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Arthritis, Osteoporosis, and Chronic Back Conditions

Arthritis, Osteoporosis, and Chronic Back Conditions

Goal

Prevent illness and disability related to arthritis and other rheumatic conditions, osteoporosis, and chronic back conditions.

Overview

Arthritis, osteoporosis, and chronic back conditions all have major effects on quality of life, the ability to work, and basic activities of daily living.

There are more than 100 types of arthritis. Arthritis commonly occurs with other chronic conditions, such as diabetes, heart disease, and obesity. Interventions to treat the pain and reduce the functional limitations from arthritis are important, and may also enable people with these other chronic conditions to be more physically active. The Arthritis objectives for 2020 track a variety of pain, function, and intervention measures that are important for monitoring progress in addressing arthritis as a public health problem.

Osteoporosis is a disease marked by reduced bone strength leading to an increased risk of fractures (broken bones). The Osteoporosis objectives for 2020 track bone mineral density as a measure of the major risk factor for fractures, and hip fractures, the major and most serious of osteoporosis-related fractures.

Chronic back pain (CBP) is common, costly, and potentially disabling. The related objective for 2020 tracks activity limitation due to chronic back conditions.

Why Are Arthritis, Osteoporosis, and Chronic Back Conditions Important?

Arthritis

Arthritis affects 1 in 5 adults1 and continues to be the most common cause of disability.2 All of the human and economic costs are projected to increase over time as the population ages.3

There are interventions that can reduce arthritis pain and functional limitations, but they remain underused.1 These include:

  • Increased physical activity
  • Self-management education
  • Weight loss among overweight/obese adults

Osteoporosis

In the United States, an estimated 5.3 million people aged 50 years and older have osteoporosis. Most of these people are women, but about 0.8 million are men. Just over 34 million more people, including 12 million men, have low bone mass, which puts them at increased risk for developing osteoporosis.4 Half of all women and as many as 1 in 4 men aged 50 years and older will have an osteoporosis-related fracture in their lifetime.5

Chronic Back Conditions

About 80 percent of Americans experience low back pain (LBP) in their lifetime. It is estimated that each year:

  • 15-20 percent of the population develop protracted back pain
  • 2-8 percent have chronic back pain (pain that lasts more than 3 months)
  • 3-4 percent of the population is temporarily disabled due to back pain
  • 1 percent of the working-age population is disabled completely and permanently as a result of LBP6

Americans spend at least $50 billion each year on LBP. LBP is the:

  • Second leading cause of lost work time (after the common cold)
  • Third most common reason to undergo a surgical procedure
  • Fifth most frequent cause of hospitalization

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Understanding Arthritis, Osteoporosis, and Chronic Back Conditions

Arthritis

Many factors determine the pain, function, and quality of life of those with arthritis. Greater physical activity can reduce pain and improve function. However, physical activity remains an underused intervention, even though there are a variety of programs to help people with arthritis increase physical activity safely and with little pain. Self-management education can achieve similar positive outcomes by teaching people skills and techniques to deal with the day-to-day issues that result from arthritis. Weight loss among those who are overweight or obese also helps reduce symptoms of arthritis.

Osteoporosis

There are many factors that contribute to osteoporosis and fractures. Nutrition and physical activity are important modifiable (controllable) risk factors. Family history and personal history of fractures are also risk factors for osteoporosis.5

Chronic Back Conditions

CBP is often progressive and its cause(s) can be difficult to determine. Most important, previous studies have shown that patients with CBP make up at least 90 percent of total spending on the treatment of lower back pain.7

Emerging Issues in Arthritis, Osteoporosis, and Chronic Back Conditions

Several emerging issues may warrant future Healthy People objectives for arthritis, osteoporosis, and chronic back conditions.

  • Pain, which is a component of all these conditions, is emerging as an important condition to address on its own regardless of cause.8 Four developmental pain objectives were added to this topic area in 2014.
  • Fatigue is only recently being recognized as a clinically important symptom of many types of arthritis and other rheumatic conditions.
  • Falls are the leading cause of injury related morbidity and mortality in older adults and are increasingly recognized as being more common among adults with arthritis.9
  • Early diagnosis of inflammatory types of arthritis is of growing importance because the early use of disease-modifying anti-rheumatic drugs has resulted in much more successful treatement of these conditions. There is continuing effort to develop early biomarkers (both biochemical and imaging markers) of arthritis, osteoporosis, and chronic back conditions to allow adequate and early assessment and treatment of these conditions.
  • Worksite accommodation will become a greater issue as an increased number of older adults with arthritis and chronic back conditions are expected to be working (versus retired) in the future.
  • Social participation, an important part of the World Health Organization (WHO) International Classification of Functioning, Disability, and Health (ICF), is an increasingly frequent outcome of interest and should be measured for people with arthritis and other chronic conditions.10
  • Anxiety and depression are frequently observed outcomes associated with chronic conditions such as arthritis, osteoporosis, and chronic back conditions.11
  • Better measures of who is receiving arthritis and chronic back pain self-management education will help target these evidence-based interventions better. 
  • Comorbidity of these common chronic conditions with other chronic conditions is growing, and addressing the symptoms of these musculoskeletal conditions may help manage those other conditions (e.g., addressing arthritis-specific symptoms may increase physical activity). 12,14
  • Greater availability of health-related quality-of-life measures, an outcome of growing interest by the public, will be important in order to better monitor nonfatal, but chronic, disabling conditions such as arthritis, osteoporosis, and chronic back conditions. 

References

1Barbour KE, Helmick CG, Theis KA, Murphy LB, Hootman JM, Brady, Cheng YJ.  Prevalence of doctor-diagnosed arthritis and arthritis-attributable activity limitation—United States, 2010-2012.  MMWR 2013;62(14):869-873. 

2Brault MW, Hootman J, Helmick CG, et al. Prevalence and most common causes of disability among adults, United States, 2005. MMWR. 2009;58(16):421-26.

3Hootman JM, Helmick CG, Barbour KE, Theis KA, Boring MA. Updated projected prevalence of self-reported doctor-diagnosed arthritis and arthritis-attributable activity limitation among US adults, 2015-2040. Arthritis Rheumatol. 2016;68(7):1582-7. doi: 10.1002/art.39692. PubMed PMID: 27015600.

4Looker AC, Melton LJ 3rd, Harris TB, et al. Prevalence and trends in low femur bone density among older US adults: NHANES 2005-2006 compared with NHANES III. J Bone Miner Res. 2010;25:64-71.

5US Dept. of Health and Human Services, Public Health Service, Office of the Surgeon General. Bone health and osteoporosis: A report of the Surgeon General. Rockville, MD: US GPO; 2004, p. 436. Available from: http://www.ncbi.nlm.nih.gov/books/NBK45513/pdf/TOC.pdf.

6Martin BI, Turner JA, Mirza SK, et al. Trends in health care expenditures, utilization, and health status among US adults with spine problems, 1997–2006, Spine. 2009 Sep 1;34(19):2077-84.

7Manek NJ, Macgregor AJ. Epidemiology of back disorders: Prevalence, risk factors, and prognosis. Curr Opin Rheumatol. 2005;17:134-40.

8U.S. Department of Health and Human Services.  National Pain Strategy:  A Comprehensive Population Health-Level Strategy for Pain. March, 2016. https://iprcc.nih.gov/docs/HHSNational_Pain_Strategy.pdf

9Barbour KE, Stevens JA, Helmick CG, Luo Y, Murphy LB, Hootman JM, Theis K, Anderson LA, Baker NA, Sugerman DE. Falls and Fall Injuries Among Adults with Arthritis—United States, 2012.  MMWR Morb Mortal Wkly Rep. 2014 May 2;63 (17):379-383.

10Theis KA, Murphy L, Hootman JM, Wilkie R. Social participation restriction among US adults with arthritis: a population-based study using the International Classification of Functioning, Disability and Health. Arthritis Care Res (Hoboken). 2013 Jul;65(7):1059-69.

11Murphy LB, Sacks JJ,Brady TJ, Hootman JM, Chapman, DP. Anxiety and depression among US adults with arthritis: Prevalence and correlates. Arthritis Care and Research. 2012; 64 (7):968–976.

12Barbour KE, Hootman JM, Murphy LB, Helmick CG.  Arthritis as a potential barrier to physical activity among adults with obesity --- United States, 2007 and 2009. MMWR Morb Mortal Wkly Rep. 2011 May 20; 60(19):614-8.

13Qin J, Theis KA, Barbour KE, Helmick CG, Baker NA, Brady TJ. Impact of Arthritis and Multiple Chronic Conditions on Selected Life Domains — United States, 2013. MMWR Morb Mortal Wkly Rep. June 5, 2015 / 64(21);578-582.

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