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| 1990-2050年绝经后女性骨质疏松跌倒负担预测 |
| Prediction of fall burden in postmenopausal women with osteoporosis from 1990 to 2050 |
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| DOI：10.3969/j.issn.1006-7108.2026.08.009 |
| 中文关键词: 绝经后女性 骨密度 跌倒 全球疾病负担 骨质疏松骨折 预测模型 老龄化 |
| 英文关键词:postmenopausal women bone mineral density falls Global Burden of Disease osteoporotic fracture predictive model aging |
| 基金项目:江西省卫生健康委科技计划资助（202410933） |
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| 中文摘要: |
| 目的 绝经后女性低骨密度（low bone mineral density，LBMD）相关的跌倒作为骨质疏松性骨折的重要诱因，已成为全球公共卫生治理的难点问题。当前针对其全球疾病负担异质性及预防策略的系统研究仍显不足。本研究基于健康公平视角，系统评估1990-2021年该群体LBMD相关跌倒的全球负担，并构建2050年趋势预测模型。方法 依托2021年全球疾病负担研究（GBD）数据库，建立包含年龄、社会人口指数（SDI）及地理区域的多维度分层框架。采用描述性分析、趋势分析、聚类分析及分解分析方法解析疾病特征，构建自回归整合移动平均(autoregressive integrated moving average, ARIMA)与指数平滑（exponential smoothing, ES）预测模型推演未来趋势。结果 2021年全球绝经后女性LBMD相关跌倒导致190 383人死亡（占全球总死亡人数的0.28%）和703万伤残调整生命年（DALYs）。与1990年相比，疾病绝对负担涨幅超100%，但年龄标准化率（ASR）呈现稳定态势。疾病负担呈现显著年龄依赖性，70岁后呈爆发式增长，80~84岁达峰值（死亡率ASR：73.6/10万）。空间分布呈现"双峰特征"：亚洲地区（印度、中国等人口大国）绝对负担居首，而低SDI区域ASR最高（死亡率ASR：8.42/10万）。趋势分析揭示"高负担三角区"（荷兰-澳大利亚-美国）与"防控示范区"（捷克-匈牙利）的典型空间地域差异。分解分析显示人口增长（贡献率125.1%）与老龄化是主要驱动因素。预测显示至2050年，死亡数（Deaths）可能增长28.7%（ARIMA）或8.7%（ES），ASR将维持稳定。结论 本研究首次揭示LBMD相关跌倒负担的“U型社会梯度”分布规律。建议低SDI地区推广FRAX等低成本筛查体系及社区干预项目，高SDI区域实施波兰膳食计划等个性化干预。“高负担三角区”凸显医疗体系适老化改造的紧迫性。全球协作机制的建立对落实联合国健康老龄化十年行动计划、降低可避免性伤残及死亡具有重要意义。 |
| 英文摘要: |
| Objective Falls associated with low bone mineral density (LBMD) in postmenopausal women, as a major cause of osteoporotic fractures, have become a challenging global public health issue. Currently, there is a lack of systematic research on the heterogeneity of the global disease burden and prevention strategies. This study, from the perspective of health equity, systematically evaluates the global burden of LBMD-related falls in this population from 1990 to 2021 and constructs a predictive trend model through 2050. Methods Data were obtained from the 2021 Global Burden of Disease (GBD) Study. We constructed a multidimensional framework stratified by age, sociodemographic index (SDI), and geographic region. Descriptive analysis, trend analysis, cluster analysis, and decomposition analysis were used to examine the disease burden. ARIMA and exponential smoothing (ES) models were applied to project future trends. Results In 2021, LBMD-related falls among postmenopausal women caused 190 383 deaths worldwide, accounting for 0.28% of all global deaths, and 7.03 million disability-adjusted life years (DALYs). Compared with 1990, the absolute burden increased by more than 100%, while age-standardized rates (ASRs) remained relatively stable. The burden was strongly age-related, rising steeply after age 70 and reaching its highest level at ages 80–84 (mortality ASR: 73.6 per 100 000). The geographic pattern showed two clear peaks: the absolute burden was highest in Asia, particularly in populous countries such as India and China, whereas the highest ASRs were seen in low-SDI regions (mortality ASR: 8.42 per 100 000). Trend analysis also revealed marked regional differences, with a “high-burden triangle” formed by the Netherlands, Australia, and the United States, and a “prevention model zone” represented by the Czech Republic and Hungary. Decomposition analysis showed that population growth (contribution rate: 125.1%) and aging were the main drivers of the increasing burden. Projections indicate that by 2050, deaths may rise by 28.7% under the ARIMA model or by 8.7% under the ES model, while ASRs are expected to remain stable. Conclusion This study identified a U-shaped social gradient in the burden of LBMD-related falls. In low-SDI regions, low-cost screening tools such as FRAX-based approach, together with community-based interventions, may be especially useful. In high-SDI regions, more individualized strategies, such as those used in Poland, may be more appropriate. The “high-burden triangle” points to the need for more age-friendly health systems. Global cooperation will be important for implementing the UN Decade of Healthy Ageing and reducing preventable disability and death. |
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