Diseases of the musculoskeletal system rank first among disease conditions that alter the quality of life. This is related to limitation of activity, disability, and impairment. In the United States, one of every seven persons suffers from some sort of musculoskeletal disorder, the cost of which exceeds $60 billion annually. This includes lost earnings and medical expenses.
Diseases of the musculoskeletal system are divided into two categories: systemic and local. Patients with systemic disease, such as rheumatoid arthritis, systemic lupus erythematosus, or polymyositis, may appear chronically ill, with generalized weakness, pain, and episodic stiffness of the joints. Patients with local disease are basically healthy individuals who suffer restriction of motion and pain from a single area. Included in this group are patients suffering from back pain, tennis elbow, arthritis, or bursitis. Although these patients may have only local symptoms, their disability can greatly limit their work capacity, and the disease can have a severe impact on the quality of their life.
Diseases of the musculoskeletal system rank first in cost to workers' compensation insurance carriers. Nearly 100,000 workers receive disability payments annually, with a total cost to the carriers of more than $200 billion annually.
It has been estimated that musculoskeletal problems rank second (after cardiovascular disorders) in accounting for visits to internists and third for surgical procedures in hospitals (after gynecologic and abdominal surgery). According to a Gallup poll, nearly 75% of individuals older than 18 years complained of foot pain at some time. More than $300 million is spent annually on insoles, corn remedies, bunion removers, other foot care products, and over-the-counter medications for foot care. Despite this widespread problem, fewer than 50% of clinicians know how to examine a foot correctly!
Although not usually fatal disorders, musculoskeletal conditions affect the quality of life. Studies indicate that backache is experienced by more than 80% of all Americans at some time in their lives. Patients with backache for longer than 6 months constitute a large portion of permanently disabled individuals. More than 50% of these patients never return to work.
More than 25 million Americans suffer from arthritis that necessitates medical attention. Arthritis ranks second to cardiac disease as a cause of limitation of activity.
In the United States at least 10% of the population experiences a bone fracture, dislocation, or sprain annually. Each year more than 1.2 million fractures are sustained by women older than 50 years. There are more than 200,000 hip fractures annually, and these are associated with prolonged disability. Osteoporosis* is the most common musculoskeletal disorder in the world and is second only to arthritis as a leading cause of morbidity in the geriatric population. Postmenopausal osteoporosis and age-related osteoporosis increase the risk of fractures in the older population. There are more than 40 million women in the United States older than 50 years, and more than 50% of them have evidence of spinal osteoporosis. Almost 90% of women older than 75 years have significant radiographic evidence of osteoporosis.
The high prevalence of musculoskeletal disease in elderly patients who require assistance has a significant impact on the American economy. The annual cost of nursing home care for patients with musculoskeletal disease is almost $75 billion. More than 10 million individuals in the United States have some form of inflammatory arthritis, the most prevalent being rheumatoid arthritis. It is estimated that more than 7 million patients have this form of arthritis.
Musculoskeletal problems have the most significant financial impact on the aged population. More than $1 billion is spent annually by Medicare for hospitalization of patients with these conditions. This represents 20% of all Medicare payments.
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