Current issue
Archive
Manuscripts accepted
About the Journal
Editorial office
Editorial board
Section Editors
Abstracting and indexing
Subscription
Contact
Ethical standards and procedures
Most read articles
Instructions for authors
Article Processing Charge (APC)
Regulations of paying article processing charge (APC)
CLINICAL RESEARCH
Global, regional, and national trends in spinal fracture burden from 1990 to 2021 and projections to 2050
1
Department of Orthopedics, Affiliated Hospital of Shandong, University of Traditional
Chinese Medicine, Zhangqiu Traditional Chinese Hospital, Zhangqiu, China
2
Department of Orthopedics, Affiliated Hospital of Shandong University of Traditional
Chinese Medicine, Jinan, China
Submission date: 2025-05-11
Final revision date: 2025-08-15
Acceptance date: 2025-08-16
Online publication date: 2026-02-11
Corresponding author
Xiao-chen Liu
Department of Orthopedics Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan 250000, China
Department of Orthopedics Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan 250000, China
KEYWORDS
TOPICS
ABSTRACT
Introduction:
Spinal fractures (SF) remain a major global cause of disability. This study aimed to quantify the global incidence, prevalence, and burden of SF in 2021, along with temporal trends from 1990 to 2021. These trends are stratified by location, age, sex, and Socio-Demographic Index (SDI). Furthermore, the study provides projections for the burden of SF over the next 30 years.
Material and methods:
Data for this study were obtained from the 2021 Global Burden of Disease Study (GBD). To quantify temporal patterns and evaluate trends in age-standardized rates (ASR) of SF prevalence (ASPR), incidence (ASIR), and age-standardized years lived with disability (ASYR), estimated annual percentage changes (EAPCs) were calculated for the study period. The analyses were stratified by gender, 20 age categories, 21 GBD regions, 204 countries/territories, and 5 SDI quintiles. Statistical analyses and plot visualizations were performed using the R statistical package (version 4.4.2).
Results:
In 2021, the global burden of SF remained considerable, with a total of 3.4 million cases and an ASPR of 65.19 cases per 100,000 individuals (95% uncertainty interval [UI]: 56.89–75.28). The ASIR was 92.75 per 100,000 individuals (95% UI: 72.12–119.99), while the ASYR was 6.62 per 100,000 individuals (95% UI: 4.43–9.2). Regionally, the highest ASPR, ASIR, and ASYR were observed in high SDI regions, while the lowest rates were found in low SDI regions.
Conclusions:
Geographically, Australasia exhibited the highest ASIR and ASPR, while the Caribbean had the highest ASYR. Among countries, New Zealand had the highest ASIR, and Andorra showed the highest ASPR and ASYR.
Spinal fractures (SF) remain a major global cause of disability. This study aimed to quantify the global incidence, prevalence, and burden of SF in 2021, along with temporal trends from 1990 to 2021. These trends are stratified by location, age, sex, and Socio-Demographic Index (SDI). Furthermore, the study provides projections for the burden of SF over the next 30 years.
Material and methods:
Data for this study were obtained from the 2021 Global Burden of Disease Study (GBD). To quantify temporal patterns and evaluate trends in age-standardized rates (ASR) of SF prevalence (ASPR), incidence (ASIR), and age-standardized years lived with disability (ASYR), estimated annual percentage changes (EAPCs) were calculated for the study period. The analyses were stratified by gender, 20 age categories, 21 GBD regions, 204 countries/territories, and 5 SDI quintiles. Statistical analyses and plot visualizations were performed using the R statistical package (version 4.4.2).
Results:
In 2021, the global burden of SF remained considerable, with a total of 3.4 million cases and an ASPR of 65.19 cases per 100,000 individuals (95% uncertainty interval [UI]: 56.89–75.28). The ASIR was 92.75 per 100,000 individuals (95% UI: 72.12–119.99), while the ASYR was 6.62 per 100,000 individuals (95% UI: 4.43–9.2). Regionally, the highest ASPR, ASIR, and ASYR were observed in high SDI regions, while the lowest rates were found in low SDI regions.
Conclusions:
Geographically, Australasia exhibited the highest ASIR and ASPR, while the Caribbean had the highest ASYR. Among countries, New Zealand had the highest ASIR, and Andorra showed the highest ASPR and ASYR.
REFERENCES (40)
1.
Qasheesh M, Shaphe MA, Iqbal A, Alghadir AH. Association of psychological variants with functional outcomes among people with spinal cord injury. Sci Rep 2021; 11: 20325.
2.
Thietje R, Pouw MH, Schulz AP, Kienast B, Hirschfeld S. Mortality in patients with traumatic spinal cord injury: descriptive analysis of 62 deceased subjects. J Spinal Cord Med 2011; 34: 482-7.
3.
van den Berg MEL, Castellote JM, de Pedro-Cuesta J, Mahillo-Fernandez I. Survival after spinal cord injury: a systematic review. J Neurotrauma 2010; 27: 1517-28.
4.
Ackery A, Tator C, Krassioukov A. A global perspective on spinal cord injury epidemiology. J Neurotrauma 2004; 21: 1355-70.
5.
French DD, Campbell RR, Sabharwal S, Nelson AL, Palacios PA, Gavin-Dreschnack D. Health care costs for patients with chronic spinal cord injury in the Veterans Health Administration. J Spinal Cord Med 2007; 30: 477-81.
6.
GBD 2017 US Neurological Disorders Collaborators, Feigin VL, Vos T, Alahdab F, et al. Burden of neurological disorders across the US From 1990-2017: a Global Burden of Disease Study. JAMA Neurol 2021; 78: 165-76.
7.
Dong Y, Peng R, Kang H, et al. Global incidence, prevalence, and disability of vertebral fractures: a systematic analysis of the global burden of disease study 2019. Spine J 2022; 22: 857-68.
8.
Saul D, Dresing K. Epidemiology of vertebral fractures in pediatric and adolescent patients. Pediatr Rep 2018; 10: 7232.
9.
Axibal DP, Mitchell JJ, Mayo MH, et al. Epidemiology of Anterior tibial spine fractures in young patients: a retrospective cohort study of 122 cases. J Pediatr Orthop 2019; 39: e87-90.
10.
Schousboe JT. Vertebral fracture identification as part of a comprehensive risk assessment in patients with osteoporosis. Curr Osteoporos Rep 2018; 16: 573-83.
11.
GBD 2019 Diseases and Injuries Collaborators. 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. Lancet 2020; 396: 1204-22.
12.
Stevens GA, Alkema L, Black RE, et al. Guidelines for accurate and transparent health estimates reporting: the GATHER statement. PLoS Med 2016; 13: e1002056.
13.
GBD 2019 Risk Factors Collaborators. Global burden of 87 risk factors in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet 2020; 396: 1223-49.
14.
GBD 2017 Disease and Injury Incidence and Prevalence Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet 2018; 392: 1789-858.
15.
Salomon JA, Haagsma JA, Davis A, et al. Disability weights for the Global Burden of Disease 2013 study. Lancet Glob Health 2015; 3: e712-23.
16.
Clegg LX, Hankey BF, Tiwari R, Feuer EJ, Edwards BK. Estimating average annual per cent change in trend analysis. Stat Med 2009; 28: 3670-82.
17.
Nelson BK. Statistical methodology: V. Time series analysis using autoregressive integrated moving average (ARIMA) models. Acad Emerg Med 1998; 5: 739-44.
18.
Guan P, Wu W, Huang D. Trends of reported human brucellosis cases in mainland China from 2007 to 2017: an exponential smoothing time series analysis. Environ Health Prev Med 2018; 23: 23.
19.
GBD 2019 Universal Health Coverage Collaborators. Measuring universal health coverage based on an index of effective coverage of health services in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet 2020; 396: 1250-84.
20.
GBD 2017 Population and Fertility Collaborators. Population and fertility by age and sex for 195 countries and territories, 1950-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet 2018; 392: 1995-2051.
21.
Tsai K, Twu S, Chieng P, Yang R, Lee T. Prevalence of vertebral fractures in chinese men and women in urban Taiwanese communities. Calcif Tissue Int 1996; 59: 249-53.
22.
van der Velde RY, Wyers CE, Teesselink E, et al. Trends in oral anti-osteoporosis drug prescription in the United Kingdom between 1990 and 2012: variation by age, sex, geographic location and ethnicity. Bone 2017; 94: 50-5.
23.
Solomon DH, Johnston SS, Boytsov NN, McMorrow D, Lane JM, Krohn KD. Osteoporosis medication use after hip fracture in U.S. patients between 2002 and 2011. J Bone Miner Res 2014; 29: 1929-37.
24.
Imaz I, Zegarra P, González-Enríquez J, Rubio B, Alcazar R, Amate JM. Poor bisphosphonate adherence for treatment of osteoporosis increases fracture risk: systematic review and meta-analysis. Osteoporos Int 2010; 21: 1943-51.
25.
Albert SG, Reddy S. Clinical evaluation of cost efficacy of drugs for treatment of osteoporosis: a meta-analysis. Endocr Pract 2017; 23: 841-56.
26.
Zeytinoglu M, Jain RK, Vokes TJ. Vertebral fracture assessment: Enhancing the diagnosis, prevention, and treatment of osteoporosis. Bone 2017; 104: 54-65.
27.
Sobczak K, Leoniuk K. Doctors’ attitudes in the situation of delivering bad news: patients’ experience and expectations. Arch Med Sci 2023; 19: 921-9.
28.
Górczewska B, Jakubowska-Pietkiewicz E. Does the duration of postmenopausal osteoporosis affect life quality and satisfaction? Arch Med Sci 2025; 21: 876-82.
29.
Ström O, Borgström F, Kanis JA, et al. Osteoporosis: burden, health care provision and opportunities in the EU: a report prepared in collaboration with the International Osteoporosis Foundation (IOF) and the European Federation of Pharmaceutical Industry Associations (EFPIA). Arch Osteoporos 2011; 6: 59-155.
30.
Burge R, Dawson-Hughes B, Solomon DH, Wong JB, King A, Tosteson A. Incidence and economic burden of osteoporosis-related fractures in the United States, 2005-2025. J Bone Miner Res 2007; 22: 465-75.
31.
Amin S, Achenbach SJ, Atkinson EJ, Khosla S, Melton LJ. Trends in fracture incidence: a population-based study over 20 years. J Bone Miner Res 2014; 29: 581-9.
32.
Cooper C, Atkinson EJ, O’Fallon WM, Melton LJ. Incidence of clinically diagnosed vertebral fractures: a population-based study in Rochester, Minnesota, 1985-1989. J Bone Miner Res 1992; 7: 221-7.
33.
Kumar R, Lim J, Mekary RA, et al. Traumatic spinal injury: global epidemiology and worldwide volume. World Neurosurg 2018; 113: e345-63.
35.
Zia A, Kamaruzzaman SB, Tan MP. Polypharmacy and falls in older people: balancing evidence-based medicine against falls risk. Postgrad Med 2015; 127: 330-7.
36.
Yang S, Zhou L, Gong W, Guo B, Wang L. Global burden of osteoarthritis from 1990 to 2019 attributable to high body mass index. Arch Med Sci 2024; 20: 1841-53.
37.
Li Y, Zhang S, Shu P. Global burden of neck pain in 204 countries from 1990–2019. Arch Med Sci 2023; 19: 1811-21.
38.
Wu H, Wang Y, Li F, Liu Z, Shi F. The national, regional, and global impact of glaucoma as reported in the 2019 Global Burden of Disease Study. Arch Med Sci 2023; 19: 1913-9.
39.
Xu W, Shao Z, Lou H, et al. Prediction of congenital heart disease for newborns: comparative analysis of Holt-Winters exponential smoothing and autoregressive integrated moving average models. BMC Med Res Methodol 2022; 22: 257.
40.
Julaiti M, Wubuli D, Cui T, Nijiati N, Huang P, Hu B. Analysis of the relationship between environmental particulate matter exposure and congenital diseases, as well as the epidemiological trends and burden of impact on newborns. Ecotoxicol Environ Saf 2025; 289: 117465.
Share
RELATED ARTICLE
| eISSN: | 1896-9151 |
| ISSN: | 1734-1922 |
We process personal data collected when visiting the website. The function of obtaining information about users and their behavior is carried out by voluntarily entered information in forms and saving cookies in end devices. Data, including cookies, are used to provide services, improve the user experience and to analyze the traffic in accordance with the Privacy policy. Data are also collected and processed by Google Analytics tool (more).
You can change cookies settings in your browser. Restricted use of cookies in the browser configuration may affect some functionalities of the website.
You can change cookies settings in your browser. Restricted use of cookies in the browser configuration may affect some functionalities of the website.
