions and countries. These estimations could be useful in priority setting, policy-making, and resource allocation in osteoporosis prevention and treatment.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fendo.2022.882241","type":"journal-article","created":{"date-parts":[[2022,5,20]],"date-time":"2022-05-20T08:55:12Z","timestamp":1653036912000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":458,"title":["The Global Burden of Osteoporosis, Low Bone Mass, and Its Related Fracture in 204 Countries and Territories, 1990-2019"],"prefix":"10.3389","volume":"13","author":[{"given":"Yuyan","family":"Shen","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xin","family":"Huang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Junyun","family":"Wu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiling","family":"Lin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiao","family":"Zhou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhiang","family":"Zhu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaowen","family":"Pan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jingya","family":"Xu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jie","family":"Qiao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tianyue","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Linxia","family":"Ye","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hongwei","family":"Jiang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuezhong","family":"Ren","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peng-Fei","family":"Shan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2022,5,20]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"S3","DOI":"10.1016\/j.ajog.2005.08.047","article-title":"Epidemiology, Etiology, and Diagnosis of Osteoporosis","volume":"194","author":"Lane","year":"2006","journal-title":"Am J Obstet Gynecol"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMcp1513724","article-title":"Clinical Practice. Postmenopausal Osteoporosis","volume":"374","author":"Black","year":"2016","journal-title":"New Engl J Med"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1016\/s0140-6736(02)08657-9","article-title":"Epidemiology and Outcomes of Osteoporotic Fractures","volume":"359","author":"Cummings","year":"2002","journal-title":"Lancet (Lond Engl)"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1007\/pl00004148","article-title":"World-Wide Projections for Hip Fracture","volume":"7","author":"Gullberg","year":"1997","journal-title":"Osteoporosis Int"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.162.1.33","article-title":"Fractures Between the Ages of 20 and 50 Years Increase Women's Risk of Subsequent Fractures","volume":"162","author":"Wu","year":"2002","journal-title":"Arch Internal Med"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1359\/jbmr.2000.15.4.721","article-title":"Patients With Prior Fractures Have an Increased Risk of Future Fractures: A Summary of the Literature and Statistical Synthesis","volume":"15","author":"Klotzbuecher","year":"2000","journal-title":"J Bone mineral"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1007\/s001980070064","article-title":"Long-Term Risk of Osteoporotic Fracture in Malm\u00f6","volume":"11","author":"Kanis","year":"2000","journal-title":"Osteoporosis Int"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.1359\/jbmr.061113","article-title":"Incidence and Economic Burden of Osteoporosis-Related Fractures in the United States, 2005-2025","volume":"22","author":"Burge","year":"2007","journal-title":"J Bone mineral Res"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.1007\/s11657-013-0136-1","article-title":"Osteoporosis in the European Union: Medical Management, Epidemiology and Economic Burden. A Report Prepared in Collaboration With the International Osteoporosis Foundation (IOF) and the European Federation of Pharmaceutical Industry Associations (EFPIA)","volume":"8","author":"Hernlund","year":"2013","journal-title":"Arch osteoporosis"},{"key":"B10","doi-asserted-by":"publisher","first-page":"34","DOI":"10.7748\/nop.2019.e1153","article-title":"Osteoporosis and Fragility Fractures: Risk Assessment, Management and Prevention","volume":"32","author":"Walker","year":"2020","journal-title":"Nurs older People"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.1038\/nrendo.2014.51","article-title":"Geographic and Ethnic Disparities in Osteoporotic Fractures","volume":"10","author":"Cauley","year":"2014","journal-title":"Nat Rev Endocrinol"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.1016\/s0140-6736(10)62349-5","article-title":"Osteoporosis: Now and the Future","volume":"377","author":"Rachner","year":"2011","journal-title":"Lancet (London England)"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.312.7041.1254","article-title":"Meta-Analysis of How Well Measures of Bone Mineral Density Predict Occurrence of Osteoporotic Fractures","volume":"312","author":"Marshall","year":"1996","journal-title":"BMJ (Clin Res ed)"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.1007\/s00198-003-1510-4","article-title":"Impact of Postural Deformities and Spinal Mobility on Quality of Life in Postmenopausal Osteoporosis","volume":"14","author":"Miyakoshi","year":"2003","journal-title":"Osteoporosis Int"},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2474-3-11","article-title":"The Impact of Incident Vertebral and non-Vertebral Fractures on Health Related Quality of Life in Postmenopausal Women","volume":"3","author":"Adachi","year":"2002","journal-title":"BMC musculoskeletal Disord"},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.1017\/cem.2019.490","article-title":"Efficacy of Calcitonin for Treating Acute Pain Associated With Osteoporotic Vertebral Compression Fracture: An Updated Systematic Review","volume":"22","author":"Boucher","year":"2020","journal-title":"Cjem"},{"key":"B17","doi-asserted-by":"publisher","DOI":"10.7861\/clinmedicine.14-2-187","article-title":"Osteoporosis and Fracture Risk in Older People","volume":"14","author":"Coughlan","year":"2014","journal-title":"Clin Med (London England)"},{"key":"B18","doi-asserted-by":"publisher","DOI":"10.1016\/s0140-6736(20)30752-2","article-title":"Global Burden of 87 Risk Factors in 204 Countries and Territories, 1990-2019: A Systematic Analysis for the Global Burden of Disease Study 2019","volume":"396","author":"Murray","year":"2020","journal-title":"Lancet (London England)"},{"key":"B19","doi-asserted-by":"publisher","DOI":"10.1016\/s0140-6736(20)30925-9","article-title":"Global Burden of 369 Diseases and Injuries in 204 Countries and Territories, 1990-2019: A Systematic Analysis for the Global Burden of Disease Study 2019","volume":"396","author":"Vos","year":"2020","journal-title":"Lancet (London England)"},{"key":"B20","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2013-204320","article-title":"The Global Burden Attributable to Low Bone Mineral Density","volume":"73","author":"S\u00e0nchez-Riera","year":"2014","journal-title":"Ann rheumatic Dis"},{"key":"B21","doi-asserted-by":"publisher","DOI":"10.1016\/s0140-6736(20)31404-5","article-title":"Five Insights From the Global Burden of Disease Study 2019","volume":"396","author":"Murray","year":"2020","journal-title":"Lancet (London England)"},{"key":"B22","doi-asserted-by":"publisher","DOI":"10.1016\/s0140-6736(20)30977-6","article-title":"Global Age-Sex-Specific Fertility, Mortality, Healthy Life Expectancy (HALE), and Population Estimates in 204 Countries and Territories, 1950-2019: A Comprehensive Demographic Analysis for the Global Burden of Disease Study 2019","volume":"396","author":"Wang","year":"2020","journal-title":"Lancet (London England)"},{"key":"B23","doi-asserted-by":"publisher","DOI":"10.1016\/s0140-6736(18)32225-6","article-title":"Global, Regional, and National Comparative Risk Assessment of 84 Behavioural, Environmental and Occupational, and Metabolic Risks or Clusters of Risks for 195 Countries and Territories, 1990-2017: A Systematic Analysis for the Global Burden of Disease Study 2017","volume":"392","author":"Stanaway","year":"2018","journal-title":"Lancet (London England)"},{"key":"B24","doi-asserted-by":"publisher","DOI":"10.1016\/s0140-6736(02)08761-5","article-title":"Diagnosis of Osteoporosis and Assessment of Fracture Risk","volume":"359","author":"Kanis","year":"2002","journal-title":"Lancet (Lond Engl)"},{"key":"B25","first-page":"1","article-title":"Assessment of Fracture Risk and its Application to Screening for Postmenopausal Osteoporosis. Report of a WHO Study Group","volume":"843","author":"Alexeeva","year":"1994","journal-title":"World Health Organ Tech Rep Ser"},{"key":"B26","doi-asserted-by":"publisher","first-page":"1","DOI":"10.4158\/gl-2020-0524suppl","article-title":"American Association Of Clinical Endocrinologists\/American College Of Endocrinology Clinical Practice Guidelines For The Diagnosis And Treatment Of Postmenopausal Osteoporosis-2020 Update","volume":"26","author":"Camacho","year":"2020","journal-title":"Endocr Pract"},{"key":"B27","doi-asserted-by":"publisher","DOI":"10.1007\/s00198-006-0172-4","article-title":"An Estimate of the Worldwide Prevalence and Disability Associated With Osteoporotic Fractures","volume":"17","author":"Johnell","year":"2006","journal-title":"Osteoporosis Int"},{"key":"B28","doi-asserted-by":"publisher","DOI":"10.1007\/s00268-019-05348-6","article-title":"Injury Pattern and Injury Severity of In-Hospital Deceased Road Traffic Accident Victims in The Netherlands: Dutch Road Traffic Accidents Fatalities","volume":"44","author":"Leijdesdorff","year":"2020","journal-title":"World J Surg"},{"key":"B29","doi-asserted-by":"publisher","DOI":"10.1359\/jbmr.071020","article-title":"A Population-Based Assessment of Rates of Bone Loss at Multiple Skeletal Sites: Evidence for Substantial Trabecular Bone Loss in Young Adult Women and Men","volume":"23","author":"Riggs","year":"2008","journal-title":"J Bone mineral Res"},{"key":"B30","doi-asserted-by":"publisher","DOI":"10.1002\/jcp.25001","article-title":"Determinants of Muscle and Bone Aging","volume":"230","author":"Curtis","year":"2015","journal-title":"J Cell Physiol"},{"key":"B31","doi-asserted-by":"publisher","first-page":"19","DOI":"10.1016\/j.bone.2016.03.006","article-title":"Epidemiology of Fractures in the United Kingdom 1988-2012: Variation With Age, Sex, Geography, Ethnicity and Socioeconomic Status","volume":"87","author":"Curtis","year":"2016","journal-title":"Bone"},{"key":"B32","doi-asserted-by":"publisher","DOI":"10.2217\/whe.12.54","article-title":"Geographic Differences in Fractures Among Women","volume":"8","author":"Litwic","year":"2012","journal-title":"Women's Health (London England)"},{"key":"B33","doi-asserted-by":"publisher","DOI":"10.1007\/bf03187467","article-title":"Incidence of Hip Fractures in the Elderly: A Cross-National Analysis","volume":"1","author":"Maggi","year":"1991","journal-title":"Osteoporosis Int"},{"key":"B34","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2009.1462","article-title":"Incidence and Mortality of Hip Fractures in the United States","volume":"302","author":"Brauer","year":"2009","journal-title":"Jama"},{"key":"B35","doi-asserted-by":"publisher","DOI":"10.1007\/s00198-009-0957-3","article-title":"Declining Incidence of Hip Fractures and the Extent of Use of Anti-Osteoporotic Therapy in Denmark 1997-2006","volume":"21","author":"Abrahamsen","year":"2010","journal-title":"Osteoporosis Int"},{"key":"B36","doi-asserted-by":"publisher","DOI":"10.1001\/jama.288.3.321","article-title":"Risks and Benefits of Estrogen Plus Progestin in Healthy Postmenopausal Women: Principal Results From the Women's Health Initiative Randomized Controlled Trial","volume":"288","author":"Rossouw","year":"2002","journal-title":"Jama"},{"key":"B37","doi-asserted-by":"publisher","first-page":"602","DOI":"10.3390\/medicina55090602","article-title":"The Controversial History of Hormone Replacement Therapy","volume":"55","author":"Cagnacci","year":"2019","journal-title":"Med (Kaunas Lithuania)"},{"key":"B38","doi-asserted-by":"publisher","DOI":"10.1097\/gme.0000000000000921","article-title":"The 2017 Hormone Therapy Position Statement of The North American Menopause Society","volume":"24","author":"Pinkerton","year":"2017","journal-title":"Menopause (New York NY)"},{"key":"B39","doi-asserted-by":"publisher","DOI":"10.1097\/01.Aog.0000441353.20693.78","article-title":"Management of Menopausal Symptoms","volume":"123","year":"2014","journal-title":"Obstetrics gynecol"},{"key":"B40","doi-asserted-by":"publisher","DOI":"10.1258\/136218004322986762","article-title":"Managing the Menopause: BMS Council Consensus Statement on HRT","volume":"10","author":"Pitkin","year":"2004","journal-title":"J Br Menopause Soc"},{"key":"B41","doi-asserted-by":"publisher","DOI":"10.3109\/13697137.2011.570590","article-title":"Updated IMS Recommendations on Postmenopausal Hormone Therapy and Preventive Strategies for Midlife Health","volume":"14","author":"Sturdee","year":"2011","journal-title":"Climacteric"},{"key":"B42","doi-asserted-by":"publisher","DOI":"10.1007\/bf01623773","article-title":"Meta-Analysis of the Effectiveness of Physical Activity for the Prevention of Bone Loss in Postmenopausal Women","volume":"7","author":"B\u00e9rard","year":"1997","journal-title":"Osteoporosis Int"},{"key":"B43","doi-asserted-by":"publisher","DOI":"10.1007\/s00198-005-1863-y","article-title":"Body Mass Index as a Predictor of Fracture Risk: A Meta-Analysis","volume":"16","author":"De Laet","year":"2005","journal-title":"Osteoporosis Int"},{"key":"B44","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0253450","article-title":"Health Care System Efficiency and Life Expectancy: A 140-Country Study","volume":"16","author":"Zarulli","year":"2021","journal-title":"PloS One"},{"key":"B45","doi-asserted-by":"publisher","DOI":"10.1016\/s2468-2667(19)30019-2","article-title":"Measuring Population Ageing: An Analysis of the Global Burden of Disease Study 2017","volume":"4","author":"Chang","year":"2019","journal-title":"Lancet Public Health"},{"key":"B46","doi-asserted-by":"publisher","DOI":"10.1002\/jbmr.5650101125","article-title":"Risk Factors for Hip Fracture in European Women: The MEDOS Study. Mediterranean Osteoporosis Study","volume":"10","author":"Johnell","year":"1995","journal-title":"J Bone Mineral"},{"key":"B47","doi-asserted-by":"publisher","first-page":"377","DOI":"10.1186\/s13018-020-01904-2","article-title":"Prevalence and Influencing Factors of Nonunion in Patients With Tibial Fracture: Systematic Review and Meta-Analysis","volume":"15","author":"Tian","year":"2020","journal-title":"J orthopaedic Surg Res"},{"key":"B48","doi-asserted-by":"publisher","DOI":"10.31729\/jnma.404","article-title":"Osteoporosis-An Update","volume":"44","author":"Lamichhane","year":"2005","journal-title":"JNMA; J Nepal Med Assoc"},{"key":"B49","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2009.50","article-title":"Mortality Risk Associated With Low-Trauma Osteoporotic Fracture and Subsequent Fracture in Men and Women","volume":"301","author":"Bliuc","year":"2009","journal-title":"Jama"},{"key":"B50","doi-asserted-by":"publisher","DOI":"10.3760\/cma.j.issn.0253-9624.2016.09.007","article-title":"[The Burden of Disease Attributed to Low Bone Mineral Density Among Population Aged \u226540 Years Old in China, 1990 and 2013]","volume":"50","author":"Zhao","year":"2016","journal-title":"Zhonghua Yu Fang Yi Xue Za Zhi [Chinese J Prev Med]"},{"key":"B51","doi-asserted-by":"publisher","DOI":"10.1093\/qjmed\/hcn022","article-title":"DXA Scanning in Clinical Practice","volume":"101","author":"El Maghraoui","year":"2008","journal-title":"QJM Monthly J Assoc Physicians"},{"key":"B52","doi-asserted-by":"publisher","DOI":"10.1016\/j.maturitas.2021.10.010","article-title":"Disparities in Osteoporosis Care Among Postmenopausal Women in the United States","volume":"156","author":"Ruiz-Esteves","year":"2022","journal-title":"Maturitas"},{"key":"B53","doi-asserted-by":"publisher","first-page":"S49","DOI":"10.1097\/bot.0000000000000949","article-title":"Osteoporotic Thoracolumbar Fractures-How Are They Different?-Classification and Treatment Algorithm","author":"Rajasekaran","year":"2017","journal-title":"J Orthopaedic Trauma"}],"container-title":["Frontiers in Endocrinology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fendo.2022.882241\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,5,20]],"date-time":"2022-05-20T08:55:16Z","timestamp":1653036916000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fendo.2022.882241\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,5,20]]},"references-count":53,"alternative-id":["10.3389\/fendo.2022.882241"],"URL":"https:\/\/doi.org\/10.3389\/fendo.2022.882241","relation":{"has-part":[{"id-type":"doi","id":"https:\/\/doi.org\/10.3389\/fendo.2022.882241.s001","asserted-by":"subject"}]},"ISSN":["1664-2392"],"issn-type":[{"value":"1664-2392","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,5,20]]},"article-number":"882241"}}