title: The global burden attributable to low bone mineral density.
abstract: BACKGROUND
  The Global Burden of Disease Study 2010 estimated the worldwide health burden of 291 diseases and injuries and 67 risk factors by calculating disability-adjusted life years (DALYs). Osteoporosis was not considered as a disease, and bone mineral density (BMD) was analysed as a risk factor for fractures, which formed part of the health burden due to falls.
  
  
  OBJECTIVE
  To calculate (1) the global distribution of BMD, (2) its population attributable fraction (PAF) for fractures and subsequently for falls, and (3) the number of DALYs due to BMD.
  
  
  METHODS
  A systematic review was performed seeking population-based studies in which BMD was measured by dual-energy X-ray absorptiometry at the femoral neck in people aged 50 years and over. Age- and sex-specific mean ± SD BMD values (g/cm(2)) were extracted from eligible studies. Comparative risk assessment methodology was used to calculate PAFs of BMD for fractures. The theoretical minimum risk exposure distribution was estimated as the age- and sex-specific 90th centile from the Third National Health and Nutrition Examination Survey (NHANES III). Relative risks of fractures were obtained from a previous meta-analysis. Hospital data were used to calculate the fraction of the health burden of falls that was due to fractures.
  
  
  RESULTS
  Global deaths and DALYs attributable to low BMD increased from 103 000 and 3 125 000 in 1990 to 188 000 and 5 216 000 in 2010, respectively. The percentage of low BMD in the total global burden almost doubled from 1990 (0.12%) to 2010 (0.21%). Around one-third of falls-related deaths were attributable to low BMD.
  
  
  CONCLUSIONS
  Low BMD is responsible for a growing global health burden, only partially representative of the real burden of osteoporosis.
authors.affiliation: Northern Clinical School, Institute of Bone and Joint Research, University of Sydney, St Leonards, New South Wales, Australia Institut d'Investigació Biomèdica de Bellvitge, Hospital Universitari de Bellvitge, Departament de Reumatologia, L'Hospitalet de Llobregat, Barcelona, Spain.
authors.forename: L
authors.initials: L
authors.lastname: Sànchez-Riera
authors.affiliation: Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA.
authors.forename: E
authors.initials: E
authors.lastname: Carnahan
authors.affiliation: Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA.
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authors.lastname: Vos
authors.affiliation: School of Population Health, University of Queensland, Herston, Queensland, Australia.
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authors.lastname: Veerman
authors.affiliation: School of Population Health, University of Queensland, Herston, Queensland, Australia Queensland Children's Medical Research Institute, University of Queensland, Herston, Queensland, Australia.
authors.forename: R
authors.initials: R
authors.lastname: Norman
authors.affiliation: Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA.
authors.forename: S S
authors.initials: SS
authors.lastname: Lim
authors.affiliation: School of Population Health, University of Queensland, Herston, Queensland, Australia.
authors.forename: D
authors.initials: D
authors.lastname: Hoy
authors.affiliation: Northern Clinical School, Institute of Bone and Joint Research, University of Sydney, St Leonards, New South Wales, Australia.
authors.forename: E
authors.initials: E
authors.lastname: Smith
authors.affiliation: Northern Clinical School, Institute of Bone and Joint Research, University of Sydney, St Leonards, New South Wales, Australia.
authors.forename: N
authors.initials: N
authors.lastname: Wilson
authors.affiliation: Institut d'Investigació Biomèdica de Bellvitge, Hospital Universitari de Bellvitge, Departament de Reumatologia, L'Hospitalet de Llobregat, Barcelona, Spain.
authors.forename: J M
authors.initials: JM
authors.lastname: Nolla
authors.affiliation: Northern Clinical School, Institute of Bone and Joint Research, University of Sydney, St Leonards, New South Wales, Australia.
authors.forename: J S
authors.initials: JS
authors.lastname: Chen
authors.affiliation: Northern Clinical School, Institute of Bone and Joint Research, University of Sydney, St Leonards, New South Wales, Australia.
authors.forename: M
authors.initials: M
authors.lastname: Macara
authors.affiliation: University of New South Wales, New South Wales, Australia.
authors.forename: N
authors.initials: N
authors.lastname: Kamalaraj
authors.affiliation: The George Institute for Global Health, University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Y
authors.initials: Y
authors.lastname: Li
authors.affiliation: Northern Clinical School, Institute of Bone and Joint Research, University of Sydney, St Leonards, New South Wales, Australia.
authors.forename: C
authors.initials: C
authors.lastname: Kok
authors.affiliation: Centro Universitario del Sur, CUSUR, Universidad de Guadalajara, Guadalajara, Jalisco, Mexico.
authors.forename: C
authors.initials: C
authors.lastname: Santos-Hernández
authors.affiliation: Northern Clinical School, Institute of Bone and Joint Research, University of Sydney, St Leonards, New South Wales, Australia.
authors.forename: L
authors.initials: L
authors.lastname: March
mesh_terms: D000058:Accidental Falls / Q000706:statistics & numerical data; D015519:Bone Density / Q000502:physiology; D005272:Femur Neck / Q000503:physiopathology; D014943:Global Health / Q000706:statistics & numerical data*; D006801:Humans; D010024:Osteoporosis / Q000453:epidemiology* / Q000503:physiopathology; D058866:Osteoporotic Fractures / Q000453:epidemiology / Q000503:physiopathology; D019057:Quality-Adjusted Life Years; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors