Disease burden of spinal fractures in China from 1990 to 2021 and temporal trends: A comparative analysis based on the Global Burden of Disease Study 2021_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

WANG Hao ^1,2 , LIU Hua ^1,2 , SHI Tianyun ^1,2 , FAN Huaixi ^1,2 ,  LI Songkai ²

1. First Clinical Medical College of Gansu University of Chinese Medicine, Lanzhou Gansu, 730000, P. R. China;
2. Department of Orthopedics, the 940th Hospital of Chinese PLA Joint Logisitcs Support Force, Lanzhou Gansu, 730050, P. R. China;

Corresponding?author：

LI Songkai, Email: lisongkai1204@qq.com

Keywords：

Spinal fracture; disease burden; trend analysis

DOI：

10.7507/1002-1892.202504088

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Objective To analyze the current status and temporal trends of the disease burden of spinal fractures in China from 1990 to 2021 based on data from the Global Burden of Disease Study 2021 (GBD 2021), aiming to provide evidence for developing prevention and treatment strategies. Methods Epidemiological data on spinal fractures in China, the United States of America (USA), and globally were extracted from the GBD 2021 database. Joinpoint regression models were applied to analyze temporal trends. Age-standardized incidence, prevalence, and disability-adjusted life years (DALYs) rates were calculated, with comparisons of gender- and age-group disparities. Results In 2021, the number of incident cases, prevalent cases, and DALYs of spinal fractures in China increased by 52.28%, 113.68%, and 106.98%, respectively, compared to 1990. The age-standardized incidence, prevalence, and DALYs rates rose by 11.80%, 16.11%, and 14.79%, respectively. The disease burden escalated significantly with age, peaking in individuals aged ≥75 years. Males exhibited higher age-standardized incidence and DALYs rates than females. Comparative analysis revealed that the age-standardized DALYs rate in China (4.19/100 000) was lower than that in globally (6.62/100 000) and USA (15.92/100 000). However, China showed an upward trend [annual average percentage change (AAPC)=0.19%], contrasting with a declining trend in the USA (AAPC=–0.08%). Conclusion The escalating disease burden of spinal fractures in China is closely linked to population aging, gender disparities, and insufficient targeted prevention policies. Future strategies should integrate age- and gender-specific interventions, including strengthened osteoporosis prevention, trauma risk control, and big data-driven precision measures, to mitigate this burden.

Citation： WANG Hao, LIU Hua, SHI Tianyun, FAN Huaixi, LI Songkai. Disease burden of spinal fractures in China from 1990 to 2021 and temporal trends: A comparative analysis based on the Global Burden of Disease Study 2021. Chinese Journal of Reparative and Reconstructive Surgery, 2025, 39(6): 762-768. doi: 10.7507/1002-1892.202504088 Copy

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2.	Jackson SA, Tenenhouse A, Robertson L. Vertebral fracture definition from population-based data: preliminary results from the Canadian Multicenter Osteoporosis Study (CaMos). Osteoporos Int, 2000, 11(8): 680-687.
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5.	Laughter MR, Maymone MBC, Karimkhani C, et al. The Burden of Skin and Subcutaneous Diseases in the United States From 1990 to 2017. JAMA Dermatol, 2020, 156(8): 874-881.
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9.	《中國老年骨質疏松癥診療指南2023》工作組, 中國老年學和老年醫學學會骨質疏松分會, 中國醫療保健國際交流促進會骨質疏松病學分會, 等. 中國老年骨質疏松癥診療指南 (2023). 中華骨與關節外科雜志, 2023, 16(10): 865-85.
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11.	張文勝, 宋振杰, 郭海威, 等. 椎旁肌功能橫截面積預測骨質疏松性椎體壓縮骨折. 中國組織工程研究, 2024, 28(33): 5315-5319.
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13.	Ahmed LA, Center JR, Bj?rnerem A, et al. Progressively increasing fracture risk with advancing age after initial incident fragility fracture: the Troms? study. J Bone Miner Res, 2013, 28(10): 2214-2221.
14.	Gu H, Shao B, Hu Y, et al. Epidemiological characteristics of traumatic spinal fractures among the elderly in China. Sci Rep, 2024, 14(1): 19170. doi: 10.1038/s41598-024-69780-y.
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16.	Shen Y, Shi Y, Gu X, et al. Using QCT for the prediction of spontaneous age- and gender-specific thoracolumbar vertebral fractures and accompanying distant vertebral fractures. BMC Musculoskelet Disord, 2024, 25(1): 828. doi: 10.1186/s12891-024-07961-6.
17.	張亞軍, 劉忠厚, 張鵬. 絕經后骨質疏松癥流行病學研究進展. 中國骨質疏松雜志, 2010, 16(3): 229-234.
18.	Horst-Sikorska W, Wawrzyniak A. The role of hormonal therapy in osteoporosis. Endokrynol Pol, 2011, 62(1): 61-64.
19.	王洪偉, 李長青, 王建, 等. 老年人外傷性脊柱骨折的臨床特點. 中國脊柱脊髓雜志, 2012, 22(12): 1072-1076.
20.	陳國強, 方秀統, 俞猛. 老年外傷性脊柱骨折的臨床特點及預防分析. 上海交通大學學報(醫學版), 2014, 34(10): 1493-1496.
21.	趙凱平, 袁蕊, 馬楠, 等. 55歲以上原發骨質疏松性骨折患者特征及趨勢分析. 中國骨質疏松雜志, 2020, 26(6): 849-856.
22.	朱福林, 李洪濤, 何曼青. 中國式現代化高質量發展路徑研究. 全球化, 2025, (1): 84-94, 134-135.
23.	高子茗, 呂洋. 新業態發展與城市內部經濟不平衡. 財貿經濟, 2024, 45(9): 110-124.
24.	姜效韋, 朱冬梅, 王明宇, 等. 2 887例老年骨質疏松性脊柱壓縮性骨折流行病學特點分析. 醫藥前沿, 2024, 14(15): 8-11+15.
25.	丁立祥, 宋繼鵬. 骨質疏松性脊柱骨折的外科治療策略及發展趨勢. 中國骨傷, 2025, 38(2): 109-113.

1. Kim BG, Dan JM, Shin DE. Treatment of thoracolumbar fracture. Asian Spine J, 2015, 9(1): 133-146.
2. Jackson SA, Tenenhouse A, Robertson L. Vertebral fracture definition from population-based data: preliminary results from the Canadian Multicenter Osteoporosis Study (CaMos). Osteoporos Int, 2000, 11(8): 680-687.
3. Bruggink C, van de Ree CLP, van Ditshuizen J, et al. Increased incidence of traumatic spinal injury in patients aged 65 years and older in the Netherlands. Eur Spine J, 2024, 33(10): 3677-3684.
4. Wiersbicki DW, Osterhoff G, Heyde CE, et al. The relation of osteoporotic vertebral fractures and spine degeneration on the occurrence of complications: a systematic review. Eur Spine J, 2024, 33(8): 3213-3220.
5. Laughter MR, Maymone MBC, Karimkhani C, et al. The Burden of Skin and Subcutaneous Diseases in the United States From 1990 to 2017. JAMA Dermatol, 2020, 156(8): 874-881.
6. Melse JM, Essink-Bot ML, Kramers PG, et al. A national burden of disease calculation: Dutch disability-adjusted life-years. Dutch Burden of Disease Group. Am J Public Health, 2000, 90(8): 1241-1247.
7. 李輝章, 杜靈彬. Joinpoint回歸模型在腫瘤流行病學時間趨勢分析中的應用. 中華預防醫學雜志, 2020, 54(8): 908-912.
8. Luo Z, He Y, Ma G, et al. Years of life lost due to premature death and their trends in people with malignant neoplasm of female genital organs in Shanghai, China during 1995-2018: a population based study. BMC Public Health, 2020, 20(1): 1489. doi: 10.1186/s12889-020-09593-6.
9. 《中國老年骨質疏松癥診療指南2023》工作組, 中國老年學和老年醫學學會骨質疏松分會, 中國醫療保健國際交流促進會骨質疏松病學分會, 等. 中國老年骨質疏松癥診療指南 (2023). 中華骨與關節外科雜志, 2023, 16(10): 865-85.
10. GBD 2019 Fracture Collaborators. Global, regional, and national burden of bone fractures in 204 countries and territories, 1990-2019: a systematic analysis from the Global Burden of Disease Study 2019. Lancet Healthy Longev, 2021, 2(9): e580-e592.
11. 張文勝, 宋振杰, 郭海威, 等. 椎旁肌功能橫截面積預測骨質疏松性椎體壓縮骨折. 中國組織工程研究, 2024, 28(33): 5315-5319.
12. Bliuc D, Alarkawi D, Nguyen TV, et al. Risk of subsequent fractures and mortality in elderly women and men with fragility fractures with and without osteoporotic bone density: the Dubbo Osteoporosis Epidemiology Study. J Bone Miner Res, 2015, 30(4): 637-646.
13. Ahmed LA, Center JR, Bj?rnerem A, et al. Progressively increasing fracture risk with advancing age after initial incident fragility fracture: the Troms? study. J Bone Miner Res, 2013, 28(10): 2214-2221.
14. Gu H, Shao B, Hu Y, et al. Epidemiological characteristics of traumatic spinal fractures among the elderly in China. Sci Rep, 2024, 14(1): 19170. doi: 10.1038/s41598-024-69780-y.
15. He Q, Yan Y, Mei J, et al. 3D-CT reconstruction for pedicle outer width assessment in patients with thoracolumbar spine fractures: a comparative analysis between age groups <60 years and ≥60 years. Front Surg, 2024, 11: 1407484. doi: 10.3389/fsurg.2024.1407484.
16. Shen Y, Shi Y, Gu X, et al. Using QCT for the prediction of spontaneous age- and gender-specific thoracolumbar vertebral fractures and accompanying distant vertebral fractures. BMC Musculoskelet Disord, 2024, 25(1): 828. doi: 10.1186/s12891-024-07961-6.
17. 張亞軍, 劉忠厚, 張鵬. 絕經后骨質疏松癥流行病學研究進展. 中國骨質疏松雜志, 2010, 16(3): 229-234.
18. Horst-Sikorska W, Wawrzyniak A. The role of hormonal therapy in osteoporosis. Endokrynol Pol, 2011, 62(1): 61-64.
19. 王洪偉, 李長青, 王建, 等. 老年人外傷性脊柱骨折的臨床特點. 中國脊柱脊髓雜志, 2012, 22(12): 1072-1076.
20. 陳國強, 方秀統, 俞猛. 老年外傷性脊柱骨折的臨床特點及預防分析. 上海交通大學學報(醫學版), 2014, 34(10): 1493-1496.
21. 趙凱平, 袁蕊, 馬楠, 等. 55歲以上原發骨質疏松性骨折患者特征及趨勢分析. 中國骨質疏松雜志, 2020, 26(6): 849-856.
22. 朱福林, 李洪濤, 何曼青. 中國式現代化高質量發展路徑研究. 全球化, 2025, (1): 84-94, 134-135.
23. 高子茗, 呂洋. 新業態發展與城市內部經濟不平衡. 財貿經濟, 2024, 45(9): 110-124.
24. 姜效韋, 朱冬梅, 王明宇, 等. 2 887例老年骨質疏松性脊柱壓縮性骨折流行病學特點分析. 醫藥前沿, 2024, 14(15): 8-11+15.
25. 丁立祥, 宋繼鵬. 骨質疏松性脊柱骨折的外科治療策略及發展趨勢. 中國骨傷, 2025, 38(2): 109-113.

Chinese Journal of Reparative and Reconstructive Surgery

Disease burden of spinal fractures in China from 1990 to 2021 and temporal trends: A comparative analysis based on the Global Burden of Disease Study 2021

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