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Editorial

The Bone and Joint Decade: 2000-2010

The United Nations has endorsed a Decade to focus attention on worldwide epidemic of musculoskeletal diseases

MJA 2000; 172: 307-308

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In January this year, the Bone and Joint Decade was launched in Geneva by the World Health Organization. The Decade was initiated because of the epidemic of musculoskeletal disease that is occurring worldwide as the population ages.1 In late November 1999, the Secretary-General of the United Nations, Kofi Annan, signed the UN Declaration of Support for the Decade.

The launch came after almost two years of negotiation by health professionals, led principally by orthopaedic surgeons and rheumatologists. These health professionals garnered support from other musculoskeletal medicine specialists and patient groups. It is hoped that orthodox and complementary practitioners and patient groups involved in musculoskeletal disease and trauma will become involved as the Decade develops.

Following the official launch, some 80 delegates from around the world spent three days at the World Health Organization, evaluating the significant burden of musculoskeletal disease on both developed and developing societies. In the WHO/World Bank Global Burden of Disease Project, musculoskeletal conditions represent more than half of all chronic conditions2 and are the most common cause of severe long-term pain and physical disability.3

There is now...evidence that,
for chronic rheumatic diseases,
something can be done.
In Australia, musculoskeletal diseases are the second most common cause of presentations to a general practitioner4 and the third leading cause of health system expenditure, with an estimated total cost of over $3 billion in 1993-19945 (Box). This compares with an estimated total cost of $3.5 billion for circulatory diseases, $2.5 billion for respiratory diseases and $1 billion for endocrine disorders.6 Furthermore, in 1993-1994,1 musculoskeletal diseases accounted for nearly 300 000 hospital admissions, nearly 15 million medical services and over 13 million prescriptions.5 Significant disability due to musculoskeletal disease has been noted in more than half of people aged over 65 years,7 and is also commonly self-reported in population samples.8 Indeed, osteoarthritis (the most common form of arthritis) accounts for over 5% of years lost due to disability in Australia.9

What is the Bone and Joint Decade and what is its intended impact? One objective is to create national networks of professional and patient organisations which will establish their own national goals and agendas. The desire is to develop a patient "focus", with individuals living with rheumatic disease being significantly involved in the process. Some 80 countries have established national coordinators, and over 20, including Australia, have endorsed the Decade.

The Decade has four major aims:

  • To raise awareness of the growing burden of musculoskeletal disorders on society;

  • To promote prevention of musculoskeletal disorders and empower patients through education campaigns;

  • To advance research on prevention, diagnosis and treatment of musculoskeletal disorders; and

  • To improve diagnosis and treatment of musculoskeletal disorders.

Groups such as the Arthritis Foundation of Australia, the Australian Rheumatology Association and the Australian Orthopaedic Association are already actively pursuing some of these aims and will play major roles in developing activities for the Decade in Australia.

Although one focus of the Decade may well be on the aged and diseases causing disability (eg, osteoporosis, osteoarthritis and back pain), the Decade will also address the increasing problem of musculoskeletal trauma. This is of particular relevance to young populations in both developed and developing countries. Much more information is needed on the epidemiology of trauma, risk factors, ways of minimising damage to tissues after trauma, and strategies to enhance rehabilitation. The recently advertised National Health and Medical Research Council Trauma Research Partnerships will be helpful in this regard.

The past decade has seen enormously exciting advances in the management of osteoporosis and in our understanding of the basic mechanisms of inflammation, which produces so much pain and disability in diseases such as rheumatoid arthritis. These advances include an understanding of the role of genetic markers in osteoporosis, elucidation of risk factors for falls and subsequent fractures, and development of the bisphosphonates. More recently, exciting advances have occurred in the therapeutics of musculoskeletal diseases, previously little changed for decades. These include the development of monoclonal antibodies to substances such as tumour necrosis factor, new specific antirheumatic drugs, and the cyclooxygenase-2 (COX-2) specific inhibitors, which have the potential to reduce pain and inflammation without major gastrointestinal adverse reactions.

Musculoskeletal surgery, particularly joint replacement, has revolutionised the lives of many elderly (and some younger) Australians. Hip and knee replacements are among the most cost-effective interventions in medicine, comparing favourably to coronary bypass surgery and renal dialysis,10 and very significantly improve the quality of life in patients with a variety of rheumatic diseases.11 In addition, data suggesting that osteoarthritis of the knee is related to obesity and can be alleviated to some extent by weight reduction present a cogent argument for primary prevention.12

Many musculoskeletal conditions produce chronic pain, which itself strongly contributes to disability and decreased quality of life. Strategies to address chronic musculoskeletal pain will also be a priority of the Decade.

The hope is that the Bone and Joint Decade will focus attention on these important diseases, demonstrating to healthcare providers that a relatively modest investment can produce significant benefits. The Bone and Joint Decade will try to bring together these important strands of research, education and service to improve the lot of the millions of Australians who suffer each week from a rheumatic condition. A meeting of professional groups, patients and patient organisations and healthcare providers will shortly be convened to begin planning for the Decade in Australia.

The 1990s were designated the Decade of the Brain, and spawned enormous interest around the world in the neurosciences, which is now starting to have significant spin-offs in treatment. It should be remembered that that Decade began with a significant financial investment from the United States Congress, while the Bone and Joint Decade has had no such funding as yet.

This week is National Arthritis Week and professional and patient groups around Australia will focus attention on these important chronic and disabling diseases and their impact on society. They should proceed in the knowledge that there is now a considerable groundswell of energy worldwide and evidence that, for chronic rheumatic diseases, something can be done.

Peter M Brooks
 Executive Dean, Health Sciences
University of Queensland, Brisbane, QLD

John A L Hart
 Clinical Associate Professor of Surgery
Monash University, Melbourne, VIC
and Australian Coordinator of the Bone and Joint Decade

  1. Hazes JM, Woolf AD. The bone and joint decade 2000-2010. J Rheumatol 2000; 27: 1-3.
  2. Dieppe P. Osteoarthritis. Acta Orthop Scand Suppl 1998; 281: 2-5.
  3. Murray JL, Lopez AD, editors. The global burden of disease: a comprehensive assessment of mortality and disability from diseases, injuries and risk factors in 1990 and projected to 2020. Cambridge, Mass: Harvard University Press, 1996.
  4. Britt H, Sayer GP, Miller GC, et al. General practice activity in Australia 1998-1999. Canberra, ACT: Australian Institute of Health and Welfare, 1999. AIHW Cat No. GEP 2.
  5. Mathers C, Penn R. Health system costs of injury, poisoning and musculo-skeletal disorders in Australia 1993-94. Canberra: Australian Institute of Health and Welfare, 1999. AIHW Cat No. HWE 12 (Health and Welfare Expenditure Series No. 6).
  6. Mathers C. Burden of disease and health system costs of heart disease, depression and back problems in Australia. Presented at the National Health and Medical Research Council National Forum. Canberra; 24 Mar 1998.
  7. March LM, Brnabic AJM, Skinner JC, et al. Musculoskeletal disability among elderly people in the community. Med J Aust 1998; 168: 439-442.
  8. Hill CL, Parsons J, Taylor A, Leach G. Health related quality of life in a population sample with arthritis. J Rheumatol 1999; 26: 2029-2035.
  9. Mathers C, Vos T, Stevenson C. The burden of disease and injury in Australia. Canberra: Australian Institute of Health and Welfare, 1999. AIHW cat. no. PHE 17.
  10. Liang MH, Cullen KE, Larson MG, et al. Cost effectiveness of total joint arthroplasty in osteoarthritis. Arthritis Rheum 1986; 29: 937-943.
  11. March LM, Cross MJ, Lapsley H, et al. Outcomes after hip or knee replacement surgery for osteoarthritis. A prospective cohort study comparing patients' quality of life before and after surgery with age-related population norms. Med J Aust 1999; 171: 235-238.
  12. Hart DJ, Spector TD. The relationship of obesity, fat distribution and osteoarthritis in women in the general population. The Chingford Study. J Rheumatol 1993; 20: 331-335.

©MJA 2000
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Other articles have cited this article:

→  Peter M Brooks, Michael J Hooper and Richard A Smallwood AO. Bone and joint diseases: prevention and control Med J Aust 2004; 180 (5 Suppl): SS4-SS5. [Bone and Joint Disorders: Prevention and] <http://www.mja.com.au/public/issues/180_05_010304/bro10458_fm.html>

→  John A L Hart. Joint replacement surgery Med J Aust 2004; 180 (5 Suppl): SS27-SS30. [Bone and Joint Disorders: Prevention and] <http://www.mja.com.au/public/issues/180_05_010304/har10356_fm.html>

→  Mellick J Chehade and Aleksander Bachorski. Development of the Australian Core Competencies in Musculoskeletal Basic and Clinical Science project — phase 1 Med J Aust 2008; 189 (3): 162-165. [Medical Education] <http://www.mja.com.au/public/issues/189_03_040808/che11371_fm.html>

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