Forearm fractures are among the most common types of fractures worldwide. According to the Global Burden of Disease (GBD) 2019 study, the global incidence rate of forearm fractures in 2019 was estimated at 396.6 per 100,000, second only to fractures of the patella, tibia, fibula, or ankle, with a corresponding years lived with disability (YLDs) rate of 2.7 (1). Forearm fractures can result from direct or, more commonly, indirect trauma, typically resulting from falls (2). Osteoporosis is a significant risk factor (3).

The functional importance of the forearm is substantial, having a pivotal role in activities of daily living, occupational tasks, and recreational pursuits. Fractures can result in significant disability and decreased quality of life. The biomechanical and anatomical complexity of the forearm includes its joint structure and intricate musculature and tendons; together, these features add unique challenges to treatment and rehabilitation. Therefore, a clear understanding of the epidemiology of forearm fractures is essential to guide prevention efforts, optimize management strategies, and minimize their impact on individuals and society.

Current treatment focuses on restoring anatomical alignment and functional capacity. Surgical intervention may be necessary for unstable or displaced fractures when closed reduction is insufficient. With the global population aging, fracture incidence is increasing, particularly in the older adult. Forearm fractures in this group not only affect quality of life but also increase the burden on the medical system. The financial costs associated with treating forearm fractures impose a substantial economic burden on healthcare systems (4, 5).

Despite their prevalence, global epidemiological studies have not clearly identified the burden and trends of forearm fractures (6–10). Prior literature using GBD 2019 data lacked depth and did not incorporate the latest 2021 estimates (1). Little is known about how the burden varies across geographic regions, age, and gender. Given the significant health and socioeconomic impact, an updated, comprehensive analysis is needed to inform targeted interventions and allocate healthcare resources. Therefore, in the current study, we aimed to comprehensively examine the global, regional, and national burden and trends of forearm fractures from 1990 to 2021 using data from the GBD 2021.

The GBD study is a global health research initiative that offers a unique perspective on understanding trends and inequalities. GBD 2021 is the latest iteration of this ongoing effort, representing the forefront of global health epidemiology. It compiles evidence from multiple global data sources, representing a robust tool aimed at understanding the burden of diseases and injuries and informing public health interventions, ultimately contributing to evidence-based decision-making (11–13). The GBD 2021 study utilizes a wide range of input data, including demographic information, disease registries, and survey data, which undergo rigorous methodological processing to generate comparable estimates. The GBD encompasses 204 countries and territories, 371 diseases and injuries, and 88 risk factors, presenting a comprehensive landscape of global health.

We extracted data on the incidence and YLDs of radius and/or ulna fractures from 1990 to 2021 using the GBD Results tool.¹ The 95% uncertainty interval (UI) represented the 2.5th and 97.5th percentiles of the sampling distribution. The GBD 2021 established 21 GBD regions, each comprising multiple countries or territories with comparable characteristics, allowing focused research and policy formulation to address specific regional health challenges. We conducted a systematic assessment of the geographical, demographic, and temporal burden of forearm fractures. To quantify the trends between 1990 and 2021, the estimated annual percentage change (EAPC) was calculated with a 95% confidence interval (CI) (14); a positive EAPC indicates an increasing trajectory, while a negative EAPC denotes a decreasing trend. Additionally, we analyzed the leading causes of forearm fractures. Finally, the Das Gupta decomposition analysis was performed (15), which partitions the total variation into three distinct components: alterations in disease epidemiology, population change, and aging. Decomposition analysis assesses the independent impacts of each factor on the overall alterations in the disease burden. All statistical analyses and data visualization were conducted in R software (version 4.2.2).

The current study presents the most comprehensive global assessment of the forearm fractures from 1990 to 2021, offering valuable insights into the evolving disease burden. Forearm fractures are among the most common types of fractures, posing a significant threat to people’s health and wellbeing and imposing a substantial burden on healthcare systems. Therefore, investigating the temporal trends, geographic distribution, and demographic factors of forearm fractures is of great importance for policymakers and health-related sectors to develop targeted measures to address this issue. The current study found that although incidence and YLDs rates have declined or stabilized, absolute numbers continue to rise. The incidence rate of forearm fractures exhibits a bimodal distribution, peaking in youth and older adulthood. The higher burden among females, particularly those who are postmenopausal, aligns with known associations between osteoporosis and fracture risk. In recent years, the burden has shown a trend toward aging populations. Falls, road injuries, and exposure to mechanical forces were the three leading causes of forearm fractures, with falls being the most prominent.

This study also revealed variations in the geographic distribution of the disease burden of forearm fractures, which may be associated with climatic factors. In cold regions like Russia, icy and slippery ground conditions can increase the risk of forearm fracture caused by falling, especially for the older adult. On the other hand, cold temperatures can also negatively impact essential physical functions necessary for independent living among older individuals (16). Literature has identified winter as the peak season for forearm fractures in the older adult (10, 17), corroborating this idea. Besides, a Norwegian epidemiologic osteoporosis study showed that under conditions of low temperature, the risk of forearm fracture was augmented by as much as 53% (18).

We identified a bimodal age distribution, with high incidence rates among youth and older adults. Previous studies have shown that forearm fractures are a common type of fracture among adolescents (19). High levels of physical activity and participation in sports or manual labor during youth and adolescence, particularly among males, contribute to the risk of forearm fractures. Implementing safety education, promoting the use of protective equipment, and ensuring safe environments can help reduce the occurrence of forearm fractures in younger individuals.

The older adult population is another high-risk group. Our study found that due to population aging and structural changes in the disease pattern of forearm fractures, the older adult, especially women, will require particular attention. Previous literature has demonstrated that the incidence of forearm fractures in women significantly increases after menopause (6, 7, 10). Women tend to have a more delicate bone structure and lower bone density compared to men, making them more susceptible to forearm fractures when subjected to external forces. Additionally, postmenopausal women experience a significant decline in bone density, resulting in more severe osteoporosis and an increased risk of forearm fractures. Even minor falls can lead to forearm fractures in this population. Therefore, it is essential to implement fall prevention interventions, osteoporosis screening, and educational programs focusing on lifestyle factors for the older adult. There is a need to enhance bone mineral density assessment and management for postmenopausal women (20). Additionally, research has found that older adults who experience forearm fracture are at high risk of subsequent fractures (21); however, the prescription rate for anti-osteoporosis medications after forearm fractures in older adult patients is low, possibly due to overlooked assessments (22, 23). One previous study in France indicated that only 10% of women aged 50 and older underwent bone density assessment after a forearm fracture (24). Overall, in addition to orthopedic treatments, comprehensive osteoporosis assessments and continued follow-up are crucial for older adult patients with forearm fractures.

In our current study, we confirmed that the leading cause of forearm fractures is falls. Previous literature has also reported a strong association between falls and forearm fractures (25–27). Falls result in significant health losses and pose a substantial global burden (28). Previous studies have shown that in 2014, 28.7% of community-dwelling individuals aged 65 and older have experienced at least one fall per year, with an average of 0.67 falls per person-year (29). Falls among the older adult are a significant public health concern, resulting in considerable socioeconomic costs (30). With the increasing aging population, healthcare system faces a significant challenge regarding falls in older adults. The risk of falling is high among the older adult (31), which is associated with weakness and declining physical functions. Even minor falls can lead to osteoporotic fracture. Multifactorial fall risk assessments and targeted multi-component interventions are necessary to prevent falls in this population (32–34). These require interventions from physiological, psychological, and social aspects, as well as the active involvement and collaboration of policymakers, healthcare workers, and community managers, to establish a comprehensive fall prevention system for the older adult.

While the GBD 2021 represents a robust platform, it is not without limitations. Firstly, the GBD 2021 relies on multiple data sources that vary by country. Although this provides broad coverage, data quality and availability may differ by region; specifically, low-income countries may have sparse or lacking data, potentially affecting the accuracy. Secondly, the incidence and YLDs values for forearm fractures typically carry a degree of uncertainty. The GBD 2021 uses sophisticated modeling techniques to address these uncertainties, but some residual errors remain and need to be considered when interpreting our results. Thirdly, the GBD 2021 provides burden estimates disaggregated by age, gender, and geographic location; however, other demographic factors, such as race/ethnicity, may also influence the risk and outcomes of fractures. The potential impact of these factors may not be fully addressed, and they could be important in interpreting the results. Fourth, the impact of the COVID-19 pandemic was not addressed in the current study; however, we did identify an increasing burden in forearm fractures during the COVID-19 pandemic, which may have been related to restrictions on hospitalization and outpatient visits.

The incidence and YLDs number of forearm fractures have increased since 1990, with a higher burden among females. The incidence rate of forearm fractures displays a bimodal distribution, peaking in youth and older adults. The age pattern exhibits a trend toward aging populations. Falls continue to demonstrate the leading cause of forearm fractures, and the disease burden they impose is the most prominent among older adult females.