Author: Patricia Nicholson

The latest POWER (Project for an Ontario Women’s Health Evidence-Based Report) study chapter reports on the number one cause of disability in Ontario: musculoskeletal conditions, including osteoarthritis, inflammatory arthritis and osteoporosis. Its findings highlight the prevalence of these conditions, as well as their impact on women’s lives.

More than one-third of people in Ontario are affected by musculoskeletal conditions – diseases that affect the bones, muscles, joints, ligaments and tendons. Among women, osteoporosis, rheumatoid arthritis and osteoarthritis cause substantial illness and disability.

The study authors – led by Dr. Gillian Hawker, a senior scientist at Women’s College Research Institute in Toronto – identified risk groups, gaps in care and other chronic illnesses that often occur with musculoskeletal conditions.

Risks and effects

Musculoskeletal conditions occur more often in women than men, and increase with age. Lower education levels and low income are also risk factors.

Many people with a musculoskeletal condition have other health issues as well. Having a second chronic health problem such as diabetes or heart disease is almost twice as common in musculoskeletal patients as it is in other types of chronic conditions. It is also more common in women than men: 40 per cent of women with musculoskeletal conditions have another chronic health problem, compared to 35 per cent of men.

The study found that depression is common among patients with musculoskeletal conditions, particularly in women and in people with low incomes. Overall, about one in 10 musculoskeletal patients (10 per cent) showed depressive symptoms, but the rate was twice that (21 per cent) in low-income women.

Unsurprisingly, disability was more common and more severe among women with musculoskeletal conditions than men. But in both sexes, musculoskeletal conditions caused greater disability than other chronic health problems.

Improving care

The study also identified some gaps in care for patients with musculoskeletal conditions. For example, findings indicate that only 15 per cent of these patients had seen a physiotherapist in the past year. Also, only one-third of people who had a low-trauma fracture – which puts them at increased risk for future osteoporotic fractures – had the recommended bone mineral density testing within a year of the fracture.

Rheumatoid arthritis – the most common form of inflammatory arthritis – may be seriously undertreated in Ontario, according to the POWER research. Although rheumatoid arthritis affects about one per cent of the population, fewer than half of diagnosed patients had been seen by a specialist in a one-year period (42 per cent of female patients and 35 per cent of male patients). Rheumatoid arthritis affects twice as many women as men.

After analyzing these issues and assessing their effects on women’s health in Ontario, the study authors made the following recommendations:

• A stronger focus on preventing musculoskeletal conditions and on health promotion could help reduce incidence of these conditions and reduce the disability associated with them. Promoting a healthy diet and active lifestyle is important, but must also address exercise challenges faced by people whose mobility is limited by hip or knee arthritis.
• Early diagnosis and treatment may reduce disability in patients with inflammatory arthritis and rheumatoid arthritis in particular. These conditions often affect women of child-bearing age, and early drug treatment can improve long-term outcomes. Raising awareness may help to increase the number of younger patients referred for treatment.
• A patient-centred approach, in which patients play an active role in self-managing their own chronic conditions, may improve outcomes as well as quality of life in patients with musculoskeletal conditions, which often occur in tandem with other chronic illnesses or health problems. Self-management is a key factor in achieving the best results for patients.

The report is based on data from several national and provincial sources, including Statistics Canada, the Canadian Institute for Health Information, the Institute for Clinical and Evaluative Sciences, the Ontario Drug Benefit Database and the Ontario Health Insurance Plan.

The POWER study is funded by Echo: Improving Women’s Health in Ontario, an agency of the Ontario Ministry of Health and Long-Term Care. The chapter on musculoskeletal conditions was a joint study from St. Michael’s Hospital and the Institute for Clinical Evaluative Sciences.