# Analysis of the disease burden of vertebral fractures in China and worldwide from 1990 to 2021 and trend forecast to 2035

## TL;DR

This study analyzed the global and Chinese disease burden of vertebral fractures from 1990 to 2021 and predicted future trends, highlighting the need for targeted public health strategies.

## Contribution

The study provides a detailed analysis of vertebral fracture trends and projections using GBD data and advanced statistical models, focusing on China's unique demographic factors.

## Key findings

- Global incident and prevalent cases of vertebral fractures increased significantly from 1990 to 2021, but age-standardized rates declined.
- In China, vertebral fracture rates rose more sharply, with significant increases in age-standardized prevalence and YLDs.
- Population growth and aging were identified as the main drivers of increased vertebral fracture burden globally and in China.

## Abstract

Using the Global Burden of Disease (GBD) 2021 database, we analyzed the epidemiological trends of VFs in China from 1990 to 2021 and further explored the disease burden characteristics by age and sex. The Joinpoint regression model was employed to calculate the average annual percentage change (AAPC) to analyze the trends. The Bayesian Age-Period-Cohort (BAPC) model was used to predict the changes in standardized rates from 2022 to 2035. Additionally, decomposition analysis was conducted to investigate the impacts of aging, population growth, and epidemiological changes on the disease burden.

In 2021, the number of incident cases, prevalent cases, and YLDs of VFs globally were 7,497,446, 5,371,438, and 545,923, respectively, which increased by 28.03%, 57.96%, and 54.67% compared with 1990. From 1990 to 2021, the global ASIR, ASPR, and ASYR all decreased (AAPC= -0.72%, -0.73%, and − 0.75%, respectively, P < 0.05). The BAPC model also predicted a similar downward trend from 2022 to 2035. In 2021, the number of incident cases, prevalent cases, and YLDs of VFs in China were 1,194,465, 717,078, and 74,079, respectively, which increased by 52.28%, 113.66%, and 107.21% compared with 1990. From 1990 to 2021, the ASIR in China showed a non-significant increase (AAPC = 0.45%, P > 0.05), while the ASPR and ASYR both increased significantly (AAPC = 0.53% and 0.51%, respectively, P < 0.05). The BAPC model predicted a downward trend in ASIR, ASPR, and ASYR from 2022 to 2035 Gender analysis revealed that the disease burden is more prominent among middle-aged men and elderly women. The age-group analysis showed that the peak age groups for the number of incident cases, prevalent cases, and YLDs all increased, and CIR, CPR, and CYR all increased with age. The decomposition analysis revealed that population growth was the primary factor driving the increase in the number of VFs cases globally, while population growth and aging were the main factors contributing to the increase in the number of VFs cases in China.

The disease burden of vertebral fractures is significant and cannot be ignored. China should develop targeted public health strategies based on its demographic structure and socio-economic development, focusing on the prevention and treatment of vertebral fractures in middle-aged men and elderly women to achieve the goal of universal health.

The online version contains supplementary material available at 10.1186/s41043-025-01114-8.