Bone and joint diseases around the world. Sweden: a brief update on burden and priority.

Musculoskeletal conditions are increasingly common with advancing age. The life expectancy increased early and rapidly in Sweden, and today 17% of the population is over age 65. Musculoskeletal problems are therefore common but in general are receiving low attention, despite enormous costs for society. The indirect costs for musculoskeletal conditions vastly exceed direct costs (80% vs 20%). This is obviated by the fact that in 2001, of all persons receiving disability pension or taking longterm sick leave, 60% had a diagnosis related to the musculoskeletal system. Further, in a population of 9 million, 70,000 fragility fractures occur each year, 18,000 of the hip and 25,000 of the forearm, corresponding to a hip fracture incidence of 20.14/10,000, among the highest in the world. Government policy is implemented through several agencies, national and local. State of the art reports are currently available in 12 areas of musculoskeletal condition, including osteoarthritis, rheumatoid arthritis, osteoporosis, and hip fracture, while no national evidence-based guidelines have been developed for these conditions. The Swedish Council on Technology Assessment in Health Care provides the scientific foundation of present methods for treatment through evidence-based evaluations. National registers are continuously evaluating orthopedic implant procedures, of which the Swedish Hip Register has provided valuable information on total hip replacements since 1979. For the future, there is a need for setting of priorities with regard to musculoskeletal conditions, including development of guidelines of mechanism of implementation.