Bone and joint health

Conditions that affect the bones, muscles and joints are known as musculoskeletal conditions. These conditions include long-term (chronic) conditions such as osteoarthritis, rheumatoid arthritis, juvenile arthritis, back pain and problems, gout, and osteoporosis or osteopenia (low bone density) (see Glossary).

How common are chronic musculoskeletal conditions?

Chronic musculoskeletal conditions affect almost 3 in 10 (29%) Australians. Self-reported data from the Australian Bureau of Statistics 2017–18 National Health Survey (NHS) provide estimates of the number of Australians affected by musculoskeletal conditions. These data indicate that, of the nearly 7.0 million people with chronic musculoskeletal conditions, 4.0 million (16% of all Australians) had back pain and problems (the most common musculoskeletal condition), 3.6 million (15%) had arthritis and 924,000 (3.8%) had osteoporosis (ABS 2018a). These rates have remained relatively consistent since 2007–08 (Figure 1).
 

Females and older people are at greater risk

Females and older people were more likely to have chronic musculoskeletal conditions. The 2017–18 NHS shows that:

• Females were 1.2 times as likely to have a musculoskeletal condition and more than 4 times as likely to have osteoporosis compared with males.
• The prevalence of arthritis was similar in males and females aged 0–44, but overall females were 1.5 times as likely to have arthritis compared with males.
• The prevalence of back pain and problems was similar in males and females across all age groups.
• More than 2 in 3 (68%) people aged 75 and over had a musculoskeletal condition (Figure 2).
   

Comorbidity

People with musculoskeletal conditions often have other long-term conditions. This is called ‘comorbidity’, which describes any additional disease that is experienced by a person with a disease of interest (the index disease). 

Musculoskeletal conditions often co-occur among people aged 45 and over. Compared with people without these conditions:

• people with arthritis were 1.8 times as likely to also have back pain and problems
• people with back pain and problems were 1.6 times as likely to also have arthritis
• people with osteoporosis were 2.1 times as likely to also have arthritis.

Mental and behavioural conditions are a common comorbidity in people aged 45 and over with musculoskeletal conditions. Compared with people without these conditions, mental and behavioural conditions were:

• 1.9 times as likely in people with back pain and problems
• 1.6 times as likely in people with arthritis
• 1.5 times as likely in people with osteoporosis (Figure 4).

Adjusting for differences in the age structure of the groups did not affect the pattern of these results.
 

Impact

Chronic musculoskeletal conditions are large contributors to illness, pain and disability in Australia. People with these conditions self-report higher rates of poor health, psychological distress and pain, after adjusting for age (Figure 5). This may affect their ability to participate in social, community and occupational activities (Briggs et al. 2016). The 2018 Survey of Disability, Ageing and Carers found that, of the people with disability in Australia, an estimated 13% had back problems and another 13% had arthritis as the main long-term health condition causing the disability (ABS 2019b).
 

Burden of disease

Ill health caused by musculoskeletal conditions can have both a human and a financial cost. According to the Australian Burden of Disease Study 2015, musculoskeletal conditions contributed to:

• 13% of the total disease burden (fatal and non-fatal) in Australia. This disease group was the third leading contributor to total burden after cancer and cardiovascular diseases
• one-quarter (25%) of non-fatal burden (that is, the impact of living with illness and injury). This was the leading disease group contributing to non-fatal burden
• a higher burden among females than males—musculoskeletal conditions contributed to 15% of total female burden compared with 11% of total male burden (AIHW 2019a).

See Burden of disease for information on definitions and the burden of disease associated with these conditions.

Expenditure

The Australian Disease Expenditure Study found that Musculoskeletal conditions was the disease group with the highest estimated expenditure in 2015–16, costing the Australian health system $12.5 billion (11% of total disease expenditure) (AIHW 2019c). See Health expenditure.

Treatment and management

Primary care

Musculoskeletal conditions are usually managed by general practitioners and allied health professionals. Treatment can include physical therapy, medicines (for pain and inflammation), self-management (such as diet and exercise), education on self-management and living with the condition, and referral to specialist care where necessary (WHO 2019). Based on survey data, an estimated 1 in 6 (18%) general practice visits in 2015–16 were for management of musculoskeletal conditions (Britt et al. 2016). See Primary health care.

Hospitals

People with musculoskeletal conditions that are very severe, or who require specialised treatment or surgery, can also be managed in hospitals. In 2017–18, there were around 795,000 hospitalisations for musculoskeletal conditions—7.1% of all hospitalisations in that year. These hospitalisations included:

• osteoarthritis (34% of all musculoskeletal hospitalisations)
• back pain and problems (23%)
• rheumatoid arthritis (1.5%)
• osteoporosis (1.0%)
• gout (1.0%). See Hospital care.

Clinical guidelines in Australia recommend joint replacement surgery as a cost-effective intervention for people with severe arthritis who are unresponsive to medication and exercise (RACGP 2018). Osteoarthritis is the most common condition leading to hip and knee replacement surgery in Australia (AOANJRR 2019). Between 2008–09 and 2017–18, the rate of joint replacement surgery in hospitalisations where osteoarthritis was the principal diagnosis increased by 27% for total knee replacements and 33% for total hip replacements, after adjusting for age (AIHW 2019d).

The prevention, management and treatment of musculoskeletal conditions beyond hospital settings cannot currently be examined in detail due to limitations in available data on:

• primary and allied health care at the national level
• use of over-the-counter medicines to manage pain and inflammation
• diagnosis information for prescription pharmaceuticals (which would allow a direct link between musculoskeletal conditions and use of subsidised medicines)
• patient outcomes, pathways through the health system and quality of care.

Variation between population groups

Among people aged 45 and over, the prevalence of musculoskeletal conditions generally increases with increasing socioeconomic disadvantage, but is similar across remoteness areas, after adjusting for age (Figure 6).
 

Where do I go for more information?

For more information on the musculoskeletal conditions covered in this report, see:

• Back problems
• Arthritis
• Osteoarthritis
• Osteoporosis
• Rheumatoid arthritis
• Australian Bureau of Statistics National Health Survey: first results, 2017–18

Visit Chronic musculoskeletal conditions for more on this topic.

References

ABS (Australian Bureau of Statistics) 2010. Microdata: National Health Survey, 2007–08. ABS cat. no. 4324.0.55.001. Findings based on Expanded Confidentialised Unit Record File analysis. Canberra: ABS.

ABS 2013. Microdata: National Health Survey, 2011–12. ABS cat. no. 4324.0.55.001. Findings based on Expanded Confidentialised Unit Record File analysis. Canberra: ABS.

ABS 2016. Microdata: National Health Survey, 2014–15. ABS cat. no. 4324.0.55.001. Findings based on Expanded Confidentialised Unit Record File analysis. Canberra: ABS.

ABS 2018a. National Health Survey: first results, 2017–18. ABS cat. no. 4364.0.55.001. Canberra: ABS.

ABS 2018b. National Health Survey: users’ guide, 2017–18. ABS cat. no. 4363.0.55.001. Canberra: ABS. 

ABS 2019a. Microdata: National Health Survey, 2017–18. ABS cat. no. 4324.0.55.001. Findings based on Detailed Microdata analysis. Canberra: ABS.

ABS 2019b. Disability, ageing, and carers, Australia: summary of findings, 2018. ABS cat. no. 4430.0. Canberra: ABS.

AIHW (Australian Institute of Health and Welfare) 2019a. Australian Burden of Disease Study: impact and causes of illness and death in Australia 2015. Australian Burden of Disease series no. 19. Cat. no. BOD 22. Canberra: AIHW.

AIHW 2019b. Australian Burden of Disease Study 2015: interactive data on risk factor burden. Cat. no. BOD 25. Canberra: AIHW. Viewed 14 November 2019.

AIHW 2019c. Disease expenditure in Australia. Cat. no. HWE 76. Canberra: AIHW. Viewed 5 August 2019. 

AIHW 2019d. National Hospital Morbidity Database 2017–18. Findings based on AIHW analysis. Canberra: AIHW.

AOANJRR (Australian Orthopaedic Association National Joint Replacement Registry) 2019. Annual report 2019: hip, knee and shoulder arthroplasty. Adelaide: AOA.

Briggs AM, Cross MJ, Hoy DG, Sànchez-Riera L, Blyth FM, Woolf AD et al. 2016. Musculoskeletal health conditions represent a global threat to healthy aging: a report for the 2015 World Health Organization World report on ageing and health. Gerontologist 56:S243–S255.

Britt H, Miller GC, Bayram C, Henderson J, Valenti L, Harrison C et al. 2016. A decade of Australian general practice activity 2006–07 to 2015–16. General practice series no. 341. Sydney: Sydney University Press.

RACGP (The Royal Australian College of General Practitioners) 2018. Guideline for the management of knee and hip osteoarthritis. 2nd edn. Melbourne: RACGP.

WHO (World Health Organization) 2019. Musculoskeletal conditions: fact sheet. Viewed 11 November 2019.