Global epidemiology of hip fractures in adults aged 70 years and older from 1990 to 2021: a cross-sectional analysis from Global Burden of Disease Study 2021

PURPOSE: Driven by population aging, osteoporosis, and the frequent coexistence of multiple chronic conditions, hip fractures mainly occur in adults aged ≥70 years. Nevertheless, the specific burden attributable to this population remains insufficiently understood. This study sought to address key gaps in the literature by analyzing the Global Burden of Disease 2021 dataset to investigate hip fracture patterns across age, sex, and sociodemographic index (SDI). METHODS: We extracted hip fracture incidence, prevalence, years lived with disability (YLD), and age-standardized rates from the Global Burden of Disease 2021 database and stratified the data by age, sex, SDI, and geographic regions. Temporal trends were assessed by Joinpoint Regression Analysis and average annual percentage change, while uncertainty intervals were calculated to reflect modeling variability. RESULTS: From 1990 to 2021, the global burden of hip fractures in adults aged ≥70 years increased significantly, with age-standardized prevalence rates climbing from 3521.6 to 4366.8 per 100,000 and age-standardized incidence rates increasing from 1866.9 to 2218.5 per 100,000, whereas the age-standardized YLD rate demonstrated minimal growth (384.4-386.5 per 100,000). Notably, a persistent gender gap was observed, with females bearing a higher absolute burden, while males exhibited significantly faster growth rates in prevalence, incidence, and YLD. Moreover, the burden increased dramatically with advancing age. Geographically, high-SDI regions retained the highest absolute caseload; middle-SDI regions exhibited the fastest-growing prevalence and incidence rates, whereas low-SDI regions recorded the highest YLD rate. CONCLUSIONS: Global hip fracture burden in adults aged ≥70 years arises from aging populations, biological vulnerabilities, and healthcare inequities. High-income nations face the largest caseloads due to demographic shifts, while low-resource settings grapple with rising disability rates from delayed diagnosis and limited care. Effective mitigation requires age-specific osteoporosis screening, fall prevention programs, and multidisciplinary care, demanding collaborative efforts for equitable resource allocation and regional-tailored strategies in aging populations worldwide.