Global, Regional, and National Burden of Hip Fractures From 1990 to 2021: Results from Global Burden of Disease Study 2021

Background: Hip fracture is a kind of injury with complex nature, difficult treatment and the high proportion of elderly female patients, which is known as the last fracture for elderly. It is an important cause of reducing health level in elderly. Current reports on burden and tendencies of global hip fractures are still incomplete. Methods: Through the Global Burden of Disease study (GBD) database, we extracted the incidence and years lived with disability (YLD) associated with hip fractures from 1990 to 2021. Our study used an estimate of the 95% uncertainty interval. Trends in hip fracture burden were assessed by estimated annual percentage change. Spearman correlation analysis was used for examining the correlation of age-standardization rate with socio-demographic index (SDI). Results: In 2021, the incidence and YLD of global hip fractures were 16.9 million and 3.1 million, which increased by 126.4% and 75.2% compared with 1990, respectively. In the past 32 years, global incidence rate kept relatively stable in both genders, while YLD rate declined. There was a slight increase of incidence in male, while the both rates were consistently higher in female. The incidence of hip fracture had a positive correlation with SDI, but there was no significant correlation with YLD. Hip fractures appear more frequently for patients over 70 years old. Falls were the pivotal cause of hip fracture, which accounted for 83.1% of total incidence and 79.7% of total YLD. Conclusions: Hip fractures remain a significant burden on global healthcare systems, with falls being the pivotal cause. The incidence and burden was higher in women, but incidence rate increased slightly in men. The majority of patients were over 70 years old. Countries with high SDI had a higher incidence, while countries with low SDI had a greater burden of disease. Policies should focus on improving malnutrition, promoting public health education on the lifestyle for bone protecting, choosing appropriate measures to prevent falls in the elderly, and raising awareness of osteoporosis screening and treatment (especially for men).