Chronic musculoskeletal conditions

What are chronic musculoskeletal conditions?

Conditions that affect the bones, muscles and joints and certain connective tissues are known as musculoskeletal conditions. These conditions include long-term (chronic) conditions such as back problems, osteoarthritis, osteoporosis or osteopenia, rheumatoid arthritis, gout, and juvenile arthritis (see glossary).

How common are chronic musculoskeletal conditions?

Around 7.3 million (29%) people in Australia were estimated to be living with chronic musculoskeletal conditions, according to self-reported data in the 2022 Australian Bureau of Statistics (ABS) National Health Survey (NHS). Prevalence has not changed since the last survey in 2017–18.

Of these people:

• 4.0 million (16%) were estimated to be living with back problems 
• 3.7 million (15%) were estimated to be living with arthritis
• 854,000 (3.4%) were estimated to be living with osteoporosis or osteopenia (ABS 2023).

Prevalence by age and sex

Females and older people were the most likely in Australia to be living with chronic musculoskeletal conditions. According to the NHS, in 2022:

• 69% of people aged 75 and over were estimated to be living with a musculoskeletal condition, compared with 23% of people aged 25–44
• females, compared with males, were 5 times as likely to be living with osteoporosis, and 1.4 times as likely to be living with arthritis
• the prevalence of back problems was similar among males and females (16% and 15%, respectively) (Figure 1) (ABS 2023).

After adjusting for different population age structures over time, between 2001 and 2022, the prevalence of:

• back problems decreased from 21% to 15% 
• arthritis remained relatively stable (14% and 12%, respectively) (Figure 1) (ABS 2023).

After adjusting for age differences, the prevalence of musculoskeletal conditions generally increased with increasing levels of disadvantage (also known as socioeconomic areas) but was similar across remoteness areas (Figure 1) (ABS 2023).

For more information see All arthritis, Back problems and Osteoporosis.

Figure 1: Prevalence of chronic musculoskeletal conditions, by age and sex, over time (2001 to 2022), by population group, 2022

Impact of chronic musculoskeletal conditions

Chronic musculoskeletal conditions are large contributors to illness, pain and disability in Australia. The 2018 Survey of Disability, Ageing and Carers found that, of the people with disability in Australia, 13% were estimated to be living with back problems and another 13% were estimated to be living with arthritis as the main long-term health condition causing the disability (ABS 2019).

Measures of impact presented in this section include burden of disease, health expenditure and mortality data.

Burden of disease

In 2023, the musculoskeletal conditions disease group accounted for 12.8% of total disease burden (also known as disability adjusted life years or DALY), 23.1% of non-fatal burden (also known as ‘years lived with disability’ or YLD) and 0.8% of fatal burden (also known as years of life lost, or YLL). It was also the second leading disease group contributing to non-fatal burden after mental health conditions and substance use disorders (AIHW 2023a).

Among all individual conditions, back problems were the leading cause of non-fatal burden (accounting for 7.9% of YLD).

Within the musculoskeletal conditions disease group:

• back problems accounted for 34% of burden (DALY)
• other musculoskeletal conditions accounted for 30% of burden (DALY)
• osteoarthritis accounted for 20% of burden (DALY)
• rheumatoid arthritis accounted for 16% of burden (DALY).

Variation by age and sex

In 2023:

• the rate of burden from musculoskeletal conditions generally increased with increasing age, peaking between ages 75–79 (66.3 DALY per 1,000 population)
• after adjusting for age differences, the rate of total burden from musculoskeletal conditions was 20% higher among females compared with males (26.2 and 21.8 per 1,000 population, respectively) (Figure 2).

Figure 2: Burden of disease due to musculoskeletal conditions by sex and age, 2003, 2011, 2015, 2018 and 2023

Trends over time

After adjusting for different population age structures over time, the rate of burden from musculoskeletal conditions was relatively stable between 2003 and 2023, averaging 24.2 DALY per 1,000 population across the 5 time points reported.

For more information, see the Australian Burden of Disease Study 2023.

Variation between population groups

In 2018, after adjusting for age differences, the rate of total burden of musculoskeletal conditions was:

• highest for people living in Inner regional areas, and lowest for people living in Remote and very remote areas (27.8 and 19.6 DALY per 1,000 population, respectively)
• 1.5 times as high for people living in the areas of most disadvantage (lowest socioeconomic areas) compared with people living in areas of least disadvantage (highest socioeconomic areas) (29.2 and 19.1 DALY per 1,000 population, respectively) (Figure 3) (AIHW 2021a).

For more information, see the Australian Burden of Disease Study 2018: Interactive data on disease burden.

Figure 3: Burden of disease due to musculoskeletal conditions for remoteness area and socioeconomic area, by sex, 2011, 2015 and 2018

Modifiable risk factors contribute to burden

In 2018, 16% of the total burden (DALY) due to musculoskeletal conditions could be attributed to modifiable risk factors. These risk factors included:

• overweight and obesity, which contributed to 8.9% of the musculoskeletal burden, and 28% of the osteoarthritis burden
• occupational exposures and hazards, which contributed to 5.6% of the musculoskeletal burden, and 17% of the back problems burden
• tobacco use, which contributed to 2% of the musculoskeletal burden (AIHW 2021a).

For definitions and information on the burden of disease associated with these conditions, see Australian Burden of disease Study 2023.

Health system expenditure

In 2020–21, an estimated $14.7 billion of expenditure in the Australian health system was attributed to musculoskeletal conditions, representing 9.8% of total health expenditure (AIHW 2023b).

Where is the money spent?

In 2020–21:

• hospital services represented 68% ($10 billion) of musculoskeletal expenditure, which was slightly higher than the hospital proportion for all disease groups (63%). The private hospital proportion of musculoskeletal expenditure was more than double the proportion for all disease groups (38% and 17%, respectively)
• primary care accounted for 22% ($3.3 billion) of musculoskeletal spending, which was slightly lower than the primary care proportion for all disease groups (28%)
• referred medical services represented 10% of musculoskeletal spending, which was similar to the referred services proportion for all disease groups. The medical imaging proportion of musculoskeletal expenditure was over double the proportion for all disease groups (6.4% and 3.0%, respectively) (Figure 4).

Figure 4: Musculoskeletal condition expenditure attributed to each area of the health system, with comparison to all disease groups, 2020–21

In 2020–21, musculoskeletal conditions accounted for:

• 22% ($5.5 billion) of all private hospital service expenditure – ranking first of all disease groups
• 21% ($943.7 million) of all medical imaging expenditure – ranking second of all disease groups (Figure 5).

For more information, see Health system spending on disease and injury in Australia, 2020–21.

Figure 5: Proportion of expenditure attributed to musculoskeletal conditions, for each area of the health system, 2020–21

Who is the money spent on?

The distribution of health system expenditure on musculoskeletal conditions by age and sex reflects the prevalence distribution, with more spending for older age groups and females. In 2020–21:

• 81% of musculoskeletal expenditure was on people aged 45 and over
• 21% more musculoskeletal expenditure was attributed to females than males ($7.9 billion and $6.5 billion, respectively) with a remaining $320.1 million (2.2%) unattributed to any sex.

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

For more information, see:

• Health system spending per case of disease and for certain risk factors
• Health system spending on disease and injury in Australia, 2020–21.

How many deaths were associated with musculoskeletal conditions?

In 2022, musculoskeletal conditions were recorded as an underlying and/or associated cause for 10,446 deaths or 40 deaths per 100,000 population. This represented 5.5% of all deaths in 2022.

Musculoskeletal conditions were more likely to be recorded as an associated cause of death only (accounting for 8,690 deaths, 83% of musculoskeletal condition deaths), than as an underlying cause of death (1,756 deaths or 17% of all musculoskeletal condition deaths).

Of the specific conditions analysed in this report, osteoporosis and osteoarthritis contributed the most to any-cause musculoskeletal deaths (25% and 22% respectively), while rheumatoid arthritis contributed the most to the underlying cause of musculoskeletal deaths (14%).

Variation by age and sex

In 2022, musculoskeletal conditions mortality (as the underlying and/or associated cause) in comparison to all deaths, was relatively more concentrated among:

• older people (79% of musculoskeletal deaths were among people aged 75 and over, compared with 68% for total deaths)
• females (61% of musculoskeletal deaths were among females compared with 48% of total deaths) (Figure 6).

Figure 6: Age distribution for musculoskeletal condition mortality, by sex, 2012 to 2022

Trends over time

After adjusting for different population age structures over time, mortality rates for musculoskeletal conditions (as the underlying and/or associated cause) between 2012 and 2022:

• remained relatively stable between 25 and 29 deaths per 100,000 population
• were 1.2 to 1.3 times higher among females compared with males (Figure 7).

Figure 7: Trends over time for musculoskeletal condition mortality, 2012 to 2022

Variation between population groups

In 2022, after adjusting for age differences, mortality rates for musculoskeletal conditions (as the underlying and/or associated cause of death) were:

• 1.2 times as high for people living in Outer regional areas compared with people living in Major cities (33 and 28 deaths per 100,000 population, respectively)
• 1.4 times as high for people living in areas of most disadvantage (lowest socioeconomic areas) compared with people living in areas of least disadvantage (highest socioeconomic areas) (35 and 24 deaths per 100,000 population, respectively).

Treatment and management of chronic musculoskeletal conditions

Primary care

Musculoskeletal conditions are usually managed by general practitioners (GP) 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). 

It is worth noting that there is currently no nationally consistent primary health care data collection to monitor provision of care by GPs. For more information, see General practice, allied health and other primary care services.

Hospital treatment

People living with musculoskeletal conditions that are very severe, or who require specialised treatment or surgery, may be admitted to hospital.

Data from the National Hospital Morbidity Database (NHMD) show that in 2021–22, there were 1.1 million hospitalisations with a principal or additional diagnosis (any diagnosis) of a musculoskeletal condition, together representing 9.5% of all hospitalisations. 

The rest of this section discusses hospitalisations with a musculoskeletal principal diagnosis, unless otherwise stated. However, charts and tables also include statistics for any diagnosis of a musculoskeletal condition.

In 2021–22:

• there were 745,100 musculoskeletal condition hospitalisations, representing 6.4% of all hospitalisations, and 2,900 hospitalisations per 100,000 population
• musculoskeletal hospitalisations included: osteoarthritis (32%), back problems (24%), osteoporosis (1.4%), rheumatoid arthritis (1.3%), gout (0.9%), and other musculoskeletal conditions (40%)
• musculoskeletal conditions accounted for 2.4 million bed days, representing 7.6% of all bed days
• 49% of musculoskeletal condition hospitalisations were overnight stays, with an average length of 5.5 days (Figure 8).

Figure 8: Age distribution for musculoskeletal hospitalisations, by sex, 2015–16 to 2021–22

Variation by age and sex

In 2021–22, musculoskeletal condition hospitalisation rates were:

• highest for people aged 75–79 years (10,200 hospitalisations per 100,000 population) 
• slightly higher for females compared with males (3,000 and 2,700 hospitalisations per 100,000 population, respectively) (Figure 8).

Trends over time

From 2015–16 to 2021–22, for musculoskeletal hospitalisations:

• the rate was steady until 2018–19 (at about 3,200 hospitalisations per 100,000 population) and then varied, decreasing to a low of about 2,900 hospitalisations per 100,000 population in 2021–22
• the proportion and average length of overnight stays were relatively stable, averaging to 49% and 5.4 days, across the period (Figure 9).

It should be noted that the rate of hospitalisations over the past few years may have been affected by the COVID‑19 pandemic.

Figure 9: Trends over time for musculoskeletal hospitalisations, 2015–16 to 2021–22

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
• the 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).

COVID‑19 impact on chronic musculoskeletal conditions

The COVID‑19 pandemic had substantial impacts on hospital activity generally. 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 2022b).

At the beginning of the pandemic in Australia, non-urgent elective surgery was suspended from late March to late April 2020. In the same financial year (2019–20), after adjusting for age differences, the rate of total hip and knee replacement surgery where osteoarthritis was the principal diagnosis decreased 8.6% and 11.4% respectively from 2018–19. This decrease was driven by the April–June 2020 quarter, which saw 31% and 37% fewer admissions for hip and knee replacements respectively, compared with the April–June 2019 quarter (Figure 10). 

In 2020–21, rates rebounded to exceed pre-pandemic levels, but in 2021–22 they decreased below pre-pandemic levels (for more information, see Osteoarthritis).

For more information, see 'Changes in the health of Australians during the COVID‑19 period’ in Australia’s health 2022: data insights.

Figure 10: Total hip and knee replacement surgeries, by month, 2019 to 2021

In 2020–21:

• the median waiting times for total hip replacement surgery and total knee replacement surgery increased compared with 2019–20, by 49% and 38% respectively. This compares to an increase of 23% for all elective surgery (AIHW 2021b)
• 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 compare to a 4.8 percentage point increase for all elective surgeries (AIHW 2021b).

Comorbidities of chronic musculoskeletal conditions

People living with chronic musculoskeletal conditions are often also living with other chronic and long-term conditions, known as ‘comorbidity’. According to the NHS, in 2022:

• an estimated 2.7 million (74%) people who were living with arthritis also had one or more other chronic conditions. Among them, 38% were estimated to be living with mental or behavioural conditions and 36% were estimated to be living with back problems
• an estimated 2.9 million (72%) who were living with back problems also had one or more other chronic conditions. Among them, 43% were estimated to be living with a mental or behavioural condition and 34% were estimated to be living with arthritis (Figure 11) (ABS 2023). 

For more information, see All arthritis and Back problems.

Figure 11: Number of selected chronic conditions and types of comorbidity in people with musculoskeletal conditions, by condition, sex and age, 2022

Where do I go for more information?

For more information on the musculoskeletal conditions covered in this report, see:

• ABS National Health Survey
• ABS Health Conditions Prevalence
• Australian Centre for Monitoring Population Health

For more on this topic, visit Chronic musculoskeletal conditions.