US bone and joint decade prepares for the future


These past 7 years have presented a real opportunity to advocate for and promote education in musculoskeletal conditions across the US. The US Bone and Joint Decade (USBJD) initiative has developed programs on osteoporosis and arthritis that have been presented to more than 200 audiences. We have prepared and published the newest edition of The Burden of Musculoskeletal Diseases in the United States (online at: We have developed a grant mentoring program that has seen the number of investigators researching musculoskeletal health increase, and our graduates have received more than $25 million in research funding. We have worked diligently on the professional education front to formalize musculoskeletal education at medical schools by working with them and the Association of American Medical Colleges, and by partnering with the National Board of Medical Examiners to launch a new shelf test for musculoskeletal medicine.

The American College of Rheumatology (ACR) has played a leading role in these initiatives. The ACR and the ACR Research and Education Foundation (REF) have been represented on the USBJD Board, involved in the USBJD strategic planning process, and have provided guidance, direction, and support as programs have developed. Christy Sandborg, MD, currently represents the ACR on the USBJD Board, and the ACR REF is represented by Marian Hannan, DSc, MPH. The Association of Rheumatology Health Professionals (a division of the ACR) is a partner in Fit to a T, the flagship public education program of USBJD on bone health and osteoporosis.

As shown in The Burden of Musculoskeletal Diseases in the United States, in which the ACR actively participated, musculoskeletal conditions are reported by US citizens more than any other health condition. It is estimated that these conditions occur in approximately one in two persons age >18 years, or ∼48% of the US population. These conditions are also the most common cause of severe long-term pain and physical disability around the world, affecting hundreds of millions of people (Woolf AD, Pfleger B. Burden of major musculoskeletal conditions. Bull World Health Organ 2003;81:646–56). Osteoarthritis is ranked fourth across the globe as a cause for years lived with disability. The prevalence of musculoskeletal conditions is predicted to increase greatly around the world due to increasing life expectancy, changes in risk factors, and availability of appropriate prevention measures.

In 2004, the estimated total cost of treatment and lost wages in patients with musculoskeletal diseases in the US alone was $849 billion, which is equal to 7.7% of the gross domestic product. In 2011, the baby boomer generation will become beneficiaries of Medicare, and the economic and societal cost of bone and joint health is expected to begin an escalation that will endure for decades.

Given the burden of disease figures, cost, and expected increase as baby boomers grow older, efforts to raise awareness and to advocate for bone and joint health must be sustained. As the USBJD has shown, there are issues of concern common to professional health care organizations, as well as patient advocate organizations, that are well suited to a united effort.

At the three-quarter mark, we realize that what the USBJD set out to do cannot be accomplished in 10 years, and an ongoing sustained effort is required, focusing on issues of common concern and greatest potential impact. There is a lot to learn from the efforts of the past 7 years about how to do this, and we should use this opportunity to build upon that knowledge to create an increasingly focused and valued campaign.

We showcased the efforts of the USBJD initiative and ACR at the USBJD Global Network Conference, held in October in Washington, DC. This conference deliberately coincided with the ACR Annual Scientific Meeting so that international delegates could go straight from one meeting to another. We were proud to have been asked to host this meeting, and we made the event a coming together of key national and international leaders in the field. Opportunities existed to meet with high-level policy makers, as well as scientific and clinical thought leaders.

The goals of the conference were first to raise awareness and advocate for musculoskeletal health using an assembly of worldwide representatives with strong US representation, and second to develop a roadmap for the future to build on the momentum created by the USBJD thus far. Along with the ACR, the leadership of many USBJD participating organizations attended, as well as representatives of a record 50 countries, leaders of international musculoskeletal societies, congressional leaders, and Washington-based ambassadors. Fifteen senators, and more than 70 congressional leaders, Dr. Peter Howe, President and CEO, Project Hope, and Susan Dentzer, Editor-in-Chief, Health Affairs, were members of the host committee.

This was all part of the conference's goal to raise awareness in Washington, and around the world, of musculoskeletal diseases and to engage policymakers and opinion leaders in discussions about solutions. If there is a lesson to be learned from the conference, it is that it should have been held 5 years ago, and perhaps annually, to bring the musculoskeletal community together in the nation's capitol.

The second goal of the conference, to build a roadmap for the future using the building blocks and momentum created by the USBJD, was achieved with a strategic planning exercise and the participation of experts working in 6 specialty groups. These groups presented their conclusions at the conference, where organization leaders agreed on where the focus of attention should be for the remaining years of the USBJD and the years beyond.

The USBJD started out with a strategic plan and expected participating organizations to take up action items relevant to their causes. In some instances that did happen, but in the main the USBJD realized it needed to take the lead position, and this has been how many of its accomplishments have been attained. In undertaking the current strategic planning exercise, we looked for a narrow set of highly focused priorities, which are of greatest likely impact to the burden of disease and value to participating organizations.

The strategic planning groups are underlining the need for good burden of disease data, improved training in musculoskeletal health at medical schools, public education programs focused on prevention, and the need for more research. So some existing programs continue to look highly relevant as we look forward. The noise level about refocusing on raising awareness and advocacy has been growing within the USBJD ranks, and we expect this is an outcome of the strategic planning exercise.

We should be proud of our accomplishments in public and professional education, in detailing the burden of disease data, and in the efforts to raise the number of investigators and quality of applications for musculoskeletal research funding. We must also recognize the amount of work that remains to be done to raise awareness about bone and joint health, most especially with the public and policymakers.