Chronic musculoskeletal conditions

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 problems, gout, and osteoporosis or osteopenia (low bone density) (see Glossary).

How common are chronic musculoskeletal conditions?

Chronic musculoskeletal conditions affect about 3 in 10 Australians. Self-reported data from the Australian Bureau of Statistics 2020–21 NHS provide estimates of the number of Australians affected by musculoskeletal conditions. These data indicate that, of the nearly 6.9 (27% of all Australians) million people with chronic musculoskeletal conditions, 3.9 million (16%) had back problems (the most common musculoskeletal condition), 3.1 million (12%) had arthritis and 889,000 (3.6%) had osteoporosis (ABS 2022a). For more detailed information see Arthritis, Back pain and problems and Osteoporosis.

Note: The information below is from the 2017–18 and earlier NHS.

Rates of chronic musculoskeletal conditions were relatively consistent from 2007–08 to 2017–18 (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 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. In comparison to those without the condition, people aged 45 and over with:

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

Mental and behavioural conditions commonly co-occur with musculoskeletal conditions. Compared with people without these musculoskeletal conditions, for people aged 45 and over with mental and behavioural conditions were:

• 1.9 times as likely in people with back 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.

Variation between population groups

The prevalence of musculoskeletal conditions generally increases with increasing socioeconomic disadvantage, but is similar across remoteness areas, after adjusting for differences in age structures (Figure 5 shows a comparison for people aged 45 and over).

Impact

Chronic musculoskeletal conditions are large contributors to illness, pain and disability in Australia. People with these conditions report higher rates of poor health, psychological distress and pain, after adjusting for age (Figure 6). 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

Burden of disease refers to the quantified impact of living with and dying prematurely from a disease or injury.

Ill health caused by musculoskeletal conditions can have both a human and a financial cost. According to the Australian Burden of Disease Study 2018, musculoskeletal conditions contributed to:

• 13% of the total disease burden (fatal and non-fatal) in Australia. This disease group was the second leading contributor to total burden after cancer.
• 24% 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 total burden among females than males – musculoskeletal conditions contributed to 15% of total female burden compared with 11% of total male burden
• a higher total burden among people aged 60–64 years compared to other 5-year age groups
• the largest component of non-fatal burden for people aged 50–84 years (AIHW 2021a).

Modifiable risk factors contribute to burden

Some of the total burden due to musculoskeletal conditions can be attributed to modifiable risk factors. In 2018, overweight and obesity contributed to:

• 8.9% of the total burden of all musculoskeletal conditions
• 28% of the burden from osteoarthritis.

Occupational exposures and hazards contributed to:

• 5.6% of the total burden of all musculoskeletal conditions
• 17% of the burden of back problems (AIHW 2021b).

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 2018–19, costing the Australian health system $13.9 billion (10% of total disease expenditure) (AIHW 2021c). See Disease expenditure in Australia 2018–19.

Condition specific expenditure

Of the $13.9 billion health system expenditure attributed to musculoskeletal conditions in 2018–19, an estimated:

• 28% ($3.9 billion) was attributed to osteoarthritis
• 24% ($3.3 billion) was attributed to back problems
• 6.5% ($902 million) was attributed to rheumatoid arthritis
• 1.5% ($203 million) was attributed to gout
• 40% ($5.6 billion) was attributed to other musculoskeletal conditions.

Areas of expenditure

In 2018–19, private hospital services and public hospital admissions were the areas of expenditure with the highest spending for all musculoskeletal conditions, at 36% and 18% respectively ($5.0 billion, and $2.5 billion).

In 2018–19, musculoskeletal conditions was the disease group with the highest spending for the following areas:

• medical imaging (29% of all disease groups)
• private hospital services (21% of all disease groups)
• public hospital outpatient services (12% of all disease groups).

Age and sex breakdown of expenditure

The relative expenditure on musculoskeletal conditions by age and sex reflects the relative prevalence of musculoskeletal conditions by age and sex. Both expenditure and prevalence are higher for females and higher for older people. In 2018–19:

• Musculoskeletal expenditure was 1.2 times higher for females compared with males ($7.4 billion and $6.1 billion, respectively).
• People aged 55 and older represented 67% of musculoskeletal 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 General practice, allied health and other primary care services.

Hospital treatment

People with musculoskeletal conditions that are very severe, or who require specialised treatment or surgery, can also be managed in hospitals. In 2020–21, there were around 832,500 hospitalisations for musculoskeletal conditions – 7.0% of all hospitalisations in that year (AIHW 2022b). These hospitalisations included:

• osteoarthritis (34% of all musculoskeletal hospitalisations)
• back problems (23%)
• rheumatoid arthritis (1.5%)
• osteoporosis (1.2%)
• gout (1.0%)
• other musculoskeletal conditions (39%).

Osteoarthritis is the most common condition leading to hip and knee replacement surgery in Australia (AOANJRR 2021).

• Between 2010–11 and 2020–21, rates of total hip replacement and total knee replacement surgery, where osteoarthritis was the principal diagnosis, both trended up. Over this period these rates increased by 2.6% and 2.0% per year on average, respectively, after standardising age structures (Figure 7).

Impact of COVID-19 on hospital treatment

The COVID-19 pandemic had substantial impacts on hospital activity. The range of social, economic, business and travel restrictions, including restrictions on, or suspension of, some hospital services, and associated measures in other healthcare services to support physical distancing in Australia resulted in an overall decrease in hospital activity between 2019–20 and 2020–21 (AIHW 2022a).

• In 2019–20, there were 7.8% fewer hospitalisations for musculoskeletal conditions than in 2018–19. This decrease was driven by the April–June 2020 quarter, which saw 33% fewer hospitalisations than April–June 2019. However in 2020–21, rates exceeded pre-pandemic levels.

At the beginning of the COVID-19 pandemic in Australia, non-urgent elective surgery was suspended for one month, from late March to late April 2020. For more information on how the pandemic has affected the population’s health in the context of longer-term trends, see 'Chapter 2 Changes in the health of Australians during the COVID-19 period’ in Australia’s health 2022: data insights.

• In 2019–20, the age standardised rate of total hip and knee replacement surgery where osteoarthritis was the principal diagnosis declined 8.6% and 11.4% respectively from 2018–19 (Figure 7). However in 2020–21, rates exceeded pre-pandemic levels.
• April and May 2020 saw large decreases in admissions for hip and knee replacement surgeries, relative to the same months in 2019 and 2018. This was followed by slight increases on previous years for June and July 2020 (Figure 8).

Figure 7: Rate of total hip and knee replacement surgeries, for osteoarthritis, 2010–11 to 2020–21

Figure 8: Total hip and knee replacement surgeries, by month, 2018 to 2020

Restrictions continued in some jurisdictions during 2020–21, and the associated impacts are still relatively unknown.  Waiting times for elective surgeries increased notably for 2020–21 admissions.

• In 2020–21, the median waiting times for total hip replacement surgery and total knee replacement surgery increased from 2019–20 by 49% and 38% respectively. This compares to an increase of 23% for all elective surgery (AIHW 2021d).
• In 2020–21, the percentage of total hip replacements and total knee replacements with waiting times exceeding one year were 21% and 32% respectively. These represent 13 and 20 percentage point increases on 2019–20, which compares to a 4.8 percentage point increase for all elective surgeries (AIHW 2021d).

Data limitations

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.

Where do I go for more information?

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

• Australian Bureau of Statistics National Health Survey: first results, 2017–18
• Australian Bureau of Statistics Health Conditions Prevalence, 2020–21
• Australian Centre for Monitoring Health

• Visit Chronic musculoskeletal conditions for more on this topic.