Declining Mortality and Rising Disability From Low Bone Mineral Density in Postmenopausal Women in China and G20 Countries.

IntroductionPopulation aging and age-related skeletal deterioration have made low bone mineral density (BMD) and fragility fractures major public health challenges among postmenopausal women. This study evaluates the 1994-2035 trends of low BMD-related burden among postmenopausal women in China and G20 countries.MethodsIn this population-based ecological study, we used GBD 2023 estimates to analyze deaths, disability-adjusted life years, years lived with disability, and years of life lost attributable to low bone mineral density among women aged 55 years and older in China and G20 countries from 1994 to 2023, with projections to 2035. Joinpoint regression, decomposition analysis, Age-Period-Cohort (APC), and Bayesian APC models were employed to assess historical drivers and project future trends.ResultsFrom 1994 to 2023, absolute low BMD burdens surged, primarily driven by population aging and growth. A "rate drops, volume surges" paradox emerged in China: age-standardized mortality decreased (AAPC=-0.60), while standardized YLDs significantly increased (AAPC=0.63). The APC model revealed exponential risk increases with biological age. BAPC projections indicate a steep, continuous escalation in absolute DALYs and YLDs through 2035.ConclusionLow BMD-related health loss among postmenopausal women is characterized by declining mortality but rising disability, indicating a shift from acute fatal outcomes to prolonged chronic functional loss. These findings highlight the need for early diagnosis, fracture liaison services, and integrated management strategies in aging populations.