Pub Date : 2025-10-14DOI: 10.1016/S2665-9913(25)00251-6
John D Pauling PhD , Prof Yannick Allanore PhD , Prof Maya H Buch PhD , Prof Maurizio Cutolo PhD , Prof Francesco Del Galdo PhD , Prof Christopher P Denton PhD , Stefano Di Donato MSc , Robyn T Domsic MD , Tracy Frech MD , Prof Ariane L Herrick MD , Prof Marco Matucci-Cerinic PhD , Prof Vanessa Smith PhD , Prof Marie-Elise Truchetet PhD , Michael Hughes PhD
Immune-mediated vascular endothelial injury is considered one of the earliest pathological features in systemic sclerosis and is thought to occur simultaneously within a broad range of organs, although typically clinically manifesting only as Raynaud's phenomenon in the early stages. Overt vascular systemic sclerosis manifestations include Raynaud's phenomenon, abnormal nailfold capillary morphology, digital ulcers, pulmonary arterial hypertension, cardiovascular disease (primary and coronary), telangiectasia, renal crisis, and gastric antral vascular ectasia. Tissue ischaemia might also contribute to aberrant tissue remodelling, resulting in calcinosis and fibrosis. Recognition of the substantial inter-relationship between these vascular complications is growing; examples of vascular treatment interventions targeting digital vasculopathy having off-target vascular benefits in other organs have been reported. In general, treatment of life-threatening vascular complications, such as pulmonary arterial hypertension, is not commenced until classifiable organ disease has occurred; however, the identification of robust prognostic biomarkers might allow such complications to be averted with preventative disease modification. In this Personal View, we describe the inter-relationship between vascular features of systemic sclerosis. We consider how these features might be exploited to establish a unified vascular conceptual framework that can inform the development of both predictive composite indices to guide preventative intervention, and a unified vascular composite endpoint model that can effectively capture clinically meaningful disease modification in future clinical trials of vasoactive treatments in systemic sclerosis.
{"title":"Exploiting a unified vascular framework to predict organ-specific complications and accomplish disease modification in systemic sclerosis","authors":"John D Pauling PhD , Prof Yannick Allanore PhD , Prof Maya H Buch PhD , Prof Maurizio Cutolo PhD , Prof Francesco Del Galdo PhD , Prof Christopher P Denton PhD , Stefano Di Donato MSc , Robyn T Domsic MD , Tracy Frech MD , Prof Ariane L Herrick MD , Prof Marco Matucci-Cerinic PhD , Prof Vanessa Smith PhD , Prof Marie-Elise Truchetet PhD , Michael Hughes PhD","doi":"10.1016/S2665-9913(25)00251-6","DOIUrl":"10.1016/S2665-9913(25)00251-6","url":null,"abstract":"<div><div>Immune-mediated vascular endothelial injury is considered one of the earliest pathological features in systemic sclerosis and is thought to occur simultaneously within a broad range of organs, although typically clinically manifesting only as Raynaud's phenomenon in the early stages. Overt vascular systemic sclerosis manifestations include Raynaud's phenomenon, abnormal nailfold capillary morphology, digital ulcers, pulmonary arterial hypertension, cardiovascular disease (primary and coronary), telangiectasia, renal crisis, and gastric antral vascular ectasia. Tissue ischaemia might also contribute to aberrant tissue remodelling, resulting in calcinosis and fibrosis. Recognition of the substantial inter-relationship between these vascular complications is growing; examples of vascular treatment interventions targeting digital vasculopathy having off-target vascular benefits in other organs have been reported. In general, treatment of life-threatening vascular complications, such as pulmonary arterial hypertension, is not commenced until classifiable organ disease has occurred; however, the identification of robust prognostic biomarkers might allow such complications to be averted with preventative disease modification. In this Personal View, we describe the inter-relationship between vascular features of systemic sclerosis. We consider how these features might be exploited to establish a unified vascular conceptual framework that can inform the development of both predictive composite indices to guide preventative intervention, and a unified vascular composite endpoint model that can effectively capture clinically meaningful disease modification in future clinical trials of vasoactive treatments in systemic sclerosis.</div></div>","PeriodicalId":48540,"journal":{"name":"Lancet Rheumatology","volume":"7 12","pages":"Pages e895-e906"},"PeriodicalIF":16.4,"publicationDate":"2025-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145313911","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-30DOI: 10.1016/S2665-9913(25)00231-0
Ryan Malcolm Hum MBChB , Maria Christofi PhD , Samantha Louise Smith PhD , Lysette Michele Marshall MSc , Darren Plant PhD , Sebastien Viatte PhD , Prof Pauline Ho PhD , Paul Martin PhD , Prof Anne Barton PhD
Although psoriatic arthritis and rheumatoid arthritis are both common types of inflammatory arthritis characterised by synovial inflammation, there are distinct molecular and cellular landscapes between these conditions. Recent advances in synovial research in psoriatic arthritis have begun to unlock important insights into disease pathogenesis and potential clinical applications. For example, studies using high-dimensional technologies have identified psoriatic arthritis-specific macrophage, fibroblast, and mast cell subsets, as well as specific cytokines, such as IL-36 and IL-41, that drive pathogenesis. This Review explores how research of the synovium has advanced the understanding of psoriatic arthritis, the potential of identified cell types and cytokines as biomarkers and novel therapeutic targets, how limited sample sizes in high-dimensional studies are hindering clinical translation, and the future directions for synovial research in psoriatic arthritis.
{"title":"Synovial immunopathology in psoriatic arthritis: cellular and molecular insights","authors":"Ryan Malcolm Hum MBChB , Maria Christofi PhD , Samantha Louise Smith PhD , Lysette Michele Marshall MSc , Darren Plant PhD , Sebastien Viatte PhD , Prof Pauline Ho PhD , Paul Martin PhD , Prof Anne Barton PhD","doi":"10.1016/S2665-9913(25)00231-0","DOIUrl":"10.1016/S2665-9913(25)00231-0","url":null,"abstract":"<div><div>Although psoriatic arthritis and rheumatoid arthritis are both common types of inflammatory arthritis characterised by synovial inflammation, there are distinct molecular and cellular landscapes between these conditions. Recent advances in synovial research in psoriatic arthritis have begun to unlock important insights into disease pathogenesis and potential clinical applications. For example, studies using high-dimensional technologies have identified psoriatic arthritis-specific macrophage, fibroblast, and mast cell subsets, as well as specific cytokines, such as IL-36 and IL-41, that drive pathogenesis. This Review explores how research of the synovium has advanced the understanding of psoriatic arthritis, the potential of identified cell types and cytokines as biomarkers and novel therapeutic targets, how limited sample sizes in high-dimensional studies are hindering clinical translation, and the future directions for synovial research in psoriatic arthritis.</div></div>","PeriodicalId":48540,"journal":{"name":"Lancet Rheumatology","volume":"7 11","pages":"Pages e808-e822"},"PeriodicalIF":16.4,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145226115","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-29DOI: 10.1016/S2665-9913(25)00258-9
Tamandeep K Bharaj , Kathrine Skarstein
{"title":"Can AI be used to classify the focus score in Sjögren's disease?","authors":"Tamandeep K Bharaj , Kathrine Skarstein","doi":"10.1016/S2665-9913(25)00258-9","DOIUrl":"10.1016/S2665-9913(25)00258-9","url":null,"abstract":"","PeriodicalId":48540,"journal":{"name":"Lancet Rheumatology","volume":"7 12","pages":"Pages e829-e830"},"PeriodicalIF":16.4,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145214190","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-29DOI: 10.1016/S2665-9913(25)00181-X
Julien Duquesne MSc , Louis Basseto MSc , Charlotte Claye MSc , Prof Michael Barnes PhD , Elena Pontarini MD , Amaya Gallagher-Syed MSc , Prof Michele Bombardieri MD , Prof Benjamin A Fisher MD , Saba Nayar MD , Rachel Brown MD , Prof Athanasios Tzioufas MD , Prof Andreas Goules MD , Loukas Chatzis MD , Kyle Thompson MD , Joe Berry MD , Prof Wan-Fai Ng MD , Matilde Bandeira MD , Prof Vasco C Romão MD , Maria Dolores López-Presa MD , Prof Gaetane Nocturne MD , Samuel Bitoun MD
Background
The classification of Sjögren's disease partly relies on focus score grading from a minor salivary gland biopsy. Expert regrading of the focus score leads to disease reclassification in half of cases. This study aimed to leverage machine learning to automatically classify the focus score and Sjögren's disease to identify new histological disease subtypes based on minor salivary gland biopsy.
Methods
This retrospective cohort study included minor salivary gland biopsy scanned haematoxylin and eosin slides from six expert centres (three centres in the UK and one each in Greece, Portugal, and France) of the European H2020 NECESSITY consortium. Participants with sicca but without Sjögren's disease and patients with Sjögren's disease and a focus score of either at least 1 or less than 1 where included. All patients with Sjögren's disease fulfilled the American College of Rheumatology–European League Against Rheumatism 2016 criteria. A deep learning model was trained on slides from five centres and validated on slides from the sixth centre. The primary outcome was the area under the receiver operator curve (AUROC) to classify the focus score and Sjögren's disease. Shapley values, an explainable machine learning technology, were computed to identify histological patterns driving the model's classification. People with lived experience of Sjögren's disease were involved in the decision to fund this research and in the dissemination of the findings.
Findings
The study was conducted between Oct 13, 2021, and Sept 5, 2024, and included 545 participants with a mean age of 54·2 (SD 13·5); 490 (90%) were female and 55 (10%) were male. After external validation, the model had an AUROC of 0·88 (95% CI 0·82–0·94) for the focus score classification task and an AUROC of 0·89 (0·82–0·94) for Sjögren's disease classification. The performance of Sjögren's disease classification for patients who were negative for anti-Sjögren's syndrome-related antigen A was 0·92 (0·87–1·00). Of histological patterns identified by the model, a new pattern of CD8+ T cells around acinar epithelial cells was associated with Sjögren's disease diagnosis.
Interpretation
This study showed that deep learning can reliably classify the focus score and Sjögren's disease using minor salivary gland biopsy exclusively. The study identified that CD8+ T-cell infiltration in acini was associated with Sjögren's disease. Further studies are needed to validate the models.
Funding
Société Française de Rhumatologie, European Alliance of Associations for Rheumatology.
{"title":"Machine learning to classify the focus score and Sjögren's disease using digitalised salivary gland biopsies: a retrospective cohort study","authors":"Julien Duquesne MSc , Louis Basseto MSc , Charlotte Claye MSc , Prof Michael Barnes PhD , Elena Pontarini MD , Amaya Gallagher-Syed MSc , Prof Michele Bombardieri MD , Prof Benjamin A Fisher MD , Saba Nayar MD , Rachel Brown MD , Prof Athanasios Tzioufas MD , Prof Andreas Goules MD , Loukas Chatzis MD , Kyle Thompson MD , Joe Berry MD , Prof Wan-Fai Ng MD , Matilde Bandeira MD , Prof Vasco C Romão MD , Maria Dolores López-Presa MD , Prof Gaetane Nocturne MD , Samuel Bitoun MD","doi":"10.1016/S2665-9913(25)00181-X","DOIUrl":"10.1016/S2665-9913(25)00181-X","url":null,"abstract":"<div><h3>Background</h3><div>The classification of Sjögren's disease partly relies on focus score grading from a minor salivary gland biopsy. Expert regrading of the focus score leads to disease reclassification in half of cases. This study aimed to leverage machine learning to automatically classify the focus score and Sjögren's disease to identify new histological disease subtypes based on minor salivary gland biopsy.</div></div><div><h3>Methods</h3><div>This retrospective cohort study included minor salivary gland biopsy scanned haematoxylin and eosin slides from six expert centres (three centres in the UK and one each in Greece, Portugal, and France) of the European H2020 NECESSITY consortium. Participants with sicca but without Sjögren's disease and patients with Sjögren's disease and a focus score of either at least 1 or less than 1 where included. All patients with Sjögren's disease fulfilled the American College of Rheumatology–European League Against Rheumatism 2016 criteria. A deep learning model was trained on slides from five centres and validated on slides from the sixth centre. The primary outcome was the area under the receiver operator curve (AUROC) to classify the focus score and Sjögren's disease. Shapley values, an explainable machine learning technology, were computed to identify histological patterns driving the model's classification. People with lived experience of Sjögren's disease were involved in the decision to fund this research and in the dissemination of the findings.</div></div><div><h3>Findings</h3><div>The study was conducted between Oct 13, 2021, and Sept 5, 2024, and included 545 participants with a mean age of 54·2 (SD 13·5); 490 (90%) were female and 55 (10%) were male. After external validation, the model had an AUROC of 0·88 (95% CI 0·82–0·94) for the focus score classification task and an AUROC of 0·89 (0·82–0·94) for Sjögren's disease classification. The performance of Sjögren's disease classification for patients who were negative for anti-Sjögren's syndrome-related antigen A was 0·92 (0·87–1·00). Of histological patterns identified by the model, a new pattern of CD8<sup>+</sup> T cells around acinar epithelial cells was associated with Sjögren's disease diagnosis.</div></div><div><h3>Interpretation</h3><div>This study showed that deep learning can reliably classify the focus score and Sjögren's disease using minor salivary gland biopsy exclusively. The study identified that CD8<sup>+</sup> T-cell infiltration in acini was associated with Sjögren's disease. Further studies are needed to validate the models.</div></div><div><h3>Funding</h3><div>Société Française de Rhumatologie, European Alliance of Associations for Rheumatology.</div></div>","PeriodicalId":48540,"journal":{"name":"Lancet Rheumatology","volume":"7 12","pages":"Pages e864-e872"},"PeriodicalIF":16.4,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145214337","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-17DOI: 10.1016/S2665-9913(25)00130-4
Jasvinder A Singh, Larry R Hearld, Seth Eisen, W Winn Chatham, Sonali Narain, Narender Annapureddy, Diane L Kamen, Kimberly Trotter, Vikas Majithia, Cathy Lee Ching, Zineb Aouhab, Swamy Venuturupalli, Daniel J Wallace, Rosalind Ramsey-Goldman, Alfred H J Kim, Maureen McMahon, S Sam Lim, Kalpana Bhairavarasu, Alexa Meara, Kenneth Kalunian, Mark Beasley
<p><strong>Background: </strong>Data on patient decision making for people with systemic lupus erythematosus (SLE) are scarce. We previously showed that an evidence-based SLE patient decision aid was more effective than the SLE information pamphlet provided by the American College of Rheumatology in reducing decisional conflict for the choice of immunosuppressive medications in women with lupus nephritis, with higher acceptability and feasibility. The aim of this study was to assess patient outcomes from the implementation of this SLE patient decision aid on disease management in people with SLE.</p><p><strong>Methods: </strong>This prospective implementation study was done in 15 geographically diverse rheumatology clinics across the USA. Adults aged 18 years or older with a diagnosis of SLE identified based on a medical record review were included. There were no exclusion criteria. Participants were invited to view the computerised SLE patient decision aid, provided through a touchscreen tablet, a website, or a smartphone app during a regular clinic visit with their rheumatologist at baseline (viewing at follow-up visits was optional). Participants viewed either the full or abbreviated (lite) version, based on SLE disease activity and treatment, as recommended by their rheumatologist. Participants completed validated computerised surveys at each of the baseline, 3-month, and 6-month clinic visits on touchpad computers or their mobile phone (depending on patient preference). These surveys included questions related to patient decisional conflict, shared decision making, patient-physician communication, and perceived acceptability and feasibility of the decision aid. The main outcome of this study was to assess the impact of the SLE patient decision aid (both full and lite versions) on patient decisional conflict, shared decision making, patient-provider communication, and perceived acceptability and feasibility. The study had a multistakeholder committee that included people with lived experience of SLE. This study was registered at ClinicalTrials.gov, NCT03735238.</p><p><strong>Findings: </strong>Between May 23, 2019, and Dec 12, 2023, 2005 patients with SLE were assessed for eligibility and 1895 were included in the study. Study participants had a mean age of 44·7 years (SD 14·4); of the 1855 respondents with data on sex, 1731 (93·3%) were female and 124 (6·7%) were male; of the 1832 respondents with data on race, 827 (45·1%) were African American. Patient outcomes were either good or excellent at the baseline visit after viewing the SLE patient decision aid, including preparation for decision making. The mean Low Literacy Decisional Conflict Scale score was low at 19·5 (SD 23·8); 1351 (82·8%) of 1631 participants matched with their preferred role versus their actual role in treatment decision making (using the control preferences scale); the mean CollaboRATE score was 25·2 (SD 4·1; for patient involvement in shared decision making); the mean p
{"title":"Patient outcomes from implementing a shared decision-making aid for systemic lupus erythematosus: a prospective implementation study.","authors":"Jasvinder A Singh, Larry R Hearld, Seth Eisen, W Winn Chatham, Sonali Narain, Narender Annapureddy, Diane L Kamen, Kimberly Trotter, Vikas Majithia, Cathy Lee Ching, Zineb Aouhab, Swamy Venuturupalli, Daniel J Wallace, Rosalind Ramsey-Goldman, Alfred H J Kim, Maureen McMahon, S Sam Lim, Kalpana Bhairavarasu, Alexa Meara, Kenneth Kalunian, Mark Beasley","doi":"10.1016/S2665-9913(25)00130-4","DOIUrl":"10.1016/S2665-9913(25)00130-4","url":null,"abstract":"<p><strong>Background: </strong>Data on patient decision making for people with systemic lupus erythematosus (SLE) are scarce. We previously showed that an evidence-based SLE patient decision aid was more effective than the SLE information pamphlet provided by the American College of Rheumatology in reducing decisional conflict for the choice of immunosuppressive medications in women with lupus nephritis, with higher acceptability and feasibility. The aim of this study was to assess patient outcomes from the implementation of this SLE patient decision aid on disease management in people with SLE.</p><p><strong>Methods: </strong>This prospective implementation study was done in 15 geographically diverse rheumatology clinics across the USA. Adults aged 18 years or older with a diagnosis of SLE identified based on a medical record review were included. There were no exclusion criteria. Participants were invited to view the computerised SLE patient decision aid, provided through a touchscreen tablet, a website, or a smartphone app during a regular clinic visit with their rheumatologist at baseline (viewing at follow-up visits was optional). Participants viewed either the full or abbreviated (lite) version, based on SLE disease activity and treatment, as recommended by their rheumatologist. Participants completed validated computerised surveys at each of the baseline, 3-month, and 6-month clinic visits on touchpad computers or their mobile phone (depending on patient preference). These surveys included questions related to patient decisional conflict, shared decision making, patient-physician communication, and perceived acceptability and feasibility of the decision aid. The main outcome of this study was to assess the impact of the SLE patient decision aid (both full and lite versions) on patient decisional conflict, shared decision making, patient-provider communication, and perceived acceptability and feasibility. The study had a multistakeholder committee that included people with lived experience of SLE. This study was registered at ClinicalTrials.gov, NCT03735238.</p><p><strong>Findings: </strong>Between May 23, 2019, and Dec 12, 2023, 2005 patients with SLE were assessed for eligibility and 1895 were included in the study. Study participants had a mean age of 44·7 years (SD 14·4); of the 1855 respondents with data on sex, 1731 (93·3%) were female and 124 (6·7%) were male; of the 1832 respondents with data on race, 827 (45·1%) were African American. Patient outcomes were either good or excellent at the baseline visit after viewing the SLE patient decision aid, including preparation for decision making. The mean Low Literacy Decisional Conflict Scale score was low at 19·5 (SD 23·8); 1351 (82·8%) of 1631 participants matched with their preferred role versus their actual role in treatment decision making (using the control preferences scale); the mean CollaboRATE score was 25·2 (SD 4·1; for patient involvement in shared decision making); the mean p","PeriodicalId":48540,"journal":{"name":"Lancet Rheumatology","volume":" ","pages":""},"PeriodicalIF":16.4,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12817298/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145103032","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-17DOI: 10.1016/S2665-9913(25)00282-6
Talha Burki
{"title":"Enabling and supporting public and patient involvement in arthritis research.","authors":"Talha Burki","doi":"10.1016/S2665-9913(25)00282-6","DOIUrl":"https://doi.org/10.1016/S2665-9913(25)00282-6","url":null,"abstract":"","PeriodicalId":48540,"journal":{"name":"Lancet Rheumatology","volume":" ","pages":""},"PeriodicalIF":16.4,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145103039","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-16DOI: 10.1016/S2665-9913(25)00105-5
<div><h3>Background</h3><div>Fractures related to osteoporosis and low bone mineral density lead to substantial morbidity, mortality, and cost to individuals and health systems. Here we present the most up-to-date global, regional, and national estimates of the contribution of low bone mineral density to the burden of fractures from falls and additional categories of injuries from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021.</div></div><div><h3>Methods</h3><div>The burden of low bone mineral density was estimated from 1990 to 2020 in terms of years lived with disability (YLDs), disability-adjusted life years (DALYs), and deaths, for individuals aged 40 years and older, using data from population-based studies from 48 countries or territories (169 unique sources). Mean standardised femoral neck bone mineral density values were estimated by GBD location, age, and sex by meta-regression. Based on a separate meta-analysis of population-based studies from nine countries (12 unique sources), we also estimated the pooled relative risk of fractures per unit decrease in bone mineral density (g/cm<sup>2</sup>). The population-attributable fraction for low bone mineral density was calculated by comparing the observed distributions of standardised femoral neck bone mineral density to an age-specific and sex-specific counterfactual distribution, defined as the 99th percentile of five rounds of the National Health and Nutrition Examination Survey in the USA, by 5-year age group and sex. Hospital and emergency department data were used to derive the incidence of fractures for six categories of injury (road injuries, other transport injuries, falls, non-venomous animal contact, exposure to mechanical forces, and physical interpersonal violence) using ICD codes. Deaths due to fractures were estimated as the proportion of in-hospital deaths due to the specified injury causes for which a fracture (nature of injury code) was more severe than the cause of injury code. YLDs and DALYs attributable to low bone mineral density by cause of injury were also determined according to previous GBD methods.</div></div><div><h3>Findings</h3><div>In 2020, 8·32 million (95% UI 5·58–10·84) YLDs, 17·2 million (14·1–20·2) DALYs, and 477 000 (411 000–536 000) deaths were attributable to low bone mineral density globally in individuals aged 40 years and older. Between 1990 and 2020, global YLDs, DALYs, and deaths attributable to low bone mineral density increased by 91·8% (88·5–95·1), 89·8% (81·5–99·0), and 127·1% (108·5–144·5), respectively. Over this period, the age-standardised global rates of YLDs, DALYs, and deaths attributable to low bone mineral density showed modest decreases. In 2020, falls accounted for 76·2% (95% UI 74·2–78·3) of YLDs, 65·2% (62·9–67·6) of DALYs, and 71·0% (67·4–72·8) of deaths attributable to low bone mineral density, and road injuries largely accounted for the remaining amount: 12·4% (11·1–13·6) of YLDs, 24·6% (22·5–27·1) of
{"title":"The global, regional, and national burden attributable to low bone mineral density, 1990–2020: an analysis of a modifiable risk factor from the Global Burden of Disease Study 2021","authors":"","doi":"10.1016/S2665-9913(25)00105-5","DOIUrl":"10.1016/S2665-9913(25)00105-5","url":null,"abstract":"<div><h3>Background</h3><div>Fractures related to osteoporosis and low bone mineral density lead to substantial morbidity, mortality, and cost to individuals and health systems. Here we present the most up-to-date global, regional, and national estimates of the contribution of low bone mineral density to the burden of fractures from falls and additional categories of injuries from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021.</div></div><div><h3>Methods</h3><div>The burden of low bone mineral density was estimated from 1990 to 2020 in terms of years lived with disability (YLDs), disability-adjusted life years (DALYs), and deaths, for individuals aged 40 years and older, using data from population-based studies from 48 countries or territories (169 unique sources). Mean standardised femoral neck bone mineral density values were estimated by GBD location, age, and sex by meta-regression. Based on a separate meta-analysis of population-based studies from nine countries (12 unique sources), we also estimated the pooled relative risk of fractures per unit decrease in bone mineral density (g/cm<sup>2</sup>). The population-attributable fraction for low bone mineral density was calculated by comparing the observed distributions of standardised femoral neck bone mineral density to an age-specific and sex-specific counterfactual distribution, defined as the 99th percentile of five rounds of the National Health and Nutrition Examination Survey in the USA, by 5-year age group and sex. Hospital and emergency department data were used to derive the incidence of fractures for six categories of injury (road injuries, other transport injuries, falls, non-venomous animal contact, exposure to mechanical forces, and physical interpersonal violence) using ICD codes. Deaths due to fractures were estimated as the proportion of in-hospital deaths due to the specified injury causes for which a fracture (nature of injury code) was more severe than the cause of injury code. YLDs and DALYs attributable to low bone mineral density by cause of injury were also determined according to previous GBD methods.</div></div><div><h3>Findings</h3><div>In 2020, 8·32 million (95% UI 5·58–10·84) YLDs, 17·2 million (14·1–20·2) DALYs, and 477 000 (411 000–536 000) deaths were attributable to low bone mineral density globally in individuals aged 40 years and older. Between 1990 and 2020, global YLDs, DALYs, and deaths attributable to low bone mineral density increased by 91·8% (88·5–95·1), 89·8% (81·5–99·0), and 127·1% (108·5–144·5), respectively. Over this period, the age-standardised global rates of YLDs, DALYs, and deaths attributable to low bone mineral density showed modest decreases. In 2020, falls accounted for 76·2% (95% UI 74·2–78·3) of YLDs, 65·2% (62·9–67·6) of DALYs, and 71·0% (67·4–72·8) of deaths attributable to low bone mineral density, and road injuries largely accounted for the remaining amount: 12·4% (11·1–13·6) of YLDs, 24·6% (22·5–27·1) of ","PeriodicalId":48540,"journal":{"name":"Lancet Rheumatology","volume":"7 12","pages":"Pages e873-e894"},"PeriodicalIF":16.4,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145092803","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
扫码关注我们
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号