The Big Picture


Fourth Edition advance copy

Disclaimer: This chapter will be included in the forthcoming The Burden of Musculoskeletal Diseases in the United States, Fourth Edition. The United States Bone and Joint Initiative is making it available here prior to its final print publication. This chapter has not been finalized for publication; therefore, it may contain errors of fact, interpretation, or information. The United States Bone and Joint Initiative editors and staff are not responsible for the use of any potentially misleading or inaccurate information or data. Click here for the suggested citation.

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Lead Author(s): 

Stuart I. Weinstein, MD
Edward H. Yelin, PhD

Supporting Author(s): 

Sylvia I. Watkins-Castillo, PhD

Worldwide declining death rates are rapidly bringing nonfatal diseases and injuries to the forefront of health concerns. As people live longer, more years are spent with disabling and life restricting diseases, including musculoskeletal diseases. Globally, life expectancy at birth in 2015 was 68.6 years,1 and 79.8 years in the US.2 By 2050, life expectancy worldwide is expected to rise to 76.2 years,1 and may be as long as 85.9 years and 93.3 years for males and females, respectively, in the US based on current improvements in health care.3 The most recent Global Burden of Disease Study4 has noted that “as countries around the world have made great progress in addressing fatal diseases, nonfatal diseases pose the next major threat in terms of disease burden.” Leading causes of years lived with disability (YLD) for both men and women include major musculoskeletal conditions.

Musculoskeletal conditions are among the most debilitating nonfatal health diseases. Persons affected with back pain and arthritis have high rates of chronic pain and disability, reducing the quality of life and limiting ability to participate in many common activities. More than one-half of the US population experience these conditions.

The Burden of Musculoskeletal Conditions in the United States, successor to Musculoskeletal Conditions in the United States published by the American Academy of Orthopaedic Surgeons (1992 and 1999), was first produced in print in 2008 as part of the United States Bone and Joint Decade, 2002-2011. The national recognition of musculoskeletal conditions as one of the most disabling and costly conditions experienced by Americans was proclaimed in March 2002 by then President George W. Bush.5,6 At the end of the decade, the multiple associations of health providers treating musculoskeletal diseases realized the work had only begun, and the United States Bone and Joint Initiative (USBJI), a part of the Global Alliance for Musculoskeletal Health, was created. The Burden of Musculoskeletal Conditions in the United States was updated in 2011, again in print. In 2014, the first electronic edition was completed. Future years will see individual chapter updates rotating in 2 to 3 year cycles.

The goal of USBJI is to improve the quality of life for people with musculoskeletal conditions and to advance understanding and treatment of these conditions through research, prevention, and education. The cornerstone of USBJI is describing the burden of musculoskeletal disease, defined as the incidence and prevalence of musculoskeletal conditions; the resources used to prevent, care, and cure them; and the impact on individuals, families, and society. Direct costs of the burden of musculoskeletal disease include hospital inpatient, hospital emergency and outpatient services, physician outpatient services, other practitioner services, home health care, prescription drugs, nursing home cost, prepayment, and administration and non–health-sector costs. Indirect cost relates to morbidity and mortality, including the value of productivity losses due to disability or premature death due to a disease, the value of lifetime earnings due to disability or early death, and the impact of the conditions on quality of life.

With the aging of the US population, musculoskeletal impairments and disability will become an increasing large burden as they are most prevalent in the older segments of the population. Using US Census Bureau projections, by the year 2060, the number of individuals in the United States older than the age of 65 years is projected to grow from the current 15% (47.8 million) of the population to 24% (98.2 million). Persons age 80 years and older will double from the current <4% to more than 8%.7 Looking at projections from the MacArthur Foundation Research Network utilizing improved health care treatments, by 2050, the population age 65 and older would be between 99.3 and 107.7 million, while the population age 85 and older would number 27.0 to 34.7 million.3

Regardless of the projection method, the share of the population age 65 and over, those most likely to suffer from musculoskeletal diseases, is projected to increase rapidly in the next few decades. Health care services worldwide will be facing severe financial pressures in coming decades unless new treatments or means of prevention are found to address the escalating number of people affected by musculoskeletal diseases.

The following pages on this website, provide data to support research, education programs, and healthcare policy research that will bring about significant advances in the knowledge, diagnosis, and treatment of musculoskeletal conditions, with the goal of improving treatment to reduce pain and disabilities brought on by chronic musculoskeletal diseases.


  • 1. a. b. Wan He, Goodkind D, Kowal  P. U.S. Census Bureau, International Population Reports, P95/16-1, An Aging World: 2015, U.S. Government Publishing Office, Washington, DC,2016. Accessed August 15, 2016.
  • 2. Central Intelligence Agency. The World Factbook, North America: United States.  Accessed November 9, 2016.
  • 3. a. b. Olshansky SJ, Goldman DP, Zheng Y, Rowe JW. Aging in America in the twenty-first century: demographic forecasts from the MacArthur Foundation Research Network on an Aging Society. Milbank Quarterly 2009;87(4):842-862.
  • 4. Murray CJL, et al. Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. The Lancet. 2015 June 8. doi: 10.1016/S0140-6736(15)60692-4.( Accessed August 15, 2016.
  • 5. Weinstein S: 2000-2010: The Bone and Joint Decade. J Bone Joint Surg Am 2000;82:1-3.
  • 6. A Proclamation by the President of the United States of America: National Bone and Joint Decade Proclamation: National Bone and Joint Decade, 2002–2011. Office of the Press Secretary, 2002.
  • 7. United States Census. 2014 National Population Projections: Downloadable Files. Accessed August 15, 2016.


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