Musculoskeletal conditions

Introduction

Musculoskeletal conditions comprise over 150 diseases and syndromes, which are usually progressive and associated with pain. They can broadly be categorized as joint diseases, physical disability, spinal disorders, and conditions resulting from trauma. Those conditions with the greatest impact on society include rheumatoid arthritis, osteoarthritis, osteoporosis, low back pain, and limb trauma. The term unspecified musculoskeletal problems is a non-diagnostic approach which includes all pain conditions in the musculoskeletal system.

Musculoskeletal pain is the complaint most frequently reported in health interview surveys. There is a confusing magnitude of names given to musculoskeletal pain complaints reflecting diverging opinions and a lack of consensus of what it is all about. Musculoskeletal conditions (MSC) are extremely common and have important consequences for the individual and the society. Typically around 50% of the population report musculoskeletal pain at one or more sites for at least one week in the last month. Population surveys show that back pain is the most common site of regional pain in younger and middle aged adults, and knee pain in older people. The prevalence of physical disability is higher in women than men. It rises with age; around 60% of women aged over 75 living in the community report some physical limitations. In individuals of working age, MSC - in particular back pain and generalised widespread pain - are a common cause of sick leave and long- term work disability and hence a big problem for the individuals affected, with huge economical consequences for society.

Among older people rheumatoid arthritis, osteoarthritis and osteoporosis are associated with a loss of independence and a need for more support in the community or admission to residential care. Around 15-20% of consultations in primary care are for MSC. Many of these people are referred to allied health professions such as physiotherapists, occupational therapists or chiropractors; or to medical specialists such as rheumatologists, orthopaedic surgeons or rehabilitation specialists. Total joint replacement (mainly of the hip or knee) is one of the most common elective operations for older people in most European countries. The major consequences for the health services of osteoporosis are forearm and vertebral fractures and hip fractures. There is a significant mortality associated with hip fracture.

Responding to the need of comparable indicators for Musculoskeletal conditions monitoring

The EU project Indicators for Monitoring Musculoskeletal Condition under the co-ordination of the University of Oslo (Norway), financed through the EC Health Monitoring Programme, has contributed in 2003 to identify and develop appropriate indicators to monitor musculoskeletal conditions in the population, including osteoporosis, focusing on the public health aspects. The Project recommends obtaining the information on MSC and functional limitation, its determinants and consequences from a variety of sources: Health interview surveys, Health examination surveys, Health care utilisation, Registers and Research projects (see European Health Survey System).

In most member states such information is available. The report recommends monitoring the following conditions: Unspecified musculoskeletal conditions (widespread and localized), Rheumatoid arthritis, Osteoarthritis and Osteoporosis.

Responding to the need of data on Osteoporosis

Following the establishment of a DG Health and Consumer Working Party to study the epidemiology, pathogenesis and the clinical management of osteoporosis in EU Member States, with emphasis on future prevention of this disease, a report was published 'Report on osteoporosis in the European Community. Action for prevention' 1998 (not available in electronic version). This Working Party made projections of future incidence and prevalence in the EU, based on current incidence and prevalence data for hip and vertebral fractures, with likely demographic changes and increasing life expectancy.

In this study the main incidence and prevalence data came from a variety of sources, especially from the EU Project Mediterranean Osteoporosis Study (MEDOS) and from the EU Project European Vertebral Osteoporosis Study (EVOS) both supported by the European Commission RTD Programme.

Results from these studies illustrate strikingly the increase of osteoporosis incidence and prevalence with age, as well as the sex differential noted above. Future projections show that the annual number of hip fractures would be 414 thousand in 2000, rising to 972 thousand by the year 2050. Over the same period, the prevalence of vertebral fractures would increase from 23.7 million in 2000 to 37.3 million in 2050. These figures, influenced greatly by the increasing proportion of the old in EU populations, indicate a considerable demand for health resources in coming years just from fractures caused by osteoporosis.

See table Incidence of hip fracture associated with osteoporosis, sex ratio of incidence by age, and projected annual incident hip fractures 2000, EU-15pdf(31 KB)
See table Prevalence of vertebral fractures associated with osteoporosis, sex ratio of prevalence by age, and projected prevalent vertebral fractures 2000, EU-15pdf(28 KB)

Results of this project were one of the main basis for the publication by the European Commission on November 2003 of the report Osteoporosis in the European Community: Action Plan in which the European Parliament Osteoporosis Interest Group and the International Osteoporosis Foundation were actively involved. This report is a "call to action" to brighten the future for Europeans at high risk of fragility fractures by outlining key next steps towards prevention.

The International Osteoporosis Foundation on behalf of the European Parliament Osteoporosis Interest Group and the EU Osteoporosis Consultation Panel disseminates a report on Indicators on Progress on Osteoporosis in Europe.

See Osteoporosis in Europe - A new report tracks road to progresspdf

Other data on musculoskeletal conditions

Prevalence studies on rheumatoid arthritis (RA) were identified from 16 countries and incidence studies from five countries (table 7). The majority (15 out of a total of 21 studies) used the 1987 ACR criteria for the classification of RA. Estimates of the annual incidence of RA range from 4.13 per 100 000 for adult males and 13- 36 per 100 000 for adult females. Estimates of the prevalence of RA range from 1-6 per 1000 for men and 3-12 per 1000 for women. In all studies the prevalence was higher in women than men (the ratio varied from 1.7 to 4.0).

Prevalence studies of osteoarthritis (OA) are too few comparable studies to draw any conclusions about geographical variation in prevalence. The prevalence of radiological osteoarthritis rises with age so that, for example, in people age 55-74 the prevalence of OA of the hand is 70%, foot OA 40%, knee OA 10% and hip OA 3% (49). Below the age of 45 men are affected more often than women. Over the age of 45 women are affected more often. There is no evidence as to whether the age and sex specific incidence of OA has changed over recent decades. However the population burden of OA will increase over the next years for two reasons. The first reason is the ageing of the population. Secondly, the principal non-genetic risk factor for OA (in particular OA knee) is obesity and the prevalence of obesity in Europe is also rising.

The European Agency for Health and Safety at Workmber that may contribute to the onset of the disease.

See table Prevalence and incidence of rheumatoid arthritis from individual studies across Europepdf(45 KB)
See table Osteoarthritis incidence and prevalence from some studies across Europepdf(60 KB)
See Musculoskeletal Disorders - European Agency for Health and Safety at Work