Musculoskeletal diseases are extremely common and have important consequences to the individual and society. They are one of the major causes of disease burden around the world and have been one of the significant drivers behind the development of the Bone and Joint Decade [1, 2]. The World Health Organisation (WHO) has reported the figures for burden due to musculoskeletal disease and shown that not only are they significant in terms of absolute disability-adjusted-life years (DALYs), but that this burden is seen (and is growing) in both the developed and developing world (Table 1).

Table 1 Estimated burden of musculoskeletal conditions by region (2001)
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It must be remembered that these data do not include fractures as a result of osteoporosis, since these are currently classified under trauma. The addition of these numbers would add significantly and clearly demonstrate that the musculoskeletal diseases are one of the most significant causes of disability around the world. Of significance is the fact that a significant majority of this burden is in the developing countries and that this is likely to increase rapidly with the increasing longevity of these populations. Table 2 shows the percentage of burden attributed to the major rheumatic diseases—rheumatoid arthritis and osteoarthritis—broken down by gender and region. Rheumatic disease burden is seen more frequently in women, and osteoarthritis is the major cause of that burden. This time one can see how much of the burden of disease in developed countries is due to arthritis—nearly 3.5%.

Table 2 Percent of total burden of disease due to OA/RA by gender and region
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These burden data should be used widely to impress on governments the importance of musculoskeletal disorders and why better recognition and support should be provided. Local country data (such as that from Australia) is important and can be used to persuade governments to recognise these conditions as was done in Australia in 2002 when arthritis and musculoskeletal disorders were added as the country’s 7th national health priority [3]. This has led to the establishment of a National Arthritis and Musculoskeletal Disease Task Force with increased research and development funding and a specific grant of some $11 million to Arthritis Australia to develop exercise programs. These data, shown in Table 3, demonstrate how priorities may change when one compares mortality and morbidity data.

Table 3 Mortality and mordibity burden data in Australia [4]
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Although these numbers are impressive, there are still significant deficiencies in musculoskeletal burden of disease data, which need to be expanded in the next few years. Like other classical epidemiological studies, a large number of COPCORD (Community-Oriented Program for the Control of Rheumatic Diseases) studies in over 17 countries around the world have provided very useful data [5–9]. These community surveys have investigated musculoskeletal pain and specific rheumatic diseases in a number of rural and urban communities around the world. These surveys have shown that back and knee pain are common in these communities, while osteoarthritis (OA) and rheumatoid arthritis (RA) have a similar prevalence to the more formal epidemiological studies as shown in Table 4 [10].

Table 4 Rheumatic diseases (COPCORD)
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One of the areas that is often not emphasised in musculoskeletal epidemiology studies is that of musculoskeletal pain. Telephone surveys and more formal epidemiological studies show it to be extremely common and increasing. A telephone survey of some 46,000 persons across 16 countries of Europe showed nearly 20% of adults suffering from chronic pain, that the most common source of pain was the back (24%) and that the most common cause was arthritis/osteoarthritis(35%) [11]. Prevalence of pain varied markedly between countries—with over 25% of adults from Norway, Poland and Italy reporting pain, while only 11% of adults in Spain suffered from chronic pain. A high proportion of sufferers indicated that they were not given adequate information about their pain and how they could manage it better. This emphasises the importance of developing better education programs for health professionals and patients and enhancing communication skills of musculoskeletal practitioners.

A similar telephone survey conducted in Sydney, Australia showed 22% of respondents affected with chronic pain (pain every day for the past 3 months) and musculoskeletal disease being the most common cause (26%) [12]. High utilisation of health services by those affected was noted in both surveys. Musculoskeletal pain seems significantly more common than it was 40 years ago, according to a recent study from the North West of England [13]. In this study, pain in the shoulder and back, and generalised musculoskeletal pain increased some two- to fourfold over a 40-year period. As practitioners of musculoskeletal medicine, we deem it important that we focus on this important and growing area of musculoskeletal disease [14].

Interesting data to support an association between musculoskeletal pain and obesity [15] and the well-known increasing prevalence of back pain with age (Fig. 1) all suggest that musculoskeletal pain will increase dramatically in the years to come.

Fig. 1
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Prevalence of low back pain by age group and region EU-BC—(developing countries in Europe)

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The area of osteoporosis is another example of an “epidemic” of musculoskeletal disease burden. The incidence of osteoporotic fractures increases dramatically with age (Fig. 2) [16] and, with the ageing population, will increase some threefold by 2050, with almost 50% of those fractures occurring in China [17].

Fig. 2
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Incidence of osteoporotic fractures in women, by age

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The ageing population and the increasing weight of individuals combined with lack of exercise will significantly influence these musculoskeletal burden statistics in the foreseeable future. We do have the ability to intervene on some of these issues, and this is where we need to direct our resources. Focussing on preventive strategies, such as weight reduction and exercise programs, will help to stabilise the increase due to age to some extent—but we need to act now. The costs of treatment of rheumatic disease are increasing, and by developing preventive intervention, we will be able to use our diminishing resources more effectively in the future. For example, total joint replacement is one of the most cost-effective operations available [18], and yet in many countries, patients cannot be treated in this way because of inability to pay or because of inadequate resources (human or otherwise). Data from our own group suggest that patients are well-satisfied with the outcome of both hip (100%) and knee (75%) replacement surgery even after 8 years with significant cost savings for-out-of pocket expenses (Fig. 3) as well as savings of $600 per year in medications [19].

Fig. 3
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Patient out-of-pocket expenses

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As we move forward, there is an urgent requirement for better data on the burden of musculoskeletal diseases around the world. We must also continue to identify and modify risk factors for both primary and secondary prevention and further develop the research agenda.

The key themes to modern public health practice have been espoused as [20]:

  1. 1.

    Leadership of the entire health system

  2. 2.

    Collaborative actions across all sectors

  3. 3.

    Multidisciplinary approach to all determinants

  4. 4.

    Political engagement in public health policy

  5. 5.

    Partnerships with the population to be serviced

To do this properly, we do need to develop partnerships with other sectors—education, transport, labour and industry, to name but a few. These partnerships are going to be vital if we are to succeed in our goal to provide patient-“centred” health care in a health service that is both ‘provider-friendly’ and ‘consumer-focussed’. Because of the multidisciplinary nature of the conditions we treat, musculoskeletal disease practitioners have a great opportunity to lead this interdisciplinary approach that we need to develop. The challenge is there for all of us—Let’s rise to it.