Global Pattern, Trend, and Cross-Country Inequality of Low Bone Mineral Density From 1990 to 2021: Findings From the Global Burden of Disease Study.

OBJECTIVES Low bone mineral density (LBMD), a major osteoporotic fracture risk factor, disproportionately affects females globally. This study analyzing its burden through trends, health inequities, and predictive modeling.

METHODS Data from the Global Burden of Disease (GBD) 2021 were used to extract summary exposure values (SEV), mortality, and disability-adjusted life years (DALYs) for LBMD. Temporal trends, demographic and epidemiological changes, health inequalities, and projections were analyzed.

RESULTS In 2021, the global age-standardized rate of SEV was 23.51 (0-100 scale), declining at an AAPC of -0.16 since 1990. The age-standardized mortality rate (ASMR) and age-standardized DALY rate (ASDR) were 5.65 (95% UI: 4.71, 6.40) and 204.99 (95% UI: 168.92, 242.95) per 100 000 population, respectively, and both declined from 1990 to 2021. SEV was higher in females than males (28.56 vs. 18.08), while ASMR (4.99 vs. 6.45) and ASDR (196.37 vs. 211.01) were higher in males. Inequality slope indices in DALYs showed widening gaps between highest and lowest SDI countries, from -26.31 in 1990 to -53.34 in 2021. The absolute burden was mainly driven by population growth and aging, and ASMR and ASDR are expected to continue declining through 2050.

CONCLUSION Although the age-standardized burden of LBMD declined from 1990 to 2021, the absolute burden remained substantial and was largely driven by population growth and aging. The burden was concentrated in low-SDI regions, while some high-SDI regions showed unfavorable trends. Females had higher exposure levels, whereas males bore a greater overall disease burden. Reducing the global LBMD burden requires improved nutrition and care in low-SDI regions, targeted prevention in postmenopausal women, and earlier detection and treatment in men.