Musculoskeletal diseases, including rheumatoid arthritis, affect more than one out of every two people in the U.S. age 18 and over, and nearly three out of four age 65 and over — costing about $213 billion a year in treatment, care, and lost wages, according to a report issued by the United States Bone and Joint Initiative (USBJI), called “The Impact of Musculoskeletal Disorders on Americans: Opportunities for Action.”

The new report outlines the magnitude of musculoskeletal diseases on the U.S. population, and provides a small slice of the cost and impact on the American economy. It also provides recommendations for strategies to improve patient outcomes while decreasing increasing health and public costs.

“This report provides the critical data needed to understand the magnitude of the problem, and the burden of musculoskeletal disease in our country,” David Pisetsky, M.D., USBJI president, and professor of medicine and immunology at Duke University Medical School, said in a news release. “The number of visits to physicians for these disorders, the cost of treating them, and the indirect costs associated with pain and loss of mobility, are proportionately much higher than the resources currently being allocated to combat these conditions and injuries.”

“As a nation, we need to establish greater funding for musculoskeletal research, improve our understanding and strategies for prevention and treatment of these injuries and conditions, and ensure that more adults and children receive appropriate treatment sooner, and on an ongoing basis, to ensure quality of life and productivity,” said Stuart L. Weinstein, M.D., co-chair of the report’s Steering Committee and a professor of orthopedics and rehabilitation at the University of Iowa Hospitals and Clinics.

According to the report, arthritis and related conditions, back and neck pain, injuries, falls, military, sports, and workplace injuries and osteoporosis are the most prevalent musculoskeletal conditions in the U.S.

Specifically, the report estimates that in the U.S.:

• 51.8 million adults report they have arthritis. With the aging of the American population, by 2030 the prevalence of arthritis is projected to increase to 67 million people;
• 75.7 million adults suffer from neck or low back pain;
• 4.5 million sports musculoskeletal injuries require medical attention each year, amounting to 64 percent of all sports injuries;
• One in two women and one in four men over age 50 will have an osteoporosis-related fracture, with a 20 percent mortality rate within 12 months of a hip fracture;
• Millions suffer from spinal deformities, congenital conditions, and cancers of bone and connective tissue.

In 2011, the annual U.S. cost for treatment and lost wages related to musculoskeletal disorders was $213 billion. When adding other conditions that affect people with musculoskeletal disorders, including heart disease, diabetes, and obesity, the total indirect and direct costs rose in 2015 to $874 billion.

Other data on the costs related to musculoskeletal diseases and injuries highlighted in the report include:

• 18 percent of all healthcare visits in 2010 were musculoskeletal-related. Of these, 52 million healthcare visits were for low-back pain; 6.7 million hospitalizations were for arthritis and other rheumatic conditions; 65.8 million healthcare visits were for injuries; 14.4 million healthcare visits were for childhood injuries; and 1.14 million hospital discharges were for fractures — 53 percent of them in people age 65 and over;
• The annual cost for treatment for one person with a musculoskeletal disorder on average is $7,800;
• The annual cost to treat all forms of joint pain and arthritis was $581 billion, a 131 percent increase since the year 2000;
• In 2012, 25.5 million people lost an average of 11.4 days of work caused by back or neck pain. And in 2012 alone, 290.8 million workdays were lost;
• Among children and adolescents, musculoskeletal disorders are second — with respiratory infections as No. 1 — as a cause of missed school days.

According to the report, federal funding is needed to improve research on both prevention and treatment, improve aspects of access and coordination, and address key data gaps, as outlined in the recommendations.

• Accelerate research comparing different treatment options, develop new treatments, and evaluate prevention strategies. The progress of treating rheumatoid arthritis (RA), where patients not long ago were routinely confined to wheelchairs but are now in many cases able to return to work, demonstrates how the promise of greater function and mobility could be achieved across the spectrum of musculoskeletal disorders. Research could also explore unanswered questions about these disorders that could lead to breakthroughs in other areas, such as why disk degeneration causes pain in some and not in others.

• Understand the role of changing behaviors in prevention and treatment, including weight loss and self-management of diseases. The success of lifestyle behavior changes for diabetes and other chronic diseases points the way. However, there is a need to better understand and promote the role of clinic-to-community links that support behavioral interventions without leaving their success up to individuals or physicians alone.
• Ensure that more affected people receive access to evidence-based therapies, including reducing disparities in the onset of disease, access to care, and outcomes by race or ethnicity and socioeconomic status.
• Ensure that children have access to care, especially for those insured through Medicaid or other government-funded insurance.
• Promote better coordination between physicians and other care providers.
• Ensure that healthcare providers have the appropriate training to diagnose and refer patients for appropriate treatment so that treatment is not delayed or diagnostic and emergency resources are not used inappropriately.
• Address data limitations that hinder the understanding of these diseases and how best to screen, diagnose, and treat them.

“If we continue on our current trajectory, we are choosing to accept more prevalence and incidence of these disorders, spiraling costs, restricted access to needed services, and less success in alleviating pain and suffering – a high cost,” said Edward H. Yelin, Ph.D., co-chair of the report’s steering committee, and professor of medicine and health policy at the University of California, San Francisco. “The time to act to change this scenario to one with more evidence-based interventions and effective treatments, while simultaneously focusing on prevention, doing better by our society and economy, is now.”

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