WHO issues benchmarks on musculoskeletal ills

U.S. study builds foundation for first-of-kind data

The Geneva-based World Health Organization (WHO) has released the Global Burden of Disease technical report, or Monitor Project as it is sometimes known, which for the first time involves the assessment and publication of benchmarks on musculoskeletal conditions worldwide. Among the key findings is that the number of hip fractures worldwide is expected to more than triple to 6 million by 2050, from 1.7 million in 1990.

The report was produced in collaboration with the Bone and Joint Decade Initiative of Musculoskeletal Conditions at the Start of the New Millennium, a worldwide enterprise.

The statistics from the American Academy of Orthopaedic Surgeons’ (AAOS) Musculoskeletal Conditions in the U.S., 1999, one of the first activities of the United States Bone and Joint Decade (USBJD), were the foundation of the case statement for the decade in the United States and a primary source for data in the global burden of disease project, according to Stuart L. Weinstein, MD, past president of The American Orthopaedic Association and a spokesman for the USBJD.

President Bush signed a presidential proclamation declaring the U.S. National Bone and Joint Decade in March 2002.

The WHO document provides a global snapshot and serves as a data benchmark for more than 150 conditions, including joint diseases, rheumatoid arthritis and osteoarthritis, osteoporosis, spinal disorders, and back pain.

"What’s most significant about this is the realization by WHO that it is very important to get a handle on how severe these conditions really are," notes Regis O’Keefe, MD, PhD, professor of orthopaedics at the University of Rochester (NY), who also is active with the USBJD. "The fact that they took on this task and produced such an outstanding document attests to the fact this is really a worldwide epidemic, and they describe it as such."

The U.S. decade

The overall goals of the USBJD are to:

  • Increase public awareness of the growing burden of musculoskeletal conditions.
  • Improve patient education.
  • Increase resources for research.
  • Improve diagnosis and treatment.
  • Increase the resources available to physicians and others who provide care.

"Musculoskeletal conditions are underrecognized, underresourced in the research field, and underappreciated," Weinstein says.

"Look at President Bush," O’Keefe suggests. "He’s getting his knees done because he can’t jog. This issue is really profound; these conditions ultimately affect all of us and our lives in really significant ways."

One of the initiatives already under way is Project 100. "We recognize the sensitivity [of this issue] to providers; and in hospitals, these conditions will really impact on care and treatment," he adds. "This project is really designed to try to get 100% of the medical schools to offer and require musculoskeletal education; that is not the case now."

To date, he says, 50% of the medical schools approached have signed on. "This is really important," O’Keefe notes. "The health care centers that educate also do a lot of research and treat a lot of patients. By raising their awareness, they will have a large impact."

Other initiatives include seminars for members of Congress. By educating legislators, it is hoped awareness will be raised for the need for public funding and research.

In addition, the USBJD is partnering with health care organizations such as the American Association of Occupational Health Nurses, which is targeting the impact of musculoskeletal diseases on workers.

There is much more work to be done, explains Weinstein. "At present, five major areas of musculoskeletal conditions are being targeted [back and other joint pain; arthritis; osteoporosis; neoplasms of bone and connective tissue; and congenital and developmental malformations involving the musculoskeletal system], and they cover an estimated 80% of the problems," he observes.

"But there are lots of areas where there are not even good data, such as childhood musculoskeletal conditions. Without an awareness of the magnitude of the problem and the shortage of funding, as the population ages and without that funding and awareness, the possibility for badly needed treatment advances just won’t happen." Weinstein adds.

(Editor’s note: For more on the WHO publication, go to: www.who.int/ncd/cra/is.htm.)

Need More Information?

For more information, contact:

• Stuart Weinstein, MD, Spokesman, United States Bone and Joint Decade. Phone: (319) 356-1872. E-mail: stuart-weinstein@uiowa.edu.

• Regis O’Keefe, MD, PhD, Professor of Ortho-paedics, University of Rochester (NY). Phone: (585) 273-5630. E-mail: regis_okeefe@urmc.rochester.edu.

• United States Bone and Joint Decade. Toby King, Executive Director. Phone: (847) 384-4010. Fax: (847) 823-0536. E-mail: tobyking@usbjd.org. Web site: www.boneandjointdecade.org/usa.