3rd Edition (Dated 12.31.16).pdf

2015

Burden of M u s c u lo sk e l e ta l The

Diseases in the United States PREVALENCE, SOCIETAL AND ECONOMIC COST

www.boneandjointburden.org 3rd Ed it ion

Burden of Musculoskeletal Diseases in the United States, Third Edition

Table of Contents Page Introduction / Credits ............................................................................................................................................. 1 Overview ............................................................................................................................................................... 11 The Big Picture ...................................................................................................................................................... 12 The Big Picture Data Tables .................................................................................................................... 30 Spine

................................................................................................................................................................ 68 Spine Data Tables ................................................................................................................................... 96

Spinal Deformity .................................................................................................................................................134 Spinal Deformity Data Tables ...............................................................................................................168 Arthritis ..............................................................................................................................................................192 Arthritis Data Tables .............................................................................................................................225 Osteoporosis .......................................................................................................................................................253 Osteoporosis Data Tables .....................................................................................................................279 Injuries: Falls and Traumatic ..............................................................................................................................289 Injuries: Workplace .............................................................................................................................................310 Injuries: Sports ....................................................................................................................................................313 Injuries: Military..................................................................................................................................................327 Injuries Data Tables: Unintentional and Falls .......................................................................................345 Injuries Data Tables: Workplace ...........................................................................................................385 Injuries Data Tables: Sports ..................................................................................................................390 Injuries Data Tables: Military................................................................................................................406 Children and Adolescents ...................................................................................................................................412 Children and Adolescents Data Tables .................................................................................................459 Tumors ..............................................................................................................................................................480 Tumors Data Tables ..............................................................................................................................516 Sex

..............................................................................................................................................................546 Sex Data Tables ....................................................................................................................................572

Aging

..............................................................................................................................................................584 Aging Data Tables .................................................................................................................................605

Economic Cost ....................................................................................................................................................625 Economic Cost Data Tables ..................................................................................................................672 Data Sources .......................................................................................................................................................706 Facts-in-Brief .......................................................................................................................................................708

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Burden of Musculoskeletal Diseases in the United States, Third Edition

Musculoskeletal Diseases And the Burden They Cause in the United States Musculoskeletal diseases affect more than one out of every two persons in the United States age 18 and over, and nearly three out of four age 65 and over. Trauma, back pain, and arthritis are the three most common musculoskeletal conditions reported, and for which health care visits to physicians’ offices, emergency departments, and hospitals occur each year. The rate of musculoskeletal diseases far outstrips that of circulatory diseases and respiratory diseases, which affect about one in three persons, with the majority reporting relatively easily treatable conditions such as chronic hypertension or hay fever and bronchitis. The cost of treating major musculoskeletal diseases, which often includes long-term pain and disability, is also greater than for treatment of many other common health conditions. Yet research dollars to identify causes, create new treatments, and reduce pain and disability remain much lower than that of other health conditions. With the aging of the US population, musculoskeletal diseases are becoming a greater burden every year. The pages of this site illustrate the magnitude of musculoskeletal diseases on the US population, and provide a small slice of the cost and impact on the US economy.

About Us The Burden of Musculoskeletal Diseases in the United States: Prevalence, Societal and Economic Costs (BMUS), 3rd edition, is produced by the United States Bone and Joint Initiative (USBJI) in collaboration with a number of organizations, mostly professional societies. The USBJI is the U.S. national action network of the Global Alliance for Musculoskeletal Health/Bone and Joint Decade (GAMH/BJD), an international collaborative movement sanctioned by the United Nations/World Health Organization. The mission of the GAMH/BJD is to raise the priority afforded to bone and joint disorders by world health organizations and national governments in line with the level of prevalence and impact on lives and economies. The mission of the USBJI is to advocate for and promote multidisciplinary, coordinated, and patient-centered care to improve the prevention, diagnosis, and treatment of musculoskeletal conditions. BMUS underpins the activities of the GAMH/BJD and USBJI, its member organizations, and healthcare professionals, researchers, patients and many others addressing musculoskeletal health issues. The first publication detailing prevalence of musculoskeletal conditions was published in 1984 by the American Academy of Orthopaedic Surgeons, and was followed with updates in 1992 and 1999. At the outset of the Bone and Joint Decade and formation of its national action network in the US, the Academy proposed the next edition become a joint project involving interested member organizations, and the 1st edition of BMUS was published in 2008. This was updated in 2011. BMUS was originally conceived as a publication designed to meet the needs of researchers, who lacked an accessible, reliable source of data on the health prevalence and economic burden of musculoskeletal diseases. With the advent of the Decade, BMUS became a useful advocacy tool

Copyright © 2014 by the United States Bone and Joint Initiative.

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Burden of Musculoskeletal Diseases in the United States, Third Edition

helping to make a stronger case for investing in research on these costly, disabling, and common diseases, as well as addressing legislative, business, professional and patient issues as they arise and making the case for necessary changes in health care. It is a key resource in the development of briefing papers, presentations, and communications of almost any kind on bone and joint disorders. The 3rd edition seeks to preserve its value for researchers and its reputation for accurate, objective data, while also presenting the burden of musculoskeletal conditions in lay language for policy makers and the general public. Many of the key contributors to previous versions of BMUS remain the same, and much of the data presented is consistent with previous versions. However, changes in chapters and content are incorporated to meet these broader audience needs, as well as contribute additional knowledge to the burden of musculoskeletal conditions.

Foreword I am pleased to introduce the 3rd edition of The Burden of Musculoskeletal Diseases in the United States, a landmark publication that has become emblematic of the presidentially declared United States Bone and Joint Decade (2002–2011), which is being continued after 2011 as the United States Bone and Joint Initiative. A collaborative effort of several Initiative supporters, The Burden of Musculoskeletal Diseases in the United States shows the current musculoskeletal landscape as reflected in solid data from the National Center for Health Statistics’ 2012 National Health Interview Survey. It provides a fresh look at conditions of the musculoskeletal system that continue to be the leading cause of physical disability in this country. As the Initiative continues the mission of the Decade, The Burden of Musculoskeletal Diseases in the United States becomes an increasingly important vehicle for assessing our present position relative to the health challenges that lie ahead. Although the musculoskeletal community is advancing its goals, much still remains to be accomplished. We continue to face such issues as the increase in our elderly population; challenges in the economics, resources, management, and utilization of health care; and the high expectations of patients and families in what is arguably the world’s most advanced medical environment. Musculoskeletal conditions remain common, chronic, and costly. Arthritis and joint and back pain, spinal problems, osteoporosis, and injuries are just a few of the conditions that affect millions of Americans, not only physically and financially, but emotionally. The Burden of Musculoskeletal Diseases in the United States provides a springboard to continue the momentum of success the Initiative has afforded us. As you read and digest the information that lies within these pages, I encourage you to consider especially those sections that address your specific areas of interest or expertise. Stephen I. Katz, MD, PhD Director National Institute of Arthritis and Musculoskeletal and Skin Diseases National Institutes of Health Bethesda, Maryland

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Burden of Musculoskeletal Diseases in the United States, Third Edition

Introduction Musculoskeletal disorders and diseases are the leading cause of disability in the United States and account for more than one-half of all chronic conditions in people older than age 50 years in developed countries. The economic impact in the United States of these conditions is also staggering: in 2011, the estimated sum of the direct expenditures in healthcare costs and the indirect expenditures in lost wages is $874 billion, or 5.7% of the 2011 GDP (national gross domestic product). Beyond these statistics, the human toll in terms of the diminished quality of life is immeasurable. This situation is unlikely to improve in the foreseeable future and will likely be intensified by current demographic trends, including the graying of the baby boomer population, the epidemic of morbid obesity, and the higher recreational activity levels of our elderly population. Despite these compelling facts, the investment in musculoskeletal research in the United States lags behind other chronic conditions. While musculoskeletal diseases are common, disabling, and costly, they remain under-appreciated, under-recognized, and under-resourced by our national policy makers. The mission of the U.S. Bone and Joint Initiative, publisher of this publication, is to advocate for and promote multidisciplinary, coordinated, and patient-centered care to improve the prevention, diagnosis, and treatment of musculoskeletal conditions. This volume serves the mission of the Initiative in that several professional organizations concerned with musculoskeletal health have collaborated to tabulate up-to-date data on the burden of musculoskeletal diseases to educate healthcare professionals, policy makers, and the public. In this third edition of The Burden of Musculoskeletal Diseases in the United States (BMUS), information presented has been updated to reflect the most current data available. This book represents a true collaboration of a coalition of professional organizations committed to the mission of the U.S. Bone and Joint Initiative. The content in this edition has been expanded to include new chapters on specific populations: children and adolescents, aging, and the military. Where available, there is increased attention to sex/gender differences, and race/ethnicity. The website has been completely revamped with new features and functionality included to facilitate use of the data. Graphs can now be downloaded for use in presentations. Tables are linked directly from the text content, and can be downloaded as PDF files or as CSV/Excel files. All the graphs and tables under each topic can be viewed together, and downloaded if desired. Search functionality has been improved. A Report Builder tool has been added allowing users to produce tailored reports on the latest available data provided by some of the original data sources used to produce the edition. These data should stimulate increased investment in basic, translational, clinical and health policy research to delineate the underlying mechanisms of these diseases and their response to treatment. Through such research, novel preventive and therapeutic approaches with potential to mitigate the societal and personal impact of musculoskeletal disease will emerge. We thank the authors and reviewers of the chapters, Sylvia Watkins-Castillo who undertook and coordinated development of the content and is so dedicated to this publication, the BMUS Steering Committee members who have guided the publication, and to the organizations which have provided support to make this edition possible. Stuart Weinstein, MD Edward Yelin, PhD, MCP Co-Chairs, Steering Committee, Burden of Musculoskeletal Diseases in the United States (BMUS) United States Bone and Joint Initiative

Copyright © 2014 by the United States Bone and Joint Initiative.

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Burden of Musculoskeletal Diseases in the United States, Third Edition

Rights, Copyright, Citation The material presented in The Burden of Musculoskeletal Diseases in the United States (BMUS) is made available for informational purposes only. This material is not intended to suggest procedures or course of treatment, only to provide an interpretation of available data on the incidence and prevalence of most major musculoskeletal conditions. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form, or by any means, electronic, mechanical, photocopying, recording, or otherwise, without prior written permission from the publisher. Suggested citation: United States Bone and Joint Initiative: The Burden of Musculoskeletal Diseases in the United States (BMUS), Third Edition, 2014. Rosemont, IL. Available at http://www.boneandjointburden.org. Accessed on (date). Copyright © 2014 by the United States Bone and Joint Initiative. ISBN: 978-0-9963091-0-3 The Burden of Musculoskeletal Diseases in the United States (BMUS) 9400 West Higgins Road, Suite 500 Rosemont, IL 60018-4976 United States of America 847-430-5054/5053 www.usbji.org

Supporting Organizations American Academy of Orthopaedic Surgeons American Academy of Physical Medicine and Rehabilitation AO North America American Orthopaedic Society for Sports Medicine American Society for Bone and Mineral Research Biomet Genentech Medtronic National University of Health Sciences Orthopaedic Trauma Association Pediatric Orthopaedic Society of North America Sanofi Biosurgery Scoliosis Research Society Zimmer

Copyright © 2014 by the United States Bone and Joint Initiative.

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Burden of Musculoskeletal Diseases in the United States, Third Edition

United States Bone and Joint Initiative The United States Bone and Joint Initiative (USBJI) is the U.S. National Action Network of the worldwide Global Alliance for Musculoskeletal Health/Bone and Joint Decade, an international collaborative movement sanctioned by the United Nations/World Health Organization. Its mission is to improve the quality of life for people with musculoskeletal conditions and to advance the understanding, prevention, and treatment of these conditions—in short, to reduce the burden of musculoskeletal conditions. The USBJI is a unique, interdisciplinary coalition of organizations. It connects thought leaders, healthcare professionals, educators, researchers, industry professionals, patients, and patient advocates. It develops collaborative programs and activities and creates forums to exchange information, build partnerships, and develop consensus on issues of common concern to its members and society at large. The USBJI raises the profile and priority of bone and joint health and disease prevention; in addition, it supports the advancement and expansion of musculoskeletal care and research through data dissemination, awareness-building programs, education initiatives, and advocacy. United States Bone and Joint Initiative 9400 West Higgins Road, Suite 500 Rosemont, IL 60018 United States of America 847-430-5054/5053 [email protected] www.usbji.org

United States Bone and Joint Initiative: The Burden of Musculoskeletal Diseases in the United States (BMUS), Third Edition, 2014. Rosemont, IL. Available at http://www.boneandjointburden.org. Accessed on April 27, 2015.

Copyright © 2014 by the United States Bone and Joint Initiative.

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Burden of Musculoskeletal Diseases in the United States, Third Edition

Credits BMUS Steering Committee Stuart L. Weinstein, MD, Co-Chair

Ignacio V. Ponseti Professor of Orthopaedic Surgery Pediatric Orthopaedic Surgery and Spinal Deformity Department of Orthopaedics and Rehabilitation University of Iowa Iowa City, IA American Academy of Orthopaedic Surgeons

Edward H. Yelin, PhD, Co-Chair

Professor of Medicine and Health Policy Department of Medicine and Institute for Health Policy Studies University of California - San Francisco, School of Medicine San Francisco, CA

Gunnar B.J. Andersson, MD, PhD

The Ronald L. DeWald, MD Professor and Chairman Emeritus Department of Orthopaedic Surgery Rush University Medical Center Chicago, IL American Academy of Orthopaedic Surgeons

Sigurd Berven, MD

Associate Professor in Residence University of California San Francisco Department of Orthopaedic Surgery San Francisco, CA Scoliosis Research Society

Leigh Callahan, PhD

Professor, Medical and Social Medicine Thurston Arthritis Research Center University of North Carolina Chapel Hill, NC

Paul Dougherty, DC

Staff Chiropractor, Canandaigua VA Medical Center Chair, Pain Oversight Committee Professor, New York Chiropractic College Department Of Chiropractic Clinical Sciences Newark, NY American Chiropractic Association

Paul W. Esposito, MD

Professor, Orthopaedic Surgery Pediatric Orthopaedics University of Nebraska College of Medicine Omaha, NE American Academy of Pediatrics

Copyright © 2014 by the United States Bone and Joint Initiative.

Julie M. Fritz, PhD, ATC

Professor Department of Physical Therapy University of Utah School of Medicine Salt Lake City, UT American Physical Therapy Association

Michael B. Furman, MD

Physician – Director of Fellowship Program (Pain Management and Rehabilitation Specialist) OSS Health York, PA American Academy of Physical Medicine and Rehabilitation

Marian T. Hannan DSc, MPH

Senior Scientist Harvard Medical School Musculoskeletal Research Institute for Aging Research Hebrew SeniorLife Boston, MA

Michael Henrickson, MD, MPH

Director of Telehealth Cincinnati Children's Hospital Medical Center Division of Rheumatology Cincinnati, OH American Academy of Pediatrics

Matthew Hepler, MD

Orthopaedic Surgeon-Spine Specialist Orthopaedic Surgery Associates, Inc. Boynton Beach, FL, FL Scoliosis Research Society

Marc C. Hochberg, MD, MPH

Professor of Medicine Head, Division of Rheum. & Clinical Immunology University of Maryland School of Medicine Baltimore, MD American Society for Bone and Mineral Research

Anne C. Looker, PhD

Senior Research Scientist/Distinguished Consultant Division of Health and Nutrition Examination Statistics National Center Health Statistics Centers for Disease Control and Prevention Hyattsville, MD

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Burden of Musculoskeletal Diseases in the United States, Third Edition

Alexis Ogdie, MD

Assistant Professor of Medicine and Epidemiology Perelman School of Medicine University of Pennsylvania Philadelphia, PA

Angela Oliver

Public Health Analysis Centers for Disease Control and Prevention Atlanta, GA

Joseph P. O'Brien, MBA

President & CEO National Scoliosis Foundation Stoughton, MA

J. Edward Puzas, PhD

Senior Associate Dean, Research Department of Orthopaedics University of Rochester Rochester, NY

Patricia Quinlan, DNSc, MPA, CPHQ

Director of Nursing Education and Research Hospital for Special Surgery New York, NY National Association of Orthopaedic Nurses

Scott B. Rosenfeld, MD (AAOS)

Assistant Professor Department of Orthopedic Surgery Baylor College of Medicine Pediatric Orthopedic Surgery and Scoliosis Texas Children’s Hospital Houston, TX Pediatric Orthopaedic Society of North America

Paul A. Ullucci, Jr., PT, PhD, DPT, ATC, SCS, CSCS Assistant Professor Musculoskeletal Care Clinic Director Department of Physical Therapy California State University, Fresno Fresno, CA National Athletic Trainers’ Association

John Ventura, DC

Rochester Chiropractic Group, LLP Rochester, NY American Chiropractic Association

Content Contributors BIG PICTURE Primary Author(s) Stuart L. Weinstein, MD

Reviewers Marian T. Hannan, DSc, MPH

Co-director of Musculoskeletal Research Center; Senior Scientist, Institute for Aging Research, HSL Associate Professor of Medicine, HMS Associate Professor of Public Health, HSPH Institute for Aging Research Harvard Medical School Affiliate

Jeremy I. Simon, MD

Board Certified, Physical Medicine & Rehabilitation Subspecialty Certificate in Pain Medicine Rothman Institute Orthopedics

SPINE: LOW BACK AND NECK PAIN Primary Author(s) Gunnar B. J. Andersson, MD, PhD

Professor, Midwest Orthopaedics at Rush Department of Orthaepedic Surgery Rush University Medical Center Chicago, IL

Reviewers Paul A. Ullucci, Jr., PT, PhD

Director, NATA Board of Directors, District 1 Ullucci Sports Medicine & Physical Therapy, Inc. 1235 Wampanoag Trail East Providence, RI

Mary E. Hardwick, MSN

Shiley Center for Orthopaedic Research & Education 11025 N. Torrey Pines Rd., Ste 200 La Jolla, CA

SPINAL DEFORMITY Primary Author(s) Sigurd H. Berven, MD

Director of Spine Fellowship and Resident Education Department of Orthopaedic Surgery University of California San Francisco San Francisco, CA

Adolfo Correa, MD, PhD

University of Mississippi Medical Center School of Medicine-JHS 2500 North State Street Jackson, MS

Matthew D. Hepler, MD

Specialist Comprehensive Spine Care Vero Orthopaedics, Vero Neurology Staff, Children’s Memorial Hospital, Speciality Scoliosis Vero Beach, FL

Reviewers

Ignacio V. Ponseti Professor of Orthopaedic Surgery Pediatric Orthopaedic Surgery and Spinal Deformity Department of Orthopaedics and Rehabilitation University of Iowa Iowa City, Iowa

Michael B. Furman, MD, MS Orthopaedic and Spine Specialists 1855 Powder Mill Rd York, PA

Edward H. Yelin, PhD

CEO and Founder SpineSearch LLC Recruitment and education source for Spine Professionals Carle Place, NY

Professor of Medicine and Health Policy Department of Medicine and Institute for Health Policy Studies University of California - San Francisco, School. of Medicine San Francisco, CA

Copyright © 2014 by the United States Bone and Joint Initiative.

Nicola Hawkinson, DNP, RN, RNFA

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Burden of Musculoskeletal Diseases in the United States, Third Edition

ARTHRITIS AND OTHER RHEUMATIC CONDITIONS (AORC)

Reviewers

Primary Author(s)

Division Director Division of Musculoskeletal Diseases National Institute of Arthritis and Musculoskeletal and Skin Diseases National Institutes of Health Bethesda, MD

Charles G. (Chad) Helmick, MD

Captain, U.S. Public Service Medical Epidemiologist, Arthritis Program National Center for Chronic Disease Prevention Centers for Disease Control and Prevention (CDC) Atlanta, GA

Supporting Author(s) Aimee O. Hersh, MD

Pediatric Rheumatologist 100 Mario Capecchi Dr Box 0107 Room U126 Salt Lake City, UT 84113

Reviewers David S. Pisetsky, MD, PhD

Professor Medicine/Immunology Duke University, Medicine-Rheumatoloty and Immunology Durham, NC

Edward H. Yelin, PhD, Co-Chair

Professor of Medicine and Health Policy Department of Medicine and Institute for Health Policy Studies University of California - San Francisco, School of Medicine San Francisco, CA

OSTEOPOROSIS Primary Author(s) Kenneth S. Saag, MD, MSc, Lead

Professor of Medicine Director, Center for Education & Research on Therapeutics of Musculoskeletal Disorders (CERTS) Director, Center for Outcomes and Effectiveness Research and Education (COERE) Director, Center of Research Translation (CoRT) University Alabama Birmingham School of Medicine Division of Clinical Immunology and Rheumatology Birmingham, AL

Jeffrey R. Curtis, MD, MS, MPH

Associate Professor of Medicine Director, Arthritis Clinical Intervention Program (ACIP) Associate Director, Center for Education and Research on Therapeutics of Musculoskeletal Disorders (CERTS) University of Alabama School of Medicine Birmingham, AL

Anne C. Looker, PhD

Senior Research Scientist/Distinguished Consultant Division of Health and Nutrition Examination Statistics National Center Health Statistics Centers for Disease Control and Prevention Hyattsville, MD

Nichole C. Wright, PhD, MPH Asst Professor Epidemiologgy Ryals School for Public Health University of Alabama Birmingham, AL

Copyright © 2014 by the United States Bone and Joint Initiative.

Joan McGowan

Jeff A. Gehret, DO

Rothman Institute Orthopedics King of Prussia, PA

Deb Sietsema, PhD, RN

Clinical Research Director Orthopaedic Associates of Michigan Grand Rapids, MI

MUSCULOSKELETAL INJURIES: Primary Author(s) UNINTENTIONAL, FALLS, AND WORKPLACE Andrew N. Pollak, MD

Professor of Orthopaedics Department of Orthopaedics University of Maryland Medical Center Baltimore, MD

SPORTS INJURIES Brett D. Owens, MD

LTC MC USA Professor, USUHS John A. Feagin, Jr. Sports Medicine Fellowship Chief, Orthopaedic Surgery Keller Army Hospital West Point, NY

Kenneth L. Cameron, PhD, MPH, ATC

Director, Orthopaedic Research John A. Feagin, Jr. Sports Medicine Fellowship Keller Army Hospital West Point, NY

MILITARY INJURIES Stephen Marshall, PhD

Professor, Dept of Epidemiology Director, Injury Prevention Research Center University of North Carolina at Chapel Hill Chapel Hill, NC

Michelle Canham-Chervak, PhD, MPH

SMRC Program Manager/Senior Epidemiologist Injury Prevention Program Army Institute of Public Health U.S. Army Public Health Command Aberdeen Proving Ground, MD

Bruce H. Jones, MD, MPH

Manager, Injury Prevention Program Injury Prevention Program Army Institute of Public Health U.S. Army Public Health Command Aberdeen Proving Ground, MD

Esther O. Dada, MPH

Epidemiologist Injury Prevention Program Army Institute of Public Health U.S. Army Public Health Command Aberdeen Proving Ground, MD

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Burden of Musculoskeletal Diseases in the United States, Third Edition

Reviewers David N. Cowan, PhD, MPH

Program Manager Accession Medical Standards Research Preventive Medicine Branch Walter Reed Army Institute of Research Silver Spring, MD

Deb Sietsema, PhD, RN

Clinical Research Director Orthopaedic Associates of Michigan Grand Rapids, MI

Gene Tekmyster, DO

The Orthopaedic & Sports Medicine Center Trumbull, CT

CHILDREN AND ADOLESCENT MUSCULOSKELETAL CONDITIONS

Robert M. Corey, MD

Saint Louis University Department of Orthopedic Surgery > Saint Louis, MO Reviewer(s)

Matthew G. Cable, MD Sarcoma Research Fellow Huntsman Cancer Institute University of Utah Salt Lake City, UT

R. Lor Randall, MD, FACS Director of Sarcoma Services Huntsman Cancer Institute< University of Utah Salt Lake City, UT

ECONOMIC BURDEN

Primary Author(s)

Primary Author(s)

Scott B. Rosenfeld, MD

Edward H. Yelin, PhD

Assistant Professor Department of Orthopedic Surgery Baylor College of Medicine Pediatric Orthopedic Surgery and Scoliosis Texas Children’s Hospital Houston, TX

Aimee O. Hersh, MD

Professor of Medicine and Health Policy Department of Medicine and Institute for Health Policy Studies University of California - San Francisco, Sch. of Med. San Francisco, CA

Miriam Cisternas, MA

Pediatric Rheumatologist Salt Lake City, UT

Owner MGC Data Services Carlsbad, CA

Reviewers

Reviewers

Sharon M. Bout-Tabaku, MD

David S. Jevsevar, MD MBA

Nationwide Children's Columbus, OH

Ellen Raney, MD

Children Orthopaedics Shriners Hospital for Children Portland, OR

Richard M. Schwend, MD Children's Mercy Hospital Kansas City, MO

Vice Chair of Orthopaedics Director, Arthritis Center Dartmouth-Hitchcock Lebanon, NH

SEX and GENDER Primary Author(s)

Kimberly J. Templeton MD

Catherine Smrcina, PhD, RN, ONC

Professor of Orthopaedic Surgery University of Kansas Medical Center Kansas City, KS

Laura L. Tosi, MD

Reviewers

Director Bone Health Program Children’s National Health System Washington, District of Columbia

MUSCULOSKELETAL TUMORS Primary Author(s)

William G. Ward Sr., MD

Chief -Musculoskeletal Service Line Novant Health, Greater Winston Salem Market Lead Physician Novant Health Orthopedics & Sports Medicine Winston Salem, North Carolina 27106 Professor Emeritus, Wake Forest University School of Medicine, Department of Orthopedic Surgery Former Chief of Orthopedics, Guthrie Clinic, Sayre, Pennsylvania

Copyright © 2014 by the United States Bone and Joint Initiative.

Amy L. Ladd, MD

Professor of Orthopaedic Surgery Stanford University Medical Center Stanford, CA

Janice L. Werbinski, MD

Associate Clinical Professor of ObGyn Western Michigan University Homer R. Stryker MD School of Medicine Portage, MI

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Burden of Musculoskeletal Diseases in the United States, Third Edition

Project Managers Toby King, CAE

Executive Director United States Bone and Joint Initiative Rosemont, IL

Sylvia I. Watkins-Castillo, PhD Proprietor TriIntel Consulting Sequim, WA

PROOFREADER Debi Schepers Chicago, IL

Special Consultants Joan McGowan, PhD

Division Director Division of Musculoskeletal Diseases National Institute of Arthritis and Musculoskeletal and Skin Diseases National Institutes of Health Bethesda, MD

Deborah S. Cummins, PhD

Director Research & Scientific Affairs American Academy of Orthopaedic Surgeons Rosemont, IL

Jayson Murray, MA

Manager Evidence Based Medicine Unit Research & Scientific Affairs American Academy of Orthopaedic Surgeons Rosemont, IL

Ryan Pezold, MA

Research Analyst Evidence Based Medicine Unit Research & Scientific Affairs American Academy of Orthopaedic Surgeons Rosemont, IL

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Burden of Musculoskeletal Diseases in the United States, Third Edition

Published on BMUS: The Burden of Musculoskeletal Diseases in the United States (http://www.boneandjointburden.org)

Musculoskeletal Diseases And the Burden They Cause in the United States Musculoskeletal diseases affect more than one out of every two persons in the United States age 18 and over, and nearly three out of four age 65 and over. Trauma, back pain, and arthritis are the three most common musculoskeletal conditions reported, and for which health care visits to physicians’ offices, emergency departments, and hospitals occur each year. The rate of musculoskeletal diseases far outstrips that of circulatory diseases and respiratory diseases, which affect about one in three persons, with the majority reporting relatively easily treatable conditions such as chronic hypertension or hay fever and bronchitis. The cost of treating major musculoskeletal diseases, which often includes long-term pain and disability, is also greater than for treatment of many other common health conditions. Yet research dollars to identify causes, create new treatments, and reduce pain and disability remain much lower than that of other health conditions. With the aging of the US population, musculoskeletal diseases are becoming a greater burden every year. The pages of this site illustrate the magnitude of musculoskeletal diseases on the US population, and provide a small slice of the cost and impact on the US economy.

Copyright © 2014 by the United States Bone and Joint Initiative.

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Burden of Musculoskeletal Diseases in the United States, Third Edition

The Big Picture Burden of Musculoskeletal Diseases (BMUS) Lead Author(s): Stuart I. Weinstein, MD Edward H. Yelin, PhD

Supporting Author(s): Sylvia I. Watkins-Castillo, PhD Musculoskeletal conditions are among the most disabling and costly conditions suffered by Americans. In March 2002, President George W. Bush proclaimed the years 2002–2011 as the United States Bone and Joint Decade, providing national recognition to the fact that musculoskeletal disorders and diseases are the leading cause of physical disability in this country.1,2 At the end of the decade, the multiple associations of health providers treating musculoskeletal diseases realized the work had only begun, and the United States Bone and Joint Initiative (USBJI), a part of the Global Alliance for Musculoskeletal Health, was created. In December 2012, a study on the Global Burden of Disease and the worldwide impact of all diseases and risk factors (http://www.usbjd.org/projects/project_op.cfm?dirID=348) found musculoskeletal conditions such as arthritis and back pain affect more than 1.7 billion people worldwide, are the second greatest cause of disability, and have the 4th greatest impact on the overall health of the world population when considering both death and disability. Professor Christopher Murray, lead investigator, and the authors of the study underline the need to address the rising numbers of individuals with a range of conditions such as musculoskeletal disorders that largely address disability, not mortality, in the future.3 The goal of USBJI is to improve the quality of life for people with musculoskeletal conditions and to advance understanding and treatment of these conditions through research, prevention, and education. The cornerstone of USBJI is the burden of musculoskeletal disease, defined as the incidence and prevalence of musculoskeletal conditions; the resources used to prevent, care, and cure them; and the impact on individuals, families, and society. Direct costs of the burden of musculoskeletal disease include hospital inpatient, hospital emergency and outpatient services, physician outpatient services, other practitioner services, home health care, prescription drugs, nursing home cost, prepayment, and administration and non–health-sector costs. Indirect cost relates to morbidity and mortality, including the value of productivity losses due to disability or premature death due to a disease and the value of lifetime earnings as well as the impact on quality of life. The current update of The Burden of Musculoskeletal Conditions in the United States, ed. 3, (BMUS) which is available in the following pages on this website, provides new, updated numbers to support members engaged in research, education programs, and healthcare policy that will bring about significant advances in the knowledge, diagnosis, and treatment of musculoskeletal conditions, and increase the number of resources at the disposal of the healthcare profession and the public at large. As the US population continues to age in the next 25 years, musculoskeletal impairments will increase because they are

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most prevalent in the older segments of the population. By the year 2040, the number of individuals in the United States older than the age of 65 years is projected to grow from the current 15% of the population to 21%. Persons age 85 years and older will double from the current