On January 13, 2000, The Bone and Joint Decade was formally launched at the headquarters of the World Health Organization in Geneva, Switzerland. This comes on the heels of the November 30, 1999, endorsement of the initiative by the United Nations. The Bone and Joint Decade is a global campaign to improve the quality of life for people who have musculoskeletal conditions and to advance the understanding and treatment of these conditions through research, prevention, and education. The aims of the campaign are to raise awareness of the increasing societal impact of musculoskeletal injuries and disorders, to empower patients to participate in decisions about their care, to increase funding for prevention activities and research, and to promote cost-effective prevention and treatment.
The Bone and Joint Decade has thus far been endorsed by fifteen nations, including the United Kingdom, Austria, Sweden, Brazil, Tanzania, and The Netherlands; by three states in the United States; and by more than 650 organizations worldwide. More than forty multidisciplinary National Action Network committees have been formed around the world to coordinate the activities of National Action Network member organizations.
In his endorsement statement, United Nations Secretary-General Kofi Annan noted that The Bone and Joint Decade initiative appeals to governments worldwide to start taking action now and to work together with national and international organizations and health-care professionals in the prevention and treatment of musculoskeletal disorders2. Health-care services worldwide will face severe financial pressures in the next ten to twenty years because of an escalation in the numbers of people affected by musculoskeletal diseases. Bone and joint disorders account for more than one-half of all chronic conditions in people older than fifty years of age in developed countries and are the most common cause of severe, long-term pain and disability3. In developing nations, people of a younger age sustain these disabilities more often as a result of accidents and wars; ten to fifteen million injuries occur each year in road-traffic accidents or through armed conflict. The financial cost in both developed and developing countries continues to escalate. Mr. Annan further stated: "Joint diseases, back pain, osteoporosis and limb trauma due to accidents and armed conflict have an enormous impact on the individual, on society and on health care and social systems … There are effective ways to prevent or treat these disabling conditions. But we must act on them now … the United Nations … welcome and support this collaborative initiative."2
The launching of The Bone and Joint Decade in Geneva was followed by a conference, sponsored jointly by the World Health Organization and The Bone and Joint Decade Steering Committee, entitled "The Bone and Joint Decade Monitor Project: Global Burden of Disease." The Bone and Joint Decade Monitor Project is aimed at determining the incidence and prevalence of musculoskeletal conditions and their impact on individuals, families, and societies; identifying gaps in knowledge; and achieving a consensus about how to quantify disability caused by musculoskeletal conditions. With this information, future strategies can be developed to improve the health-related quality of life for people with musculoskeletal disorders.
In preparation for this conference, on October 5, 1999, the American Academy of Orthopaedic Surgeons' Council on Research and Scientific Affairs, in conjunction with the Academy's Task Force on The Bone and Joint Decade, sponsored a conference entitled "Measuring Burden of Disease: Musculoskeletal Conditions and Injuries: Current Status and Future Goals." The conference was attended by representatives from thirty-four organizations, including medical specialty and professional societies, patient-advocacy groups, and government agencies with an interest in musculoskeletal conditions. The goals of the conference were to identify and analyze measures of the burden of musculoskeletal conditions and injuries, to familiarize musculoskeletal care providers with international efforts to measure the burden of musculoskeletal disease (The Bone and Joint Decade Monitor Project), to produce a preliminary action plan for measuring the burden of musculoskeletal disease in the United States, and to describe ways that participating organizations can support the international Bone and Joint Decade Monitor Project. At the conference, the second edition of the publication Musculoskeletal Conditions in the United States10 was introduced.
Musculoskeletal conditions affect hundreds of millions of people around the world, and this figure is projected to increase sharply because of the predicted doubling of the number of people older than the age of fifty by the year 20205. Musculoskeletal conditions, injuries, and deformities also deprive children of normal development. In the United States alone, musculoskeletal conditions rank first among diseases according to measures of disability and on the basis of visits to physicians' offices, and they are the number-one category of reported impairments, according to the National Health Interview Survey7. They number 36.4 million in the civilian, noninstitutionalized population, and an additional 0.5 million residents of nursing homes have musculoskeletal impairments7. This translates into one of every seven Americans. Musculoskeletal impairments rank first among both men and women and among the major racial groups, and they are a leading cause of limitation of activity among Americans, accounting for 488 million restricted-activity days and 153 million bed-days in 19957.
In 1995, 28.6 million persons incurred a musculoskeletal injury, accounting for more than one-half of all injuries in that year7. Sprains, dislocations, and fractures accounted for almost one-half (46 percent) of all musculoskeletal injuries7. Musculoskeletal conditions and injuries accounted for more than three million hospitalizations and were ranked fourth among system or disease categories8; they also accounted for 130.7 million visits to physicians' offices and hospital outpatient and emergency departments6. More than 5.7 million hospitalizations or patient visits resulted in 7.3 million musculoskeletal procedures8. Musculoskeletal conditions were estimated to account for $215 billion in direct and indirect costs (mortality and morbidity) in 199510.
Arthritis is the leading chronic condition reported by the elderly; it affects one of every eight Americans of all ages and almost 50 percent of people who are sixty-five years or older. Currently, arthritis is a more frequent cause of limitation of activity than heart disease, cancer, or diabetes. Back and spine impairments are the most prevalent musculoskeletal disorders and account for approximately one-half of restricted-activity days and slightly more than 60 percent (61 percent) of bed-days7. Seventy-five to 85 percent of all people will have 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 workforce has a compensable back injury each year. Almost 16.2 million office visits result from back-pain conditions10.
Musculoskeletal impairments will increase over the next thirty years, as they are most prevalent in the older segments of the population and the population is aging. The number of individuals older than the age of fifty is expected to double between 1990 and 2020. In Europe, by 2010, for the first time there will be more people older than sixty years of age than people younger than twenty years of age5.
Osteoporosis affects ten million Americans, and eighteen million more are at risk; 80 percent are women9. Each year, almost 1.3 million fractures, including 500,000 vertebral fractures, are attributed to osteoporosis. The cost of these treatments is expected to double over the next fifty years unless prevention and treatment strategies are initiated. Two-thirds of people who have a hip fracture do not return to their prefracture level of functioning. Approximately one in every six white women will have a hip fracture in their lifetime. The rate of hip fracture increases exponentially with increasing age. Beginning at the age of sixty-five, the rates for men and women double in each decade of life10. One-half of all American women older than the age of fifty years are expected to sustain an osteoporosis-related fracture in their lifetime9.
Despite this information on the burden of disease and the cost of $215 billion per year, expenditures for orthopaedic research had been estimated to total only about $92 million per year. Of that total, only $16 million is devoted to clinical research1. In addition, the amount of time spent on musculoskeletal education in many medical schools is minimum4. In a recent study, one-third of the physician participants graduated from medical schools with no rotation (either required or elective) in orthopaedics4.
In October, the American Academy of Orthopaedic Surgeons Task Force on The Bone and Joint Decade began working on the development of the United States National Action Network. This network for The Bone and Joint Decade will provide the umbrella organization by which orthopaedic surgery will partner with other organizations, patient-advocacy groups, government, industry, and researchers interested in musculoskeletal care. Through the partnerships facilitated and promoted by The Bone and Joint Decade, the Academy and all orthopaedic associations and organizations, together with patients, will be better able to achieve our respective organizational missions and to fulfill the goals of The Bone and Joint Decade initiative. We must search for innovative ways to collaborate with our partners so that we can achieve the goals of The Bone and Joint Decade. The Bone and Joint Decade deserves the strong support of each and every member of the musculoskeletal community.
Stuart L. Weinstein, M.D.
American Academy of Orthopaedic Surgeons
Task Force on The Bone and Joint Decade