Health needs assessment of musculoskeletal conditions: an international bone and joint burden of disease study

  • N Khaltaev1,

    Affiliated with

    • B Pfleger1,

      Affiliated with

      • AD Woolf2,

        Affiliated with

        • K Åkesson3,

          Affiliated with

          • JM Hazes4,

            Affiliated with

            • D Symmons5 and

              Affiliated with

              • and the Bone and Joint Monitor Group

                Affiliated with

                Arthritis Res Ther20046(Suppl 3):103

                DOI: 10.1186/ar1334

                Published: 13 September 2004


                The Bone and Joint Monitor Project was developed to quantify the global burden of musculoskeletal conditions and develop strategies for their prevention. Experts within the Monitor Project have worked previously with officers at the World Health Organization (WHO) to estimate morbidity and mortality associated with rheumatic conditions. The present collaboration seeks means of providing additional and more current burden data.


                To develop recommendations for performing epidemiologi-cal studies in sample populations with musculoskeletal conditions and problems, accounting for determinants and consequences to the individual and society.


                Recommendations have been developed identifying the most relevant domains for measuring and monitoring the various muscu-loskeletal conditions by review of epidemiological data on occurrence, determinants and outcomes, and by expert opinion. Instruments that measure these domains were reviewed.


                The domains recommended follow the principles of the WHO International Classification of Functioning, Disability and Health [1, 2], and consider: health condition; body function and structure; activity limitation; participation restriction; personal and environmental contextual factors; and, in addition, the resource utilisation and social consequences. The musculoskeletal conditions and problems considered were osteoarthitis, inflammatory arthritis, osteoporosis, spinal problems, musculoskeletal trauma and injuries, and musculoskeletal pain with restricted activity. The selection of indicators for each domain considered the feasibility of their use in a health interview survey (HIS), a health examination survey (HES), a register or a clinical study. Consensus on case definition was reached depending on the study methodology. For example, osteoporosis defined by bone densitometry cannot be ascertained in an HIS, whereas the outcome of osteoporosis (i.e. fragility fracture) can be. Osteoarthitis can be identified as joint pain in an HIS but the preferred definition is pain with X-ray changes and can only be ascertained in an HES. Previously validated generic and disease-specific instruments have been identified that include indicators for all or most of the recommended domains for the consequences of the different conditions and problems. The indicators of the domains for resource utilisation and social consequences and feasibility for collection will vary in different socioeconomic and geographic areas. Guidance on sampling methods is also being developed.


                The comparability of data collected across the globe will improve by the application of agreed upon indicators that consider key domains for the different musculoskeletal conditions and problems in epidemiological studies conducted in different populations.

                Authors’ Affiliations

                Management of Noncommunicable Diseases, World Health Organization
                Duke of Cornwall Rheumatology Department, Royal Cornwall Hospital
                Department of Orthopaedic Surgery, Malmö University Hospital
                Department of Rheumatology, University Hospital of Rotterdam
                Epidemiology Research Unit, University of Manchester


                1. The burden of musculoskeletal diseases at the start of the new millenium Report of a WHO Scientific Group (WHO Technical Report Series No 919) Geneva: World Health Organization 2003.
                2. International Classification of Functioning, Disability and Health 2004 [http://​www3.​who.​int/​icf/​icftemplate.​cfm]


                © BioMed Central Ltd 2004