October 1999 Bulletin

Musculoskeletal conditions in the U.S.

Academy publication documents huge impact on society

Millions of Americans-young and old, sturdy and frail-are afflicted with musculoskeletal conditions that limit their productivity, distract them with pain, rob some of their independent living and cost the economy billions of dollars each year.

The impact on the quality of life and the nation is so huge that it's difficult to grasp.

Musculoskeletal conditions and injuries are usually viewed individually-arthritis, osteoporosis, back sprain. They are often accepted stoically as the consequence of aging or just another hazard of the workplace. Because musculoskeletal conditions are generally not fatal, they don't get the same attention from policymakers and the media as other "deadly" diseases. When musculoskeletal conditions and injuries are reckoned in the aggregate-in terms of people, costs, health care resources-the impact on society and the nation is staggering.

The full dimensions are disclosed in the Academy's just-published Musculoskeletal Conditions in the U.S. (second edition). It's a comprehensive, up-to-date view of the impact on the well being of Americans, the health care system and the economy. Using the latest available statistics and expert analysis, the Academy's department of research and scientific affairs documents the significance of musculoskeletal diseases and injuries.

Musculoskeletal conditions cost the United States economy more than $215 billion a year. Arthritis and other rheumatic conditions, alone, have an annual economic impact on the nation roughly equivalent to a moderate recession, with an total cost of about 1.1 percent of the gross national product, says Edward H. Yelin, PhD, professor of medicine and health policy, University of California, San Francisco.

There's the human toll, too. One in every 7 Americans, or 36.4 million people, have a musculoskeletal impairment that limits or decreases their ability to function at home, work or at play.

Musculoskeletal impairments are a leading cause of restricting a person's activity or confinement to bed and a leading cause of work loss.

The impact of musculoskeletal conditions and injuries is expected to grow as the population increases and ages in the coming decades. That's also true in other countries. The United States and nations around the world are raising awareness of the societal burden of musculoskeletal conditions and the need for research in an international effort, the Bone and Joint Decade 2000-2010. (See story on page 37.)

The need to make the case for musculoskeletal conditions as a target for research funding is critical in an era when there is great competition for limited funding. Although musculoskeletal conditions cost the economy more than $215 billion a year, only $92 million is devoted to orthopaedic research and of that, $15 million is for clinical research.

"Musculoskeletal Conditions in the U.S. provides the most complete and current documentation concerning musculoskeletal diseases and injuries, including arthritis, back pain, bone and joint injuries and developmental disorders in children," says Joseph A. Buckwalter, chairman of the Academy's Council on Research and Scientific Affairs. "It will help direct future efforts to improve prevention and treatment of these conditions through research and improved diagnosis and treatment."

Here are some highlights.


Arthritis affects more than 32 million Americans or almost 1 out of 8 Americans. It is reported by almost 50 percent of people age 65 and older.

Although some significant research holds out hope for new treatments, until they come into use, the demographics of an aging population indicate that by 2020 an estimated 60 million Americans, or more than 18 percent of the population, will be affected by arthritis.

Today, arthritis is the leading cause of disability. It is a more frequent cause of limitation of activity than heart disease, cancer or diabetes. It is second to heart disease in causing work disability.

Arthritis is the second most frequently reported chronic condition. Among females, arthritis ranks second to chronic sinusitis; among men it ranks fifth, following chronic sinusitis, deformities or orthopaedic impairments, hearing impairments and hypertension.

The condition accounts for 39 million visits to physicians and more than 500,000 hospitalizations.

The total of arthritis is more than $82 billion.


In the last few years, public education campaigns have been launched to encourage increased consumption of calcium to prevent osteoporosis and for good reason. Osteoporosis affects 25 million Americans, 80 percent of whom are women.

Every year, almost 1.3 million fractures are attributed to osteoporosis-about 250,000 are hip fractures; 250,000, wrist fractures; and 500,000 vertebral fractures.

The cost of treating these fractures was estimated to be $13.8 billion in 1995 and is expected to double in the next 50 years unless prevention and treatment strategies are initiated. The Academy is developing a public education program on osteoporosis as well as a program aimed at encouraging orthopaedic surgeons to be aware of the diagnostic and treatment strategies for the bone disease.

Hip fractures are the most serious consequence of osteoporosis and are more likely to lead to functional impairments than other serious medical conditions, including heart attack, stroke and cancer. Two-thirds of the people who fracture a hip do not return to their prefracture level of functioning.

About 1 of every 6 white women will have a hip fracture in their lifetime. Hip fracture rates increase exponentially with increasing age so that beginning at age 65, the rates double for men and women in each decade of their life.


Knee procedures were a key factor in a 22 percent increase in arthroplasties in the 1990s. An average of 648,000 arthroplasties were performed annually from 1993 through 1995 in short-term general hospitals, compared to average of 531,000 in the 1985-1988 period. Knee procedures accounted for almost half-47 percent-of procedures. In the 1985-1988 period, knee procedures accounted for 35.8 percent of procedures.

From 1990 through 1996, total knee replacement procedures soared almost 90 percent, while total hip replacements increased 16 percent and partial hip replacements, 13.2 percent.

In 1996, almost 74 percent of total knee replacements and 68 percent of total hip replacements were performed on patients who were age 65 and older.

As the population increases and ages, it is estimated that total knee replacements will increase 85 percent from 245,000 in 1996 to 454,000 by 2030. Total hip replacements will increase almost 80 percent from 138,000 to 248,000 in the same period.

Back pain

It's hardly news to most people, but now it is documented: 75 percent to 85 percent of all people will experience some form of back pain during their lifetime.

About 1 percent of the United States population is chronically disabled because of back pain and an additional 1 percent is temporarily disabled. Two percent of the United States work force has compensable back injuries each year.

From 1993 through 1995, conditions related to back pain accounted for more hospitalizations than any other musculoskeletal condition. Conditions related to back pain, including back injuries resulted in an annual average of 524,000 hospitalizations a year.

Almost 16.2 million office visits resulted from back pain conditions; nondisc-related disorders accounted for almost 45 percent of the office visits. Disc disorders accounted for more than half of hospitalizations for conditions related to back pain.


About 37 million musculoskeletal injuries are reported annually. Slightly more than half result in limitation of activity and 20 percent, bed confinement.

From 1993 through 1995, almost 1.3 million hospitalizations occurred annually for all types of musculoskeletal injuries. Fractures were the leading injury requiring inpatient services, and accounted for almost 72 percent of the hospitalizations. Sprains and strains were second. However, strains and sprains injuries accounted for 16.1 million physician visits, while fractures resulted in 9.4 million visits.


Musculoskeletal conditions and injuries place great demands on the health care system. Three million inpatient procedures were performed in short-stay hospitals for musculoskeletal conditions in 1995, accounting for 11 percent of all procedures. About 3.3 million ambulatory surgery visits were made to hospital outpatient facilities and free standing ambulatory surgical centers. More than 4.3 million surgical procedures were provided.

Musculoskeletal conditions accounted for almost 131 million visits to physicians' offices, hospital outpatient departments and hospital emergency rooms. Of 99 million visits to physicians' offices, 40 million were new problem visits.

Musculoskeletal Conditions in the United States is available for $50 for members and $80 for nonmembers by calling the Academy's customer service department (800) 626-6726.

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