Global Burden of Vertebral Fractures in Women by Menopausal Status, 1990–2021, With 2050 Projections: An Analysis of Global Burden of Disease 2021

Study DesignEco-epidemiological study.ObjectivesVertebral fractures (VFs) are a major cause of morbidity, disability, and mortality in women, with risk increasing sharply after menopause due to accelerated bone loss. However, global patterns of VF burden by menopausal status and long-term projections remain poorly characterized.MethodsWe analyzed Global Burden of Disease (GBD) 2021 data on VF incidence, prevalence, and years lived with disability (YLDs) for 204 countries from 1990-2021. Women were categorized as premenopausal (15-49 years) or postmenopausal (≥50 years). Age-standardized rates (ASRs) were calculated per 100,000 population. Temporal trends were assessed using estimated annual percentage change and joinpoint regression. Socio-demographic disparities were examined with Slope Index of Inequality and Concentration Index. Decomposition analysis quantified contributions of population growth, aging, and epidemiologic change. Bayesian age-period-cohort models projected trends to 2050.ResultsIn 2021, 1.15 million VFs occurred in premenopausal women and 1.63 million in postmenopausal women, causing 50,060 and 206,652 YLDs, respectively. Absolute VF counts rose substantially since 1990, although ASRs declined in most regions. Postmenopausal women bore the highest burden, with marked geographic heterogeneity and persistent pro-poor inequality. Population growth and aging were the main drivers of increasing burden, and projections indicate that absolute VF cases will continue to rise globally through 2050 despite modest ASR declines.ConclusionsThe global burden of vertebral fractures in women is rising in absolute terms, especially among postmenopausal women. Targeted osteoporosis screening, fall-prevention programs, and equitable treatment access are needed to mitigate the projected growth.