A growing global burden: Insights from WHO and GBD
From 1990 to 2019, the absolute number of new fractures worldwide increased significantly, while prevalent cases also saw substantial growth. Although age-standardized rates showed a slight decline, the overall burden is rising due to global population growth and aging. Fractures contributed significantly to years lived with disability (YLDs) in 2019. The World Health Organization plays a leading role in initiatives like the UN Decade of Healthy Ageing to address this issue.
The link between aging, osteoporosis, and fragility fractures
Most fractures in older individuals are fragility fractures, occurring from low-energy trauma. These are a main consequence of osteoporosis, a condition characterized by reduced bone density. Fracture risk escalates with age and is higher in older women. Common sites include the hip, spine, wrist, and upper arm. Risk factors involve low bone mineral density and clinical factors assessed by tools like FRAX.
Key risk factors for fracture
Identifying risk factors is vital for effective prevention. Factors are divided into modifiable and non-modifiable categories.
Modifiable Risk Factors
- Lifestyle: Smoking and heavy alcohol use increase fracture risk.
- Nutrition: Insufficient vitamin D and calcium weaken bones.
- Physical Activity: Sedentary lifestyles lead to lower bone density and muscle weakness.
- Medication: Certain long-term medications can harm bone health.
- Falls: Falls are a major cause of fractures in older adults; balance training and home safety help reduce risk.
Non-Modifiable Risk Factors
- Age and Sex: Older age is a significant risk, with women facing higher risk after menopause.
- Genetics: A family history of fractures, especially hip fractures, increases risk.
- Ethnicity: Some ethnicities, like Caucasians, have a higher baseline risk.
- Prior Fractures: A previous fracture substantially increases the risk of subsequent fractures, especially in the following two years.
The socioeconomic dimension of fractures
The epidemiology of fractures is linked to socioeconomic status (SES). Lower individual SES, based on education or income, is associated with a higher incidence of fragility fractures. This may be due to factors like lower body weight and unhealthier lifestyles in disadvantaged groups. Fractures also impose a significant economic burden. Addressing socioeconomic inequalities is crucial for public health policy.
The global landscape: A comparative perspective
| Feature | Younger Adults | Older Adults |
|---|---|---|
| Primary Cause | High-energy trauma (e.g., sports, motor vehicle accidents) | Low-energy trauma (e.g., falls from standing height) |
| Common Locations (example) | Patella, tibia, fibula, ankle (high-impact sports injuries) | Hip, vertebral column, distal forearm (fragility fractures) |
| **Dominant Sex (general)*** | Males (higher participation in high-risk activities) | Females (osteoporosis risk post-menopause) |
| Risk Factors | Lifestyle, activity level, safety practices | Age, osteoporosis, falls, comorbidities, medications |
*While men have higher fracture rates in some age groups, women face a higher risk of fragility fractures over 50.
Preventive action and WHO’s response
Preventing fractures requires a multi-faceted approach. The WHO recommends healthy diets with calcium and vitamin D, regular physical activity, and avoiding smoking and excessive alcohol. Fall prevention is also key for older adults. Early detection and treatment of osteoporosis, using risk prediction tools, are vital. The WHO's Bone Health and Ageing Initiative focuses on preventing fractures in older populations. You can find more information on the WHO Fragility Fractures Fact Sheet.
Conclusion
Drawing on extensive epidemiological data, the WHO emphasizes that fractures, particularly in aging populations, are a major global health issue. The rising number of cases necessitates understanding factors like demographic changes, osteoporosis, lifestyle, and socioeconomic disparities. Implementing evidence-based prevention, detection, and management strategies is crucial to reduce the impact of these common and costly injuries.
