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 ABS 2020–21 NHS provide estimates of the number of Australians affected by musculoskeletal conditions. These data indicate that, of the nearly 6.9 million people with chronic musculoskeletal conditions (27% of all Australians), 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 2022). 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).

Figure 1: Prevalence of chronic musculoskeletal conditions, by sex, 2007–08 to 2017–18

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).

Figure 2: Prevalence of chronic musculoskeletal condition, by sex and age, 2017–18 

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) (Figure 3).

Figure 3: Proportion of people with musculoskeletal conditions who have at least one other chronic condition in people aged 15 and over, by sex and age, 2017–18

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.

Figure 4: Prevalence of other chronic conditions in people aged 45 and over, with and without musculoskeletal conditions, 2017–18

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).

Figure 5: Prevalence of chronic musculoskeletal conditions in people aged 45 and over, by remoteness and socioeconomic area, 2017–18

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).

Figure 6: Impact of musculoskeletal conditions in people aged 45 and over, with and without the condition, 2017–18

Burden of disease

In 2022, the musculoskeletal conditions disease group accounted for 12.6% of total disease burden (DALY); 23.7% of non-fatal burden (YLD), and 0.8% of fatal burden (YLL). It was the second leading disease group contributing to total burden after cancer.

Within the musculoskeletal conditions disease group, back pain and problems accounted for 34% of burden (DALY), other musculoskeletal (31%), osteoarthritis (19%) and rheumatoid arthritis (16%).

At the individual condition level, back pain and problems was the third leading cause of total burden of disease (accounting for 4.2% of total burden in 2022) after coronary heart disease and dementia.

Variation by age and sex

In 2022:

• The rate of burden from musculoskeletal conditions increased with age peaking at age 75–79 (65.8 DALY per 1,000 population).
• The age-standardised rate of total burden from musculoskeletal conditions was higher among females compared with males (25.7 and 21.8 per 1,000 population respectively) (Figure 7).

Figure 7: Burden of disease due to musculoskeletal conditions by sex, age and year

Trends over time

The rate of burden from musculoskeletal conditions decreased slightly between 2003 and 2022 (25.3 to 23.8 DALY per 1,000 population, respectively) – 0.3% per year on average, after adjusting for changes in age structure.

Further detail is available in the Australian Burden of Disease Study 2022.

Variation between population groups

In 2018, after adjusting for age:

• Inner regional areas had the highest total burden for musculoskeletal conditions compared with Remote and very remote areas (27.8 and 19.6 DALY per 1,000 population, respectively).
• Total burden (DALY) had the greatest contrast between socioeconomic groups compared with fatal (YLL) and non-fatal burden (YLD) in the musculoskeletal conditions group, for example, the lowest socioeconomic group (people living in areas with the most disadvantage) had 1.5 times the rate of burden than the highest group (people living in areas with the least) (29.2 and 19.1 DALY per 1,000 population, respectively) (AIHW 2021a) (Figure 8).

Further detail is available in the Australian Burden of Disease Study 2018: Interactive data on disease burden.

Figure 8: Burden of disease due to musculoskeletal conditions by sex, remoteness area, socioeconomic group and year 

Modifiable risk factors contribute to burden

In 2018, 16% of the total burden due to musculoskeletal conditions could be attributed to modifiable risk factors. 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.

Tobacco use contributed to 2% of the total burden of musculoskeletal conditions (AIHW 2021a).

See Burden of disease for information on definitions and the burden of disease associated with these conditions.

Health system expenditure

In 2019–20, an estimated $14.6 billion of expenditure in the Australian health system was for musculoskeletal conditions, representing 10% of total health expenditure (AIHW 2022c).

Where is the money spent?

Figure 9 presents a detailed breakdown of estimated expenditure for musculoskeletal conditions by area of the health system, showing that:

• Hospital services represented 63% ($9.2 billion) of musculoskeletal conditions expenditure, which was the same as the proportion of total health expenditure for hospital services. The private hospital service proportion musculoskeletal expenditure was relatively high, at more than double that for total health expenditure (33% compared with 16%).
• Primary care accounted for 26% ($3.7 billion) of musculoskeletal condition spending, which is less than the primary care portion of total health expenditure (28%). However, the pharmaceutical benefit scheme proportion of musculoskeletal conditions expenditure was relatively high, at 1.3 times that for total health expenditure (16% compared with 12%).
• Referred medical services represented 12% of musculoskeletal condition spending, which was more than the referred medical services portion of total health expenditure (9%). The medical imaging proportion of musculoskeletal expenditure was especially large in comparison to the average, at 3 times the proportion for total health expenditure (8% compared with 2.8%).

Figure 9: Amount and proportion (%) of musculoskeletal condition expenditure attributed to each area of the health system, compared to expenditure for all disease groups, 2019–20

Figure 10 presents the component (%) that musculoskeletal conditions expenditure makes up for each for each area of the health system, showing that in 2019–20, musculoskeletal conditions accounted for:

• 29% ($1.2 billion) of all medical imaging expenditure – ranking first of all disease groups.
• 21% ($4.9 billion) of all private hospital service expenditure – ranking first of all disease groups.

Further detail is available in Disease expenditure in Australia 2019–20.

Figure 10: Proportion of expenditure attributed to musculoskeletal conditions, for each area of the health system, 2019–20

Who is the money spent on?

In 2019–20:

• the age distribution of spending on musculoskeletal conditions reflects the prevalence distribution, with most spending being for older age groups (80% for people aged 45 and over)
• more musculoskeletal conditions expenditure was attributed to females than males ($7.7 billion and $6.4 billion, respectively with a remainder $527 million (3.6%) not specified.

In 2018–19, it was estimated that musculoskeletal conditions expenditure per case was equal for females and males ($1,200 per case) (AIHW 2022d).

Further detail is available in Health system spending per case and for certain risk factors.

Deaths

How many deaths were associated with musculoskeletal conditions?

Musculoskeletal conditions were recorded as an underlying or associated cause for 9,277 deaths or 26.5 deaths per 100,000 population in Australia in 2021, representing 5.4% of all deaths. Musculoskeletal conditions were the underlying cause for 1,602 deaths (17% of musculoskeletal condition deaths) and an associated cause only, for 7,675 deaths (83% of musculoskeletal condition deaths).

Of the specific conditions analysed in this report, osteoporosis and osteoarthritis contributed the most substantially to any-cause musculoskeletal deaths (26% and 24% respectively). While rheumatoid arthritis contributed the most substantially to underlying-cause musculoskeletal deaths (14%).

Variation by age and sex

In 2021, musculoskeletal condition mortality (as the underlying and/or associated cause) was concentrated amongst:

• older people (78% aged 75 and over), which was slightly more than the proportion of people aged 75 and over for total deaths (67%)
• females (62% of musculoskeletal deaths were female compared with 48% of total deaths) (Figure 11).

Figure 11: Age profile of musculoskeletal mortality statistics, by sex

Trends over time

Age standardised mortality rates for musculoskeletal conditions (as the underlying and/or associated cause) between 2011 and 2021:

• fluctuated between 24 and 27 per 100,000 population
• was 1.2 to 1.3 times higher amongst females compared with males (Figure 12).

Figure 12: Historical musculoskeletal mortality statistics, by sex, 2011–2021 

Variation between population groups

Remote and very remote areas had 1.3 times more musculoskeletal condition deaths per population compared with Outer regional.

The lowest socioeconomic group (people living in areas with the most disadvantage) had 1.5 times more musculoskeletal condition deaths per population than the highest group (people living in areas with the least disadvantage) in 2021.

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 2022e). 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 13).

Figure 13: Rate of total hip and knee replacement surgeries for osteoarthritis, 2010–11 to 2020–21

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 13). 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 14).

Figure 14: 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 2021b).

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 2021b).

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:

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

• Visit Chronic musculoskeletal conditions for more on this topic.