Study Isolates Population Aging as Primary Driver of Musculoskeletal Disorders

Novel research shows that in approximately one third of countries and territories worldwide, population aging was the largest contributor to the growing burden of musculoskeletal disorders from 1990 to 2021. The new study in the Annals of the Rheumatic Diseases, published by Elsevier, is poised to inform targeted public health strategies and healthcare resource allocation to alleviate the global burden and economic impact of these disorders.

Musculoskeletal disorders—conditions like arthritis, osteoporosis, and back pain—are among the leading causes of disability globally. As the global population ages at an accelerating pace, so do the associated health and economic challenges. While a growing concern, little was known about to what extent the increasing burden of musculoskeletal disorders is directly driven by population aging itself, as opposed to other factors like population growth.

This new study quantified the net effect of population aging on the global burden and healthcare costs of these disorders. Using the Global Burden of Disease 2021 data, researchers disentangled the effects of population aging from those of population growth and changes in age-specific epidemiological rates, while accounting for geographic variation, sociodemographic factors, sex differences, and major musculoskeletal subcategories. They also estimated healthcare costs of musculoskeletal disorders attributed to population aging.

“Population aging is an inevitable global trend, but its impact on musculoskeletal disorders is not equally distributed. Our study shows that middle-income countries are experiencing the steepest proportional increases yet often have the least prepared healthcare systems to respond,” explains lead investigator Hai-Feng Pan, MD, Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, and Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Anhui, China.

Key findings include:

• In about one third of countries and territories, population aging was the largest contributor to the increasing burden of musculoskeletal disorders.

• Middle-income countries bore the highest proportional burden of musculoskeletal disorders from population aging, despite having younger populations than high-income countries. This reflects the rapid demographic shift in these countries combined with limited health system readiness to meet older adults’ needs.

• Globally, men experienced greater impact of population aging, particularly in high- and high-middle-income countries. Women were more affected in low- to middle-income countries.

• Osteoarthritis was the most affected musculoskeletal disorder globally, followed by gout and rheumatoid arthritis.

• Population aging-related musculoskeletal disorders cost US$96 billion in global healthcare costs in 2021, equivalent to 0.10% of the global gross domestic product (GDP), surpassing the costs attributed to common modifiable risk factors.

“This research has confirmed that population growth and aging of populations in all countries drive most of these increases, and the study’s uniqueness lies in its inclusion of the financial impact on societies aiming to deliver healthcare for musculoskeletal conditions,” comments leading authority in the field Professor Lyn March, AM, MBBS, PhD, Global Burden of Diseases (GBD), Principal Collaborator; Global Alliance for Musculoskeletal Health (GMUSC), Executive Co-Lead; and Professor of Rheumatology and Musculoskeletal Epidemiology, University of Sydney and Kolling Institute, Australia. “Musculoskeletal health is crying out for attention and costing individuals and societies physically, emotionally, and financially. If not now, when will there be a global strategy addressing the pain and mobility loss of the billions living with a musculoskeletal disorder?”

Co-lead investigator of the study Shi-Yang Guan, MD, Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Second Affiliated Hospital of Anhui Medical University, and Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Anhui, notes, “Our results can help policymakers prioritize interventions tailored to sociodemographic context, sex differences, and specific musculoskeletal disorders, including strengthening preventive measures, improving long-term management, and ensuring sustainable financing to address the rising costs attributed to population aging. Ultimately, this could reduce disability, improve quality of life for older adults, and make healthcare systems more resilient.”

“This study is a wake-up call for politicians and other stakeholders in the European Union and other parts of the world to focus research efforts on understanding, preventing, and treating musculoskeletal disorders, such as osteoarthritis and rheumatoid arthritis, in an aging population to ensure aging in health and with good quality of life,” adds Josef Smolen, MD, Medical University of Vienna, and Editor-in-Chief of the Annals of the Rheumatic Diseases.

Notes for editors

The article is “The impact of population ageing on musculoskeletal disorders in 204 countries and territories, 1990-2021: global burden and healthcare costs,” by Shi-Yang Guan, Jin-Xin Zheng, Xin-Yu Feng, Shun-Xian Zhang, Shu-Zhen Xu, Peng Wang, Hong-Yan Cai, and Hai-Feng Pan (https://doi.org/10.1016/j.ard.2025.08.002). It appears online in the Annals of the Rheumatic Diseases, published by Elsevier.

The article is openly available for 60 days at https://ard.eular.org/article/S0003-4967(25)04301-8/fulltext.

Full text of this article is also available to credentialed journalists upon request; contact Eileen Leahy at +1 732 406 1313 or [email protected]. Journalists wishing to interview the authors should contact Hai-Feng Pan, MD, Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China, at [email protected]. Professor Lyn March, AM, MBBS, PhD, may be reached for comment at [email protected].

This study was supported by the National Natural Science Foundation of China (Grant No. 82273710).

About Annals of the Rheumatic Diseases (ARD)

Annals of the Rheumatic Diseases (ARD), an official journal of EULAR, is an international peer reviewed journal committed to promoting the highest standards of scientific exchange and education. It is the leading rheumatology journal publishing a combination of high-quality scientific papers, including original research, reviews, recommendations, viewpoints, and more. Clinical, basic, and translational science across the inflammatory and non-inflammatory musculoskeletal conditions are part and parcel of this spectrum.

About EULAR

EULAR is the European umbrella organization representing scientific societies, health professional associations, and organizations for people with rheumatic and musculoskeletal diseases (RMDs). EULAR aims to reduce the impact of RMDs on individuals and society, as well as improve RMD treatments, prevention, and rehabilitation. To this end, EULAR fosters excellence in rheumatology education and research, promotes the translation of research advances into daily care, and advocates for the recognition of the needs of those living with RMDs by EU institutions.

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