Reprinted with permission from the World Health Organization. An electronic version of the report is available at Kenneth D. McClatchey, DDS, MD†

Joint diseases, rheumatoid arthritis and osteoarthritis, osteoporosis, spinal disorders, low back pain, and severe trauma are among 150 musculoskeletal conditions affecting millions of people globally, according to a comprehensive publication recently released by the World Health Organization (WHO) in collaboration with the Bone and Joint Decade Initiative. “The Burden of Musculoskeletal Conditions at the Start of the New Millennium”—the first report of its kind—provides both a snapshot of the size of the problem and a baseline against which to measure the effects of health interventions. The aim is to determine the burden of the most prominent musculoskeletal conditions.

One of the major diseases, osteoporosis, is characterized by low bone mass and structural deterioration of bone tissue, leading to an increased susceptibility to fractures, especially of the hip, spine, and wrist. Hip fracture is the most costly result of osteoporosis as it always requires hospitalization, is fatal in 20% of cases, and permanently disables a further 50%. Only 30% of hip fracture patients recover fully. A total of 1.7 million hip fractures occurred worldwide in 1990; this figure is expected to rise to 6 million by 2050.

“Musculoskeletal conditions are giving rise to enormous health-care expenditures and loss of work,” says Dr Catherine Le Galès-Camus, WHO Assistant Director-General for Noncommunicable Diseases and Mental Health. “There will be a marked increase in requirements for health care and community support in the coming years.”

These debilitating conditions are painful for the individual, lead to the inability to work and to enjoy life fully, and are a cost to societies and countries. The number of those people affected is set to rise during the next few decades. In the developing world, successful treatment of communicable diseases, combined with a rapid increase in road traffic accidents, is expected to lead to an increase in the burden of musculoskeletal conditions. In industrialized countries, the increasing numbers of elderly people is a key factor in this expected rise.

Rheumatoid arthritis, which often strikes between the ages of 20 and 40, is a chronic disabling condition affecting between 0.3% and 1% of the global population. Women in developed countries are the most affected. Within 10 years of the onset of rheumatoid arthritis, at least 50% of all patients in developed countries are unable to work full-time. Osteoarthritis is one of the 10 most disabling diseases in developed countries. Worldwide estimates indicate that 9.6% of men and 18% of women older than 60 years have osteoarthritis. Eighty percent of those with osteoarthritis will have limited movement, and 25% are unable to perform their daily activities.

Low back pain, the most common spinal disorder, affects more than 80% of people at some point during their life. Back pain is the most common cause of disability among young adults. Psychosocial and economic aspects of health and work seem to have more impact on work loss than the physical aspects of disability or the physical requirements of a job.

Severe limb trauma resulting in permanent disability can arise from amputations, fractures, crushing injuries, dislocations, open wounds, and blood vessel and nerve injuries. In developed countries, serious limb trauma requiring hospitalization arises 50% of the time from falls, 15% to 20% from road traffic accidents, and about 20% from machinery and tool usage.

The highest rates for limb trauma occur in 2 distinct age groups: those 5 to 34 years of age and those older than 75 years of age. In the elderly, falls represent the greatest threat for incurring limb injury, while road traffic accidents present the highest risk factor for adolescents and young adults.