Strategies for optimising musculoskeletal health in the 21st century

Abstract

We live in a world with an ever-increasing ageing population. Studying healthy ageing and reducing the socioeconomic impact of age-related diseases is a key research priority for the industrialised and developing countries, along with a better mechanistic understanding of the physiology and pathophysiology of ageing that occurs in a number of age-related musculoskeletal disorders. Arthritis and musculoskeletal disorders constitute a major cause of disability and morbidity globally and result in enormous costs for our health and social-care systems.By gaining a better understanding of healthy musculoskeletal ageing and the risk factors associated with premature ageing and senescence, we can provide better care and develop new and better-targeted therapies for common musculoskeletal disorders. This review is the outcome of a two-day multidisciplinary, international workshop sponsored by the Institute of Advanced Studies entitled "Musculoskeletal Health in the 21st Century" and held at the University of Surrey from 30th June-1st July 2015.The aim of this narrative review is to summarise current knowledge of musculoskeletal health, ageing and disease and highlight strategies for prevention and reducing the impact of common musculoskeletal diseases.

Keywords: Ageing; Global burden; Joint diseases; Low back pain (LBP); Metabolic disease; Musculoskeletal disorders; Musculoskeletal health; Obesity; Osteoarthritis (OA); Osteoporosis (OP); Rheumatoid arthritis (RA); Sarcopenia; Type II diabetes.

Fig. 1

a The global burden of hip and knee osteoarthritis; estimates from the Global Burden of Disease Study 2010. The numbers show the number of case studies reported in the literature for each country, extracted via a systematic review process. Reproduced from Cross M, Smith E, Hoy D, et al. The global burden of hip and knee osteoarthritis: estimates from the Global Burden of Disease 2010 study. Note the absence of data from Central America, South America and Sub-Saharan Africa. Annals of the Rheumatic Diseases Published Online First: 19 February 2014. doi: 10.1136/annrheumdis-2013-204,763. b. The global burden of musculoskeletal disease attributable to low bone mineral density. The numbers show the number of case studies reported in the literature for each country, extracted via a systematic review process. Reproduced from Sànchez-Riera L, Carnahan E, Vos T, et al. The global burden attributable to low bone mineral density Annals of the Rheumatic Diseases Published Online First: 01 April 2014. doi: 10.1136/annrheumdis-2013-204,320. c. The prevalence rheumatic and musculoskeletal diseases in France. This figure highlights the dominance of osteoarthritis and back pain from the fifth to the 9th decade of life. Reproduced from Palazzo C, Ravaud JF, Papelard A, Ravaud P, Poiraudeau S (2014) The Burden of Musculoskeletal Conditions. PLOS ONE 9(3): e90633. 10.1371/journal.pone.0090633

Fig. 2

Evidence-based interventions for the musculoskeletal conditions that cause the most DALYs (Disability-adjusted life years) in England, including low back and neck pain, falls and osteoarthritis. https://publichealthmatters.blog.gov.uk/2016/01/11/preventing-musculoskeletal-disorders-has-wider-impacts-for-public-health/

Fig. 3

The burden of musculoskeletal disease in the United States and the funding gap for research on musculoskeletal conditions (2009–2013). a. Despite the major health care burden presented by musculoskeletal conditions, research funding falls well below that of most other conditions. Injury research accounted for half of the musculoskeletal condition research dollars ($4 billion) from NIH for the years 2009 to 2013. Funding for arthritis research is second, at $1.4 billion, followed by osteoporosis ($965 million). These numbers are well below the $8.6 to $55.2 billion in funding for the top 25 NIH research areas, dominated by cancer, cardiovascular disease and other disease areas. b. Research funding allocated to different musculoskeletal conditions by NIAMS. The data clearly indicate that musculoskeletal conditions receive less funding support compared to other disease areas despite the heavy burden on healthcare systems worldwide