Research on the burden of femoral fracture disease in China from 1990 to 2021 and future trends_Chinese Journal of Evidence-Based Medicine

Authors：

PAN Dongchuan ¹ , LI Huijing ² , LI Qinghua ³ , YUAN Chunli ¹ , TANG Xiaochun ¹ , SHI Kang ¹ , MO Dijuan ¹ , LI Xiang ^4,5 ,  LIU Ling ⁶ ,  HU Xiaoshen ³

1. Santai Hospital Affiliated to North Sichuan Medical College (The People's Hospital of Santai County), Mianyang 621100, P. R. China;
2. College of Clinical Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu 610075, P. R. China;
3. School of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu 610075, P .R. China;
4. College of Acupuncture and Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu 610075, P. R. China;
5. Key Laboratory of Acupuncture for Senile Disease (Chengdu University of TCM), Ministry of Education, Chengdu 610075, P. R. China;
5. Chengdu Bayi Orthopaedic Hospital China RongTong Medical Healthcare Group Co.Ltd, Chendu 610012, P. R. China;

Corresponding author：

LIU Ling, Email: 2622644@qq.com; HU Xiaoshen, Email: huxiaoshen@cdutcm.edu.cn

Keywords：

Burden of disease; Femoral fractures; Age-period-cohort model; Incidence; Prevalence

DOI：

10.7507/1672-2531.202503159

Video：

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Objective To analyze the changing trends in disease burden of femoral fractures in China from 1990 to 2021, evaluate the impacts of age, period, and cohort effects, and project the age-standardized prevalence rate and age-standardized incidence rates of femoral fractures from 2022 to 2036. Methods Utilizing open data from the 2021 Global Burden of Disease (GBD) study, this research characterized the disease burden of femoral fractures in China between 1990 and 2021, including trends in incidence, prevalence, and years lived with disability (YLDs). Age-standardized rates were calculated, and Joinpoint regression models were employed to estimate annual percentage changes (APC) and average annual percentage changes (AAPC). An age-period-cohort (APC) model was applied to quantify the effects of age, period, and birth cohort on disease burden. A Bayesian age-period-cohort (BAPC) model was further utilized to project age-standardized prevalence rates and age-standardized incidence rates from 2022 to 2036, with stratified analyses by age, sex, and time period. Results From 1990 to 2021, age-standardized prevalence (AAPC=0.138 5%), incidence (AAPC=0.294 2%), and YLD rates (AAPC=0.128 3%) exhibited sustained upward trends. Unintentional injuries constituted the predominant etiology of femoral fractures, followed by transport accidents and interpersonal violence/self-harm. In 2021, disease burden escalated with advancing age, with females over 60 years demonstrating significantly higher burdens than males. Age effect coefficients showed a monotonic increase, period effects displayed a U-shaped trajectory (decline followed by rebound), and cohort effects exhibited an inverted U-shaped pattern (rise then decline). Projections indicated continued growth in age-standardized prevalence rates and age-standardized incidence rates through 2036. Conclusion As the population aging intensifies in China, the disease burden of femoral fractures in our country remains extremely severe. Among them, the elderly female group has become the key focus for prevention and control due to the high prevalence of osteoporosis.

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2.	许锦兰, 李密, 吴淑华. 老年股骨骨折患者流行病学特点. 中国老年学杂志, 2021, 41(5): 995-997.
3.	饶莹, 李英芝, 岑霞. 聚焦解决模式下的护理干预对老年股骨骨折患者康复进程的影响. 基层医学论坛, 2024, 28(35): 94-96,106.
4.	任彦峰, 王丽燕, 宋佳璐, 等. 医护一体化模式在高龄股骨转子间骨折病人中的应用. 护理研究, 2023, 37(22): 4163-4165.
5.	魏伟娜, 石玉君, 樊志媛. 多学科康复联合舒适护理对老年股骨骨折患者康复效果及生活质量的影响. 医学理论与实践, 2023, 36(6): 1037-1040.
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10.	Wang Y, Wang Z, Chen B, et al. Global epidemiology of lower limb fractures: trends, burden, and projections from the GBD 2021 study. Bone, 2025, 193: 117420.
11.	Hoveidaei AH, Nakhostin-Ansari A, Heckmann ND, et al. Increasing burden of lower-extremity fractures in the Middle East and North Africa (MENA): a 30-year epidemiological analysis. J Bone Joint Surg Am, 2024, 106(5): 414-424.
12.	Gu H, Yan D, Li J, et al. Trends and future projections of incidence rate and mortality of rheumatoid arthritis in China: a systematic analysis based on GBD 2021 data. Clin Rheumatol, 2024, 43(9): 2799-2806.
13.	姚一民, 张聪, 檀臻炜, 等. 汶川与玉树地震伤员伤情分析及医疗救治的比较. 中国骨与关节损伤杂志, 2011, 26(5): 469-470.
14.	杨立明, 谢直跃, 熊敏. 股骨近端髓内钉修复青年股骨转子周围骨折: 3个月随访关节功能及并发症. 中国组织工程研究, 2015, 19(44): 7137-7141.
15.	Chen Q, Li T, Ding H, et al. Age-period-cohort analysis of epidemiological trends in pelvic fracture in China from 1992 to 2021 and forecasts for 2046. Front Public Health, 2024, 12: 1428068.
16.	祁丽, 柴培培, 翟铁民, 等. 1990-2021年我国骨质疏松疾病负担变化及趋势分析. 中国卫生经济, 2024, 43(12): 33-37,42.
17.	马远征, 王以朋, 刘强, 等. 中国老年骨质疏松诊疗指南(2018). 中国老年学杂志, 2019, 39(11): 2557-2575.
18.	Shojaa M, Von Stengel S, Schoene D, et al. Effect of exercise training on bone mineral density in post-menopausal women: a systematic review and meta-analysis of intervention studies. Front Physiol, 2020, 11: 652.
19.	邵佳申, 金柱成, 刘勃, 等. 2010年-2011年河北省老年髋部骨折的流行病学特征分析. 中国修复重建外科杂志, 2019, 3 3(10): 1287-1290.
20.	Gao J, Li Y. Relationship between muscle size and density and proximal femoral bone mineral density in elderly men with hip fractures across different age groups. J Orthop Surg Res, 2025, 20(1): 162.
21.	戴婷, 马彩莉, 周雅琴, 等. 老年人跌倒致骨折的影响因素研究. 现代预防医学, 2021, 48(14): 2608-2612.
22.	陈宇杰, 冷美玲. 太极拳运动对老年人平衡能力的干预研究. 武术研究, 2022, 7(1): 64-67.
23.	李兴国, 邓叶龙, 刘朝晖, 等. 中国老年髋部骨折流行性病学特征分析. 实用骨科杂志, 2021, 27(7): 601-606.
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29.	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): 580-592.
30.	Feng JN, Zhang CG, Li BH, et al. Global burden of hip fracture: the global burden of disease study. Osteoporos Int, 2024, 35(1): 41-52.

1. Tong YYF, Holmes S, Sefton A. Early bisphosphonate therapy post proximal femoral fracture fixation does not impact fracture healing: a systematic review and meta-analysis. ANZ J Surg, 2022, 92(11): 2840-2848.
2. 许锦兰, 李密, 吴淑华. 老年股骨骨折患者流行病学特点. 中国老年学杂志, 2021, 41(5): 995-997.
3. 饶莹, 李英芝, 岑霞. 聚焦解决模式下的护理干预对老年股骨骨折患者康复进程的影响. 基层医学论坛, 2024, 28(35): 94-96,106.
4. 任彦峰, 王丽燕, 宋佳璐, 等. 医护一体化模式在高龄股骨转子间骨折病人中的应用. 护理研究, 2023, 37(22): 4163-4165.
5. 魏伟娜, 石玉君, 樊志媛. 多学科康复联合舒适护理对老年股骨骨折患者康复效果及生活质量的影响. 医学理论与实践, 2023, 36(6): 1037-1040.
6. 王琳珏, 郭锐, 李钦宗, 等. “筋揉骨正”中医特色疗法在股骨粗隆间骨折术后康复中的应用. 世界中医药, 2024, 19(4): 537-541.
7. 宁吉喆. 第七次全国人口普查主要数据情况. 中国统计, 2021, (5): 4-5.
8. Yang W, Li G, Liu J. The incidence, prevalence, and health burden of hip fractures in China: data from the global burden of disease study 2019. Prev Med Rep, 2024, 38: 102622.
9. Wu J, Che Y, Zhang Y, et al. Global, regional, national trends of femur fracture and machine learning prediction: Comprehensive findings and questions from global burden of disease 1990-2019. J Orthop Translat, 2024, 46: 46-52.
10. Wang Y, Wang Z, Chen B, et al. Global epidemiology of lower limb fractures: trends, burden, and projections from the GBD 2021 study. Bone, 2025, 193: 117420.
11. Hoveidaei AH, Nakhostin-Ansari A, Heckmann ND, et al. Increasing burden of lower-extremity fractures in the Middle East and North Africa (MENA): a 30-year epidemiological analysis. J Bone Joint Surg Am, 2024, 106(5): 414-424.
12. Gu H, Yan D, Li J, et al. Trends and future projections of incidence rate and mortality of rheumatoid arthritis in China: a systematic analysis based on GBD 2021 data. Clin Rheumatol, 2024, 43(9): 2799-2806.
13. 姚一民, 张聪, 檀臻炜, 等. 汶川与玉树地震伤员伤情分析及医疗救治的比较. 中国骨与关节损伤杂志, 2011, 26(5): 469-470.
14. 杨立明, 谢直跃, 熊敏. 股骨近端髓内钉修复青年股骨转子周围骨折: 3个月随访关节功能及并发症. 中国组织工程研究, 2015, 19(44): 7137-7141.
15. Chen Q, Li T, Ding H, et al. Age-period-cohort analysis of epidemiological trends in pelvic fracture in China from 1992 to 2021 and forecasts for 2046. Front Public Health, 2024, 12: 1428068.
16. 祁丽, 柴培培, 翟铁民, 等. 1990-2021年我国骨质疏松疾病负担变化及趋势分析. 中国卫生经济, 2024, 43(12): 33-37,42.
17. 马远征, 王以朋, 刘强, 等. 中国老年骨质疏松诊疗指南(2018). 中国老年学杂志, 2019, 39(11): 2557-2575.
18. Shojaa M, Von Stengel S, Schoene D, et al. Effect of exercise training on bone mineral density in post-menopausal women: a systematic review and meta-analysis of intervention studies. Front Physiol, 2020, 11: 652.
19. 邵佳申, 金柱成, 刘勃, 等. 2010年-2011年河北省老年髋部骨折的流行病学特征分析. 中国修复重建外科杂志, 2019, 3 3(10): 1287-1290.
20. Gao J, Li Y. Relationship between muscle size and density and proximal femoral bone mineral density in elderly men with hip fractures across different age groups. J Orthop Surg Res, 2025, 20(1): 162.
21. 戴婷, 马彩莉, 周雅琴, 等. 老年人跌倒致骨折的影响因素研究. 现代预防医学, 2021, 48(14): 2608-2612.
22. 陈宇杰, 冷美玲. 太极拳运动对老年人平衡能力的干预研究. 武术研究, 2022, 7(1): 64-67.
23. 李兴国, 邓叶龙, 刘朝晖, 等. 中国老年髋部骨折流行性病学特征分析. 实用骨科杂志, 2021, 27(7): 601-606.
24. Iuliano S, Poon S, Robbins J, et al. Effect of dietary sources of calcium and protein on hip fractures and falls in older adults in residential care: cluster randomised controlled trial. BMJ, 2021, 375: n2364.
25. Hussain Z, Bin Sahl A, Hussain A, et al. Socioeconomic and demographic determinants of hip fracture incidence: a comprehensive analysis. Cureus, 2024, 16(9): e68790.
26. 韩杏梅, 金淑霞, 武剑, 等. 社区老年人群生活质量与骨折风险性的关系. 中国骨质疏松杂志, 2019, 25(6): 817-820.
27. Iuliano S, Poon S, Robbins J, et al. Effect of dietary sources of calcium and protein on hip fractures and falls in older adults in residential care: cluster randomised controlled trial. BMJ, 2021, 375: n2364.
28. 孟露, 刘福尧, 韩杉, 等. 老年股骨脆性骨折患者基于骨折联络服务模式的出院计划干预研究. 护理学杂志, 2023, 38(17): 1-4,24.
29. 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): 580-592.
30. Feng JN, Zhang CG, Li BH, et al. Global burden of hip fracture: the global burden of disease study. Osteoporos Int, 2024, 35(1): 41-52.

Chinese Journal of Evidence-Based Medicine

Latest ArticlesResearch on the burden of femoral fracture disease in China from 1990 to 2021 and future trends

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