EPIDEMIOLOGY & PREVENTIVE

MEASURES FOR
MUSCULOSKELETAL DISEASE

dr. Suryani Tawali, MPH

BASIC CONCEPTS

The fields of preventive medicine and public health

share the goals of promoting general health, preventing
specific diseases, and applying the concepts and techniques
of epidemiology towards these goals.
Preventive medicine seeks to enhance the lives of
individual by helping them improve their own health
Public health attempts to promote health in
populations through the application of organized
community efforts
BASIC CONCEPTS
Althought, they ( preventive medicine and public
health) are discussed somewhat separately.

There should be a seamless continuum between:

The practice of preventive medicine by physicians
and other health professionals

The attempts of individuals and families their own

and neighbours health

The efforts of government and voluntary agencies to

achieve the same health goals for populations
NATURAL HISTORY OF DISEASE

Before a disease process begins (during

pre-disease/ pre-pathogenesis period). An
individual can be though as possessing
various factors that promote or resist
disease. These factors include genetic
makeup, demographic characteristics
(especially age), environmental exposures,
nutritional history, social environment,
immunologic state, and behavioral
patterns
NATURAL HISTORY OF DISEASE

Over time, the sum of these and other factors

may cause a disease process to begin either
slowly (as is usually the case with infectious
diseases) or quickly (infectious diseases).
If the disease-producing process is under way
but no symptoms of the disease have become
apparent, the disease is said to be in the latent
stage (early pathogenesis). If the underlying
disease is detectable by a reasonably safe and
cost-effective means during this stage, then
screening may feasible.
NATURAL HISTORY OF DISEASE
(contd)

In this sense, the latent stage may

represent a window of opportunity, during
which detection followed by treatment
provides better chance of cure or at least
effective treatment
For some disease there is no window of
opportunity, because safe and effective
screening technology is not available.
NATURAL HISTORY OF DISEASE
(contd)
When the disease is advanced enough to
produce clinical manifestations, it is said to
be in symptomatic/ manifest stage.
Even in this stage, the earlier the
condition is diagnosed and treated, the
more likely the treatment effective to cure
the patient, or to prevent from serious
complication/ death. Or at least to provide
the opportunity for rehabilitation.
 The natural history of disease is its normal
course in the absent of intervention. The
central question for studies of prevention
(field studies/ trials) and studies of
treatment (clinical trials) is whether the
institution/body of a particular preventive
or treatment measure will change the
natural history of the disease in a
favorable direction.
 THE NATURAL HISTORY OF ANY DISEASE OF MAN
Before man involved The course of the disease in man death

Interrelations of the various Chronic

state
AGENT Disability

illness
HOST
Defect
and Signs and
ENVIRONMENTAL CLINICAL HORIZON symptom
factors
Known or unknown
Tissue and
physiologic Immunity and
Bring AGENT and
changes resistance
HOST together
STIMULUS and AGENT
STIMULUS or BECOMES established and
AGENT becomes increases by multiplication or RECOVERY
Or Produce a increment
disease-provoking

STIMULUS Interactions of HOST HOST REACTION

in and SIMULUS
human Discernible
Early Advanced
HOST pathogenesis early lesions Convalescence
disease

PREPATHOGENESIS
PERIOD PERIOD OF PAT H O G E N E S I S
THE NATURAL HISTORY OF ANY DISEASE OF MAN
Interrelation of Agent, Host, and Environmental Reaction of the HOST to the STIMULUS
factors
Early Discernible Advanced
pathogenesis earlyl esions disease Convalescence
Production of STIMULUS
PREPATHOGENESIS PERIOD PERIOD OF PATHOGENESIS

EARLY DIAGNOSIS and REHABILITATION

HEALTH PROMOTION
SPECIFIC PROTECTION
Use of specific
Immunizations
Health education
Attention to
Good standard
of nutrition personal hygiene
Use of environmental
Provision of adequate
sanitation
Housing, recreation,
and agreeable
work conditions Protection against
occupational hazards
Marriage counseling
and sex education Protection from accidents
Use of specific nutrients
Genetics
Protection from carsinogens To shorten period of disability
Avoidance of allergens
PROMPT TREATMENT
Case-finding measures,
individual and mass
Screening survey
Selective examinations
Objectives :
To cure and prevent
disease processes
To prevent the spread of
communicable diseases
To prevent complications
and sequele
Provision of hospital
and community facilities
DISABILITY LIMITATION for retraining and
education for
maximum use
Adequate treatment of remaining capacities
to arrest
the disease process Education of the public
and to prevent and industry to utilized
further complication the rehabilitated
and sequelae as full employment
Provision of Selective placement
facilities to limit
disability Work therapy in hospitals
and to prevent death
Use of sheltered colony

PRIMARY PREVENTION SECONDARY PREVENTION TERTIARY PREVENTION

LEVELS OF APPLICATION of PREVENTIVE MEASURES
OSTEOARTHRITIS
Epidemiology
Morbidity: USA : 16.000.000 (1997)
Incidence in Indonesia:
12.000.000 penderita / 207 juta jiwa
(1997) 6%
70% penggantian sendi panggu/lutut
disebabkan oleh OA
OSTEOARTHRITIS

Epidemiology
- Sex: Wanita>>> laki2 , 5.8 : 1
- Umur tua >>>> 40 tahun, meningkat
oleh pertambahan umur
 THE NATURAL HISTORY OF OSTEO-ARTHRITIS
The course of the disease in man DEATH

Interrelations of the various Chronic

state
AGENT: PHYSICAL , INFECTION
Disability
SEVERE
HOST: HUMAN illness
(GENETIC, AGE,
NUTRITION Defect
Signs and
MODERATE
CLINICAL HORIZON symptom :
ENVIRONMENT:
OA (MILD)
TRAUMA
Tissue and
THICKENING
physiologic
Bring AGENT and OF JOINT Immunity and
changes CAPSULE resistance
HOST together
STIMULUS and AGENT NARROWING
STIMULUS or BECOMES established and
AGENT becomes OF JOINT RECOVERY
increases by multiplication or SPACE
Or Produce a increment
disease-provoking

STIMULUS Interactions of HOST HOST REACTION

in and SIMULUS
human Discernible
Early Advanced
HOST pathogenesis early lesions Convalescence
disease

PREPATHOGENESIS
PERIOD PERIOD OF PAT H O G E N E S I S
THE NATURAL HISTORY OF OSTEORTRITIS
Interrelation of Agent, Host, and Environmental Reaction of the HOST to the STIMULUS
factors OA-
Early O-A MILD
MODERATE- REHABILITATION
pathogenesis
Production of STIMULUS SEVERE
PREPATHOGENESIS PERIOD PERIOD OF PATHOGENESIS

HEALTH PROMOTION

EARLY DIAGNOSIS and REHABILITATION

SPECIFIC PROTECTION DISABILITY LIMITATION
PROMPT TREATMENT

PRIMARY PREVENTION SECONDARY PREVENTION TERTIARY PREVENTION

LEVELS OF APPLICATION of PREVENTIVE MEASURES
Levels of prevention
(OSTEO-ARTHRITIS)

1. Primary prevention:
1. Health promotion
Health education to avoid behaviour and
environment risk HEALTHY LIFESTYLE
HEALTHY LIFESTYLE

Balance diet:
Hormonal factor (age)
Exercise, along with balance diet to avoid
obesity
Avoid injury / Trauma
Avoid smoking
Levels of prevention
(OSTEO-ARTHRITIS)
2. Specific protection
Specific nutrient for joints
Reduce weight to reduce risk
Chondroprotective medicine
Assistive device to avoid injury
2. Secondary Prevention
3. Early diagnosis & prompt treatment:
- Screening for people in risk (age, obesity, sex,
hormonal factor)
- Adequate treatment
to avoid progression of disease:
analgesics, physical/occupational therapy, reduce
weight, chondro/joints protective nutrients/medicine,
assistive devices, follow-up
3. Tertiary prevention
4. Disability limitation
Minimise disability
(Surgery, use assistive device)
5. Rehabilitation
To rehabilitate as much as possible
individual normal ability: physical/
occupational therapy
EPIDEMIOLOGY OF
MUSCULOSKELETAL DISEASE
 1. OA = has been explained
2. Rheumatoid Art.= 1% population
Women : men = 3-5 : 1
Peak incidence : 30s & 50s (could be
all ages
3. Gout 2-2.6 per 1000 population
>>>> men
4. SLE : reproductive age
Women >>> men
Incidence: 1: 1000
 5. Osteoporosis: 15-20 juta orang (AS)
>>>women
66% of women aged 65 y have radiological
features of osteoporosis
About 50% women in western countries will
have fracture due to osteoporosis
25% of women aged 70s & 50% of 80s suffer
from spine (vertebrae) fracture
Hip fracture: the 12th cause of death in people
age > 65 years
IN MAKASSAR
Five major musculoskeletal disease in Wahidin Hospital
MAKASSAR 2002

No Disease/disorders Men Women

1. Fracture & ligament 32.2% 18.4%
injury
2. Pain syndrome 24.1% 29.0%
3. Musculoskeletal cancer 12.4% 11.5%
4. Rheumatic 12.3% 12.4%
5. Degenerative disorders of 11.9% 20.7%
bone & joints