The Burden of Musculoskeletal Diseases in the United States Second Editi on Prevalence, Societal, and Economic Cost The Burden of Musculoskeletal Diseases in the United Project Coordinator States, Second Edition, is a joint project of the Sylvia I. Watkins-Castillo, PhD American Academy of Orthopaedic Surgeons, American Academy of Physical Medicine Staff and Rehabilitation, American College of Robert H. Haralson, III, MD, MBA, Medical Director, Rheumatology, American Society for Bone and AAOS Mineral Research, Arthritis Foundation, National Toby R.W. King, CAE, Executive Director, USBJD University of Health Sciences, Orthopaedic Amy Miller, Senior Director, Research, Training and Research Society, Scoliosis Research Society, and Quality, ACR the United States Bone and Joint Decade. Thomas E. Stautzenbach, MA, MBA, CAE, Executive Director, AAPM&R Management Oversight Team and Charles M. Turkelson, PhD, Director, Research and Major Contributing Organizations Scientifi c Aff airs, AAOS Marilyn Fox, PhD, Director, Publications, AAOS Joshua J. Jacobs, MD Mary Steermann Bishop, Senior Manager, Production Chair, Management Oversight Team, The Burden of & Archives, AAOS Musculoskeletal Diseases in the United States Courtney Astle, Assistant Production Manager, AAOS Gunnar B. J. Andersson, MD, PhD Cover Design John-Erik Bell, MD Rick Cosaro, Cosaro & Associates, Ltd. Stuart L. Weinstein, MD American Academy of Orthopaedic Surgeons (AAOS) The material presented in The Burden of Musculoskeletal Diseases in the United States is made available for informational purposes John P. Dormans, MD only. This material is not intended to suggest procedures or course of Scoliosis Research Society (SRS) treatment, only to provide an interpretation of available data on the incidence and prevalence of most major musculoskeletal conditions. Steve M. Gnatz, MD, MHA American Academy of Physical Medicine and All rights reserved. No part of this publication may be reproduced, Rehabilitation (AAPM&R) stored in retrieval system, or transmitt ed, in any form, or by any means, electronic, mechanical, photocopying, recording, or otherwise, Nancy Lane, MD without prior writt en permission from the publisher. United States Bone and Joint Decade (USBJD) Copyright © 2008 by the American Academy of Orthopaedic J. Edward Puzas, PhD Surgeons. Orthopaedic Research Society (ORS) ISBN 978-0-89203-533-5 President, United States Bone and Joint Decade (USBJD) The Burden of Musculoskeletal Diseases in the United States 6300 N. River Road E. William St. Clair, MD Rosemont, IL 60018 Edward H. Yelin, PhD United States of America American College of Rheumatology (ACR) 1-800-626-6726 Additional Contributing Organizations Suggested citation: United States Bone and Joint Decade: The Burden American Society for Bone and Mineral Research of Musculoskeletal Diseases in the United States, Second Edition. (ASBMR) Rosemont, IL: American Academy of Orthopaedic Surgeons;2010. Arthritis Foundation National University of Health Sciences ii The Burden of Musculoskeletal Diseases in the United States - Copyright © 2010 Authors and Reviewers Steven M. Kurtz, PhD Gunnar B. J. Andersson, MD, PhD Nancy Lane, MD Jeannett e Bouchard Assia Miller, MD, MPH Kevin J. Bozic, MD, MBA Reba L. Novich, MSW Robert M. Campbell, Jr., MD Richard Olney, MD, MPH Miriam G. Cisternas, MS Peter Panopalis, MD Adolfo Correa, MD. MPH, PhD David J. Pasta, MS Felicia Cosman, MD Andrew N. Pollak, MD Janet D. Cragan, MD, MPH J. Edward Puzas, PhD Kristen D’Andrea, BA B. Steven Richards, III, MD Nancy Doernberg John P. Sestito, JD, MS John P. Dormans, MD, FACS Csaba Siff el, MD, PhD Ann L. Elderkin, PA Paul D. Sponseller, MD Zarina Fershteyn, MPH E. William St. Clair, MD Aimee J. Foreman, MA Andrew Stuart, MA Steven Gitelis, MD Kimberly J. Templeton, MD Steve M. Gnatz, MD, MHA George Thompson, MD Robert H. Haralson, III, MD, MBA Laura Tosi, MD Charles G. (Chad) Helmick, MD William G. Ward, Sr., MD Serena Hu, MD Sylvia I. Watkins-Castillo, PhD Jeff rey N. Katz, MD Stuart L. Weinstein, MD Toby King, CAE James G. Wright, MD, MPH, FRCSC Ron Kirk, MA, DC Edward H. Yelin, PhD Bone and Joint Decade The Bone and Joint Decade is an international collaborative movement sanctioned by the United Nations/ World Health Organization and working to improve the quality of life for people with musculoskeletal conditions and to advance the understanding, prevention and treatment of these conditions. Offi cially proclaimed by the U.S. President, the United States Bone and Joint Decade (USBJD) 2002-2011 has been endorsed by all 50 States and more than one hundred national health care professional, patient and public organizations, all 125 U.S. medical schools and many colleges of medicine. The goal of the United States Bone and Joint Decade is to improve bone and joint health by enhancing collaborative eff orts among individuals and organizations in order to raise awareness of the growing burden of musculoskeletal disorders on society, to promote wellness and prevent musculoskeletal disease, and to advance research that will lead to improvements in prevention, diagnosis and treatment. www.usbjd.org [email protected] Phone: 847-384-4010 The Burden of Musculoskeletal Diseases in the United States - Copyright © 2010 iii Table of Content vii Preface ix Foreword 1 Chapter 1: Burden of Musculoskeletal Disease Overview 21 Chapter 2: Spine: Low Back and Neck Pain 57 Chapter 3: Spinal Deformity and Related Conditions 75 Chapter 4: Arthritis and Related Conditions 103 Chapter 5: Osteoporosis and Bone Health 129 Chapter 6: Musculoskeletal Injuries 181 Chapter 7: Congenital and Infantile Developmental Conditions of the Musculoskeletal System 195 Chapter 8: Neoplasms of Bone and Connective Tissue 219 Chapter 9: Health Care Utilization and Economic Cost of Musculoskeletal Diseases 253 Appendices 269 Index The Burden of Musculoskeletal Diseases in the United States - Copyright © 2010 v Preface It is with pleasure that I introduce you to this high expectations of the health system. With publication of the Burden of Musculoskeletal the National Center for Health Statistics’ 2008 Diseases in the United States, the timely result of National Health Interview Survey as a solid base, a partnership between the American Academy this publication examines such issues as spinal of Orthopaedic Surgeons and a number of other problems, arthritis and joint pain, osteoporosis, organizations supporting the U.S. Bone and injuries, congenital conditions, neoplasms, and Joint Decade (2002-2011). The level of disease health care utilization and costs. The biomedically recognition that the Decade has provided has done inclined reader will fi nd within these pages both much to push the state of the science forward, and food for thought and a call to action. this new publication presents a snapshot of how far we have come since its predecessor, the 1999 The plight of millions of Americans whose Musculoskeletal Conditions in the United States, was lives are aff ected by the physical, fi nancial, and released. emotional demands of musculoskeletal conditions make the fi ndings of Burden diffi cult to ignore. I Although many advances have been made, encourage you to read and digest its contents, and musculoskeletal conditions remain common, to appropriate for yourself those parts within your chronic, and costly—and potentially disabling— specifi c areas of interest or expertise. to an increasingly graying population with Stephen I. Katz, MD, PhD Director National Institute of Arthritis and Musculoskeletal and Skin Diseases National Institutes of Health Bethesda, Maryland January 10, 2008 The Burden of Musculoskeletal Diseases in the United States - Copyright © 2010 vii Foreword Musculoskeletal disorders and diseases are the two previous editions entitled Musculoskeletal leading cause of disability in the United States Conditions in the United States, published in and account for more that one-half of all chronic 1992 and 1999 by the American Academy of conditions in people over 50 years of age in Orthopaedic Surgeons, and the second edition developed countries. The economic impact of these of the most recent edition, renamed The Burden conditions is also staggering: in 2004 the sum of of Musculoskeletal Diseases in the United States the direct expenditures in health care costs and when published in 2070. The book represents a the indirect expenditures in lost wages has been true collaboration of a coalition of professional estimated to be $950 billion dollars, or 7.4% of the organizations committ ed to the mission of the US 2006 GDP (national gross domestic product.) Bone and Joint Decade. Beyond these statistics, the human toll in terms These data should stimulate increased investment of the diminished quality of life is immeasurable. in basic, translational, clinical and health policy This situation is unlikely to improve in the research to delineate the underlying mechanisms foreseeable future and will likely be intensifi ed by of these diseases and their response to treatment. current demographic trends, including the graying Through such research, novel preventive of the baby boomer population, the epidemic of and therapeutic approaches with potential to morbid obesity, and the higher recreational activity mitigate the societal and personal impact of levels of our elderly population. musculoskeletal disease will emerge. Despite these compelling facts, the investment Joshua J. Jacobs, M.D. in musculoskeletal research in the United States President, U.S. Bone and Joint Decade lags behind other chronic