Medical Problems with Musculoskeletal Implications


Lead Author(s): 

Scott B. Rosenfeld, MD
Brielle Payne Plost, MD

Supporting Author(s): 

Sylvia I. Watkins-Castillo, PhD

Many medical problems have musculoskeletal implications. This section discusses some of the more common of those diagnoses, including hemophilia, sickle cell disease, and endocrine and metabolic disorders such as rickets and lysosomal storage disorders.

Hemophilia is a genetic disorder characterized by abnormal blood clotting secondary to congenital deficiency of clotting factors VIII or IX. It may result in musculoskeletal problems by way of intramuscular hemorrhage and hemophilic arthropathy. Hemophilic arthropathy occurs through spontaneous bleeding into a weight-bearing joint, resulting in cartilage degeneration and arthrosis as well as asymmetric growth stimulation and deformity.

Sickle cell disease is inherited in an autosomal dominant fashion and is characterized by production of abnormal hemoglobin. This results in reduced oxygen delivery to tissues and can lead to multiple musculoskeletal manifestations, including painful bone infarcts, osteomyelitis, avascular necrosis, and vertebral compression fractures.

Metabolic bone diseases, such as rickets, occur due to abnormal calcium and phosphate metabolism. Rickets occurs in many forms, including vitamin D deficiency, vitamin D resistance, hypophosphatemia rickets, and renal osteodystrophy. Regardless of the cause, the result is inadequate calcification of bone and cartilage, resulting in bone pain and deformity.

The most common lysosomal storage disease is Gaucher’s disease, an autosomal recessive condition characterized by a deficiency in the enzyme beta-glucocerebrosidase. In Gaucher’s disease, there is an accumulation of glucocerebrosides, which contain glucose, in the tissues. This results in musculoskeletal manifestations that include bone deformity secondary to bone marrow infiltration, avascular necrosis, bone pain, pathologic fracture, and osteomyelitis.

Healthcare Utilization

Medical problems with musculoskeletal implications were diagnosed in 566,700 children and adolescent healthcare visits in 2013, of which 24% (134,000) had a primary diagnosis of a medical problem with musculoskeletal implications condition. One in ten children and adolescents with any medical problem diagnoses were hospitalized (54,700), while 3.5% (4,700) with a primary diagnosis had a hospital discharge. (Reference Table 7C.1.1 PDF CSV and Table 7C.1.2 PDF CSV)

Males and females were hospitalized with a medical problem with musculoskeletal implications in about the same numbers, but with a primary diagnosis, males were more likely to be hospitalized. The highest rate of hospitalization, when compared to other MSK conditions, was for adolescents age 14 to 20 years of age.

Any diagnoses of a medical problem with musculoskeletal implications accounted for 10.9% of hospitalizations for any musculoskeletal condition diagnosis, and less than 1% of all hospitalizations for any healthcare condition. Hospitalizations with a primary diagnosis of a medical problem with musculoskeletal implications were less than 1% of all musculoskeletal diagnoses and 0.1% of hospitalizations for any health condition diagnosis. However, it is often the case that the primary diagnosis would reflect the problem associated with the condition rather than the condition itself. For example, a child with rickets is going to be hospitalized for a lower extremity deformity rather than for rickets. (Reference Table 7C.11 PDF CSV)

Rickets accounted for 45.5% of all healthcare visits for medical problems with musculoskeletal implications, but 72% of the hospitalized cases. (Reference Table 7C.1.1 PDF CSV)

Hospital Charges

Total charges averaged $119,200 for a mean 11.9-day stay when children and adolescents were hospitalized with any diagnosis of a medical problem with musculoskeletal implications along with other medical conditions. With a primary medical problem with musculoskeletal implications diagnosis, the stay was shorter (3.2 days), and mean charges about a fourth that of medical problems as a contributing condition ($29,500).

When hospitalized with any diagnosis of a medical problem with musculoskeletal implications along with other medical conditions, neonates and children less than 1 year of age had significantly longer stays and higher charges than other age groups, primarily due to cases of rickets. Total hospital charges for primary medical problem with musculoskeletal implications diagnosis discharges in 2013 were $138.7 million. (Reference Table 7C.11 PDF CSV)


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