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 and IX. It may result in musculoskeletal problems by way of hemophilic arthropathy and intramuscular hemorrhage. 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, hypophosphatemic 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.
Medical problems with musculoskeletal implications were diagnosed in 455,800 children and adolescent health care visits in 2012, of which 45% (207,000) had a primary diagnosis of a medical problem with musculoskeletal implications condition. More than one in ten (12%) children and adolescents with any medical problem diagnoses were hospitalized (55,300), while 2% (4,800) with a primary diagnosis had a hospital discharge. (Reference Table 7.1.1 PDF [1] CSV [2] and Table 7.1.2 PDF [3] CSV [4])
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 18 to 20 years of age, the ages just entering adulthood. However, this age group tends to have a higher rate of musculoskeletal hospitalizations overall.
Any diagnoses of a medical problem with musculoskeletal implications accounted for 11% of hospitalizations for any musculoskeletal condition diagnosis, and less than 1% of all hospitalizations for any health care condition. Hospitalizations with a primary diagnosis of a medical problem were 1% of all musculoskeletal diagnoses and 0.1% of hospitalizations for any health condition diagnosis. (Reference Table 7.10 PDF [5] CSV [6])
Rickets accounted for 35% of all health care visits for medical problems with musculoskeletal implications, but 69% of the hospitalized cases. (Reference Table 7.1.1 PDF [1] CSV [2])
Total charges averaged $112,300 for a mean 11.5-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 diagnosis, the stay was shorter (3.5 days), and mean charges about a fourth that of medical problems as a contributing condition ($31,600).
When hospitalized with any diagnosis of a medical problem with musculoskeletal implications along with other medical conditions, males had slightly longer hospital stays and charges than females did. Infants under the age of 1 year had significantly longer stays and higher charges than other age groups, primarily due to cases of rickets. However, for primary medical diagnoses of musculoskeletal implications along with another medical condition, sex and age were not major factors in length of hospital stay and mean charges. Total hospital charges for primary medical problem with musculoskeletal implications diagnosis discharges in 2012 were $151.7 million. (Reference Table 7.10 PDF [5] CSV [6])
Links:
[1] https://www.boneandjointburden.org/docs/T7.1.1.pdf
[2] https://www.boneandjointburden.org/docs/T7.1.1.csv
[3] https://www.boneandjointburden.org/docs/T7.1.2.pdf
[4] https://www.boneandjointburden.org/docs/T7.1.2.csv
[5] https://www.boneandjointburden.org/docs/T7.10.pdf
[6] https://www.boneandjointburden.org/docs/T7.10.csv