Geriatric and rheumatological linkages: public health implications

Editors in medical journals worldwide have selected aging as the 1997 Global Theme Issue. In proposing this article, the editors of theAnnals have considered the importance and implications of the growth of the very elderly population in developed countries and the widespread prevalence of musculoskeletal conditions in this age group. Broadening the scope of this discussion from osteoarthritis, about which I have written in this journal earlier,2 to include musculoskeletal disorders, permits consideration of a range of interactive conditions that also affect soft tissues, tendons, and ligaments (fibromyalgia, tendinitis), bones (osteoporosis), the intervertebral discs (degeneration), and muscles (polymyalgia, myopathies). This article will focus primarily on aging associated conditions involving bones, muscles, and peripheral joints. Table 1presents the unifying features of the musculoskeletal disorders. Their public health implications in elderly persons are enormous, and encompass (a) physical and social impacts from pain, limited mobility, reduced quality of life; (b) direct expenditures for diagnosis and treatment; (c) indirect economic costs from loss of participation in the labour force.3 Among impairments identified in the National Health Interview Survey in 1988, musculoskeletal disorders were the most frequently reported— almost 30 million in the US population. In 1992 the total cost of musculoskeletal and associated conditions for all ages was $149 billion. The elderly incurred the largest share of the direct costs of medical care ($51 billion) with still substantial indirect costs caused by lost wages.4 There are at least 26 million white women at risk for fractures by virtue of low bone mass or osteoporosis.5 Hip fracture incidence will continue …