Between 1996 to 1998 and 2009 to 2011, the number of persons reporting a musculoskeletal disease increased by 26.5 million from the 76.0 million reported in 1996 to 1998 to the 102.5 million reported in 2009 to 2011.

The impact of musculoskeletal disease on the aging population is evident in the shifting burden carried by older persons. Among the population under the age of 18 years, the prevalence of musculoskeletal conditions is reported in 7.9 to 8.8 persons each year between 1996 and 2011. For the same years, persons age 18 to 44 years account for 26.4 to 29.8 million persons with the condition each year. However, as the population in the two older age groups has grown, the number of individuals with musculoskeletal diseases in those groups has increased substantially. In the years 1996 to 1998, an average of 21.7 million persons age 45 to 64 years reported a musculoskeletal disease condition, while 16.5 million of those 65 years and older did so. By 2009 to 2011, these numbers had risen to 39.2 million and 25.1 million, respectively. (Reference Table 10.1.1 PDF [5] CSV [6])

The 94.2 million persons age 18 years and older reporting a musculoskeletal disease in the MEPS is a substantially lower number than the 126.6 million musculoskeletal diseases self-reported by adults age 19 years and older in the National Health Interview Survey in 2012, and reported in the Big Picture section of this report.

A more expansive definition of musculoskeletal diseases includes persons with musculoskeletal diseases as a primary health concern, as well as persons in whom the musculoskeletal disease is a by-product of another condition (eg, bone metastases from cancer) or is overshadowed by a life-threatening disease, and, therefore, is often not the primary diagnosis (Dx1). The more expansive definition codes can be found in the ICD-9-CM codes [7] section.

Using this more expansive definition of musculoskeletal diseases, an average of 156.6 million persons of all ages, or 50.7% of the population, reported a musculoskeletal disease annually for the years of 2009 to 2011. This compares to 52.8% of persons age 18 years and older reported in the Big Picture section.

Approximately 8% of all persons reporting musculoskeletal diseases in MEPS for the years 2009 to 2011 are under the age of 18 years. Roughly one in four (24.5%) musculoskeletal diseases occurs in persons age 65 years and older. Almost 40% of musculoskeletal diseases occur among persons age 45 to 64 years. Overall, more than 75% of musculoskeletal diseases are reported by persons under the age of 65 years.  

The fastest rate of growth in musculoskeletal diseases between 1996 and 2011, by age group, was among persons age 45 to 64 years. (Reference Table 10.1 PDF [3] CSV [4])

 

Arthritis and joint pain showed the largest change in rate reported for musculoskeletal disease conditions between 1996 to 1998 and 2009 to 2011, but much of this increase is probably due to methodological changes in MEPS in 2001 and 2007 that improved the accuracy of capturing these conditions. Spine conditions remained the same, while injuries showed a slight decline in rate, consistent with other reported numbers in this report. Osteoporosis and other musculoskeletal conditions showed slight rate increases.  (Reference Table 10.1 PDF [3] CSV [4])

While one in four persons in the "all musculoskeletal diseases" category is older than age 65 years, nearly one-half of osteoporosis cases occur among persons 65 years and older. Only about 15% of persons reporting injuries are in this age range. (Reference Table 10.1.1 PDF [5] CSV [6])
  

Over the 13 3-year average periods, 1996 to 1998 to 2009 to 2011, for which the MEPS data is analyzed, prescription medications and ambulatory nonphysician care visits increased more than other categories of health care percentage-wise. The former showed an average annual increase of more than 8%, while the latter showed an increase of 6.6%. Of note, however, the increases for all services were much slower in the most recent three-year period, at 1.4% across the board. (Reference Table 10.3 PDF [8] CSV [9])
  

Utilization of health care services increased in several service categories for musculoskeletal disease conditions. The largest increase was found for persons with arthritis and joint pain in the service categories of physician visits, nonphysician visits, prescription medications, and hospital discharges. However, a large proportion of these increases are due to the increase in the numbers of individuals with arthritis and joint pain, which is due at least in part to changes in MEPS methodology in 2001 and 2007. Home health care days increased fastest among those with osteoporosis and related conditions, but this was closely followed by persons with arthritis and joint pain. The lowest increase in hospital discharges occurred among those reporting musculoskeletal injuries, while those with spine conditions experienced the lowest growth in the remaining services. (Reference Table 10.3 PDF [8] CSV [9])
 

Overall, total average expenditures for persons with musculoskeletal diseases increased from $4,832 in 1996 to 1998 to $7,768 in 2009 to 2011, in 2011 dollars, a 60% increase. Ambulatory care had the largest share of total average per person costs for musculoskeletal diseases. (Reference Table 10.4 PDF [14] CSV [15])

Per-person average expenditures for prescriptions had the largest increase among all components of musculoskeletal diseases, ranging from an increase of 102% for osteoporosis to an increase of 208% for injuries. Overall, prescription per person costs rose by 167% for all musculoskeletal diseases. Inpatient and residual costs showed the lowest increase between 1996 and 2011. 

Incremental average expenditures for persons with musculoskeletal diseases almost doubled in real terms between 1996 to 1998 and 2009 to 2011, in 2011 dollars, from $1,280 in the earlier three-year period to $2,075 in the later one. Incremental costs for inpatient services for musculoskeletal diseases increased the most in relative terms, rising by 207% between 1996 and 2011. (Reference Table 10.5 PDF [16] CSV [17])

Aggregate total expenditures increased from $367.1 billion to $796.3 billion, in 2011 dollars, during this time frame, or more than doubling. In 1996 to 1998, aggregate total expenditures for persons with a musculoskeletal disease, whether for musculoskeletal disease or other conditions, represented 3.2% of the GDP in 2011 dollars. By 2009 to 2011, the proportion had grown to 5.2% of the GDP.

Aggregate incremental expenditures, due to the higher number of persons with a musculoskeletal condition and the increased incremental expenditures per person, increased from $97.3 billion in 1996-1998 to $212.7 billion, in 2009 to 2011 when expressed in constant (2011) dollars, or by about 119%. Incremental cost associated with a musculoskeletal condition represented the equivalent of 0.25% and 0.5% of the GDP in 2011 dollars, for the respective time frames.

Over the full time range of 1996 to 1999 through 2009 to 2011, the annual average rate of increase in total and incremental costs for musculoskeletal diseases has been 9%. (Reference Table 10.7 PDF [18] CSV; [19] Table 10.9 PDF [22] CSV [23]; Table 10.11 PDF [26] CSV [27]; Table 10.14 PDF [28] CSV [29])

 

The mean direct cost per year per individual patient with a musculoskeletal disease has increased nearly 61% between the years 1996 to 1998 and 2009 to 2011, rising from just over $4,800 to nearly $7,800 per person in this time frame. Incremental costs, those cost most likely attributable to a musculoskeletal disease, rose from about $1,300 to $2,075. (Reference Table 10.4 PDF [14] CSV [15], Table 10.5  PDF [16]CSV [17]) 

At the same time, with the increasing number of individuals with musculoskeletal diseases in a growing and aging population, aggregate total direct cost to treat persons with a musculoskeletal disease between the years 1996 to 1998 and 2009 to 2011 increased by about 117%. For the years 2009 to 2011, the annual aggregate total direct cost, in 2011 dollars, is estimated to be $796.3 billion. Aggregate incremental medical cost is estimated to be $212.7 billion in 2009 to 2011, an increase of about 119% from the earlier time period. (Reference Table 10.6  PDF [12]  CSV [13], Table 10.7  PDF [18]  CSV [19])

Indirect total cost, as the difference in wages for persons age 18 to 64 years with a work history, and with and without musculoskeletal conditions, add another $77.5 billion to the aggregate cost for all persons with a musculoskeletal disease. Incremental indirect costs attributable to musculoskeletal disease alone are estimated to amount to $130.7 billion, indicating that wage losses attributable to musculoskeletal conditions are greater than the mean difference in wages between the two groups. Aggregate total indirect cost increased by 168% from the estimate in 1996 to 1998 to that of 2009 to 2011; aggregate incremental indirect costs rose by about 184%. (Reference Table 10.12  PDF [30]  CSV [31])

Taking into account all costs for persons with a musculoskeletal disease, including other comorbid conditions, the total aggregate cost of treating these individuals, plus the cost to society in the form of decreased or lost wages (indirect cost), is estimated to be $873.8 billion per year. (Reference Table 10.14  PDF [28]  CSV [29])

Between the years 1996 to 1998 and 2009 to 2011, the Gross Domestic Product (GDP), in constant 2011 dollars, has risen from $11.5 trillion to $15.2 trillion, an increase of 32%.1 Over the same two time frames, total direct and indirect costs of musculoskeletal conditions rose from $396.1 billion to $873.8 billion. This is an increase of 121%, or nearly four times the rate of increase as the GDP. 

As a share of GDP, using the same 2011 dollars base, total direct and indirect costs for musculoskeletal conditions increased by 67%, from 3.43% to 5.73%. Indirect costs saw a sharper rate of increase of slightly more than 100%. However, indirect cost are a much smaller share of total cost than direct costs, constituting 0.25% of GDP in 1996 to 1998 and 0.51% in 2009 to 2011. Direct costs rose from a 3.18% share to a 5.22% share over the same time period. (Reference Table 10.14 PDF [28] CSV [29])

To provide a basis for comparison, the economy is said to be in a recession when GDP declines by at least 1% for two or more consecutive quarters. Accordingly, the aggregate economic impact of the medical expenditures attributable to persons with musculoskeletal diseases is far in excess of the amount used to define a recession and, unlike a recession, occurs in perpetuity.

• 1. Agency for Healthcare Research and Quality: Medical Expenditure Panel Survey. Available at:Current GDP multiplied by inflation factors calculated per http://meps.ahrq.gov/mepsweb/about_meps/Price_Index.shtml [32]. Accessed November 11, 2014.

Over the period 1996 to 1998 through 2009 to 2011, slight changes in the proportion of total medical care expenditures devoted to ambulatory physicians visits (from 31% to 34% of total) and to inpatient care (from 36% to 29%) occurred. However, the share of musculoskeletal health care costs devoted to prescription medications increased the most, growing by more than 60%, from 14% to 23% of total cost. Computed in 2011 dollars, the mean annual prescription cost per person increased 167%, from $665 to $1,778. During this time, development of biologic agents for several inflammatory conditions, particularly rheumatoid arthritis, occurred, as well as the widespread use of the cox-2 inhibitors (coxibs) for musculoskeletal pain, and may have accounted for some of the rapid increase. However, the growth in per-person total expenditures for prescription drugs has slowed. From 1998 to 2000 through 2002 to 2004, annual growth in expenditures for prescription drugs averaged 15%, but since 2004 has averaged about 3% a year. (Reference Table 10.4 PDF [14] CSV [15])

The per person increment in ambulatory care expenditures for musculoskeletal diseases grew by 51% between 1996 to 1998 and 2009 to 2011, from $570 to $859 in 2011 dollars. The increment for inpatient care more than doubled, from $102 in the 1996 to 1998 to $313 in 2009 to 2011.  Ambulatory care represents the largest component of the increment in expenditures, indicative of the importance of ambulatory care in musculoskeletal diseases relative to other condition groups. (Reference Table 10.5 PDF [16] CSV [17])

In the studies conducted by Rice and colleagues starting in the early 1960s, indirect cost associated with earnings losses due to musculoskeletal diseases constituted between 38% and 59% of the total cost of these diseases.1^,2^,3^,4^,5 The percentage shifted because in various eras, medical costs were rapidly escalating while earnings stagnated (1970s) and in other times wage growth exceeded the increase in medical costs (1960s and late 1990s). Analysis of the Medical Expenditures Panel Survey to estimate direct and indirect cost (ie, the cost of lost wages due to musculoskeletal conditions for persons age 18 to 64 years with a work history) as a proportion of GDP shows a slow but steady increase in the share of GDP accounted for by musculoskeletal conditions, from about 3.4% of GDP in 1996 to 1998 to about 5.7% in 2009 to -2011, an increase of 67%.6^,7 (Reference Table 10.14 PDF [28] CSV [29])

The method to estimate earnings losses is based on the notion that presence of musculoskeletal conditions is one among many factors affecting employment. Thus, estimates of total earnings losses, grew from 1996 to 1998 through the mid 2000s, then declined substantially with the recession because it became more difficult to differentiate the employment situation of persons with musculoskeletal conditions from that of similar individuals. However, when other characteristics of individuals were taken into account, the estimate of incremental earnings losses continued to trend upward, despite the recession. Overall, the average increment in earnings losses grew from $949 in 1996 to 1998 to $2,063 in 2009 to 2011, or by more than 100%. (Reference Table 10.12 PDF [30] CSV [31])

Estimates of earnings losses are limited to persons age 18 to 64 years, both because the number of workers older than 65 years in MEPS is too small to permit statistically reliable estimates in this age group and because in the United States, most workers retire by that age. However, it is probable that some individuals with musculoskeletal diseases would continue working past the age of 65 years in the absence of the condition. Similarly, the tabulation of earnings losses is limited to those who have established a work history either prior to or after the onset of disease. There may be some among those without a work history who would have begun to work in the absence of a musculoskeletal disease, but who never had the opportunity to do so. Thus, the magnitude of earnings losses shown should be considered a conservative estimate.

As of 1996 to 1998, about 48.5 million persons with a musculoskeletal disease had established a work history. On average, these individuals earned $596 in 2011 dollars less than those without musculoskeletal conditions; their earnings losses aggregated to $28.9 billion. By 2009 to 2011, the number of persons with musculoskeletal diseases and a work history had grown to over 63.3 million. On average, these workers had earnings losses of $1,224 each, or roughly a doubling. Aggregate total earnings losses grew to $77.5 billion, despite the decline associated with the recession.

Some of the estimated earnings losses of persons with musculoskeletal diseases might have occurred in the absence of these conditions because of other factors. For example, older workers and women, two groups with high rates of musculoskeletal diseases, have lower employment rates and earnings than the average US worker. The incremental earnings loss measure takes into consideration many of the factors that might cause persons to have lower earnings even without the presence of the musculoskeletal disease. Earnings losses using the incremental measure grew substantially between 1996 to 1998 and 2009 to 2011. In the earlier triad of years, the 48.5 million persons with musculoskeletal diseases and a work history sustained average incremental earnings losses of $949, or $46.1 billion overall, in 2011 dollars. Average incremental earnings losses more than doubled by 2009 to 2011, to $2,063; aggregate incremental earnings losses increased almost three-fold to $130.7 billion.  

Using the more expansive definition of musculoskeletal diseases, average earnings losses rose from 1996 to 1998 through 1998 to 2000, but have been falling ever since; as of 2006 to 2008, earnings were actually greater among those included within the more expansive definition of musculoskeletal conditions than among the remainder of the working age population. In parallel, aggregate earnings losses have been falling since 1998 to 2000, turning negative in 2006 to 2008 and reaching -$158.6 billion in 2009 to 2011. (Note: Data on earnings losses of persons meeting the expansive definition of musculoskeletal diseases are not included in the tables.) Estimates of aggregate total earnings losses using the base case definition for this publication have declined from their peak in 2003 to 2005, but still are indicative of an adverse impact on earnings. It follows that the more expansive definition of conditions must necessarily include conditions which are not associated with work loss and resultant earnings losses.

• 1. Rice D: Estimating the Cost of Illness. Hyattsville, MD: National Center for Health Statistics, Health Economic Series, 1966, No. 6.
• 2. Cooper B, Rice D: The economic cost of illness revisited. Health Economics Series No. 6. Social Security Bulletin 1979;39:21-35.
• 3. Rice D, Hodgson T, Kopstein A: The economic costs of illness: A replication and update. Health Care Fin Rev 1985;7:61-80.
• 4. Rice D: Cost of musculoskeletal conditions, in Praemer A, Furner S, Rice D, eds: Musculoskeletal Conditions in the US. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1992.
• 5. Rice D: Cost of musculoskeletal conditions, in Praemer A, Furner S, Rice D, eds: Musculoskeletal Conditions in the US, ed 2. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1999.
• 6. The National Arthritis Data Task Force concluded that about half of the increase between the 1972 and 1980 studies by Rice and colleagues was due to improvements in the data sources available to Rice and colleagues, but the remainder represented a real increase.
• 7. Lawrence R, Helmick C, Arnett FC, et al: Estimates of the prevalence of arthritis and selected musculoskeletal disorders in the United States. Arthritis Rheum 1998;41:788-799.

Medical conditions in MEPS are self-reported and may result in misreporting of some conditions. With respect to musculoskeletal diseases, under-reporting might occur when physicians do not provide patients with a discrete diagnosis. For example, osteoarthritis may not be reported because it may be too mild to be recognized or treatment is included with other conditions and not distinct. Over-reporting of a condition could occur when respondents indicate they have a specific form of arthritis, for example, rheumatoid arthritis, even though their physician did not so indicate it. It should be noted that self-reporting of discrete medical conditions is lower than would be expected on the basis of epidemiological studies.1 As a result of differences in reporting, the measures of the aggregate economic impacts of discrete conditions summarized in Table 10.14 and select graphs throughout these pages may differ from those presented in the discussion of specific conditions in prior chapters. These discussions are based on larger samples, such as all musculoskeletal disease, or major subcategories, such as all forms of arthritis. Nevertheless, the data on expenditures do indicate, in broad stroke, the average economic impact for self-recognized disease and for conditions likely to be under-reported, such as osteoarthritis, a conservative estimate of aggregate economic impact. Estimates for discrete musculoskeletal diseases merged four years of MEPS data (2008-2011) to provide more stable estimates given the relatively few cases of each condition reported in individual years.

Average total direct cost for all four conditions studied—disorders of the back, rheumatoid arthritis, osteoarthritis and allied disorders, and gout—are relatively large. Over the period 2008 to 2011, per-person direct costs exceeded $12,000 a year for gout, $11,000 a year for osteoarthritis, $17,000 a year for rheumatoid arthritis, and just under $8,000 for disorders of the back. These costs aggregate to about $141.5 billion for gout, $339.7 for osteoarthritis, $17.8 billion for rheumatoid arthritis, and $141.5 billion for disorders of the back.  

Average total earnings losses were highest for rheumatoid arthritis, $13,886 per year, followed by osteoarthritis at $7,548 per year. However, because of the lower prevalence of rheumatoid arthritis, the aggregate impact of the earnings losses for these two conditions were $12.3 billion and $121.8 billion, respectively. Persons with both gout and back disorders actually had higher earnings than the corresponding populations without those conditions. (Reference Table 10.13 PDF [33] CSV [34])
 

• 1. Lawrence R, Helmick C, Arnett F, et al: Estimates of the prevalence of arthritis and selected musculoskeletal disorders in the United States. Arthritis Rheum 1998;41:788-799.

Much of the increase in the economic impact of treating musculoskeletal conditions is due to the increased prevalence and increased cost per case. As to the latter, the increase is due to increased use of surgical interventions and the expansion in the number and cost of prescription medicines.  However, research has indicated that the prevalence rate need not increase in exact proportion as the increase in the overall population. There are preventive measures that have been discovered, such as the impact of weight loss on the prevalence of many musculoskeletal conditions, and of environmental agents in several of the conditions. In addition, researchers have uncovered several behavioral interventions that reduce the impact of the conditions once they arise, such as evidence-based exercise programs and self-management. However, relatively few resources are devoted to discovering additional behavioral interventions to reduce the prevalence and impact of these diseases. In addition, research into the causes of many of the conditions, which made substantial progress in treatment over the last several decades, has been adversely affected by the decrease in Federal basic science funding. An example is the biological agents for the treatment of autoimmune conditions such as rheumatoid arthritis.

As noted, there is likely to be a dramatic increase in the number of persons with musculoskeletal conditions seeking access to health care as a result of the ACA. This may result in increased use of mechanisms to limit access to select providers. It may also result in increased cost sharing required of those with insurance to limit their use.

The dramatic increase in the prevalence of musculoskeletal conditions would provide a challenge to the health care system even in the absence of the major changes in health care occurring as a result of the Affordable Care Act (ACA). Earlier in the chapter, it was noted there were almost 9 million persons with musculoskeletal conditions who lacked health insurance. As many of these individuals obtain insurance through the ACA, it will place additional strain the existing care system. Presently, health care expenditures for the uninsured are only about a quarter of the cost of those with public insurance, and about a third the cost of those with private insurance. As medical care access increases for the previously uninsured, result will be greater utilization of health care resources. Health insurers may respond by making it more burdensome for patients to access some resources such as specialists or they may increase the amount the insured have to pay out of pocket.

The pipeline to expand the number of health care providers able to serve persons with musculoskeletal conditions is a long one. For someone to be trained as an orthopedic surgeon may require 15 years or more, including medical school; it may take only slightly fewer years for someone to be trained as a rheumatologist. The increased access to health insurance as a result of the ACA may, therefore, strain the existing workforce. 

Spine        
    Special Symptoms or Syndromes, NEC : 307
    Migraine: 346
    Trigeminal Nerve Disorders : 350
    Nerve Root and Plexus Disorders : 353
    Dentofacial Anomalies, Including Malocclusion : 524
    Pain and Other Symptoms Associated with Female Genital Organs : 625
    Menopausal and Postmenopausal Disorders : 627
    General Symptoms : 780
    Symptoms Involving Skin and Other Integumentary Tissue : 782
    Symptoms Involving Head and Neck : 784
    Symptoms Involving Respiratory System and Other Chest Symptoms :    786
    Symptoms Involving Digestive System : 787
    Other Symptoms Involving Abdomen and Pelvis : 789
    Injury to Other Cranial Nerve(s) : 951
    Injury to Nerve Roots and Spinal Plexus : 953
Arthritis and Joint Pain        
    Gonococcal Infections : 098
    Other Venereal Diseases : 099
    Other and Unspecified Infectious and Parasitic Diseases : 136
    Other and Unspecified Disorders of Metabolism : 277
    Purpura and Other Hemorrhagic Conditions : 287
    Other Paralytic Syndromes : 344
    Mononeuritis of Upper Limb and Mononeuritis Multiplex : 354
    Inflammatory and Toxic Neuropathy : 357
    Other and Ill-defined Cerebrovascular Disease : 437
    Other Peripheral Vascular Disease : 443
    Polyarteritis Nodosa and Allied Conditions : 446
    Other Disorders of Arteries and Arterioles : 447
    Psoriasis and Similar Disorders : 696
Osteoporosis        
    Other Disorders of Bone and Cartilage : 733        
Musculoskeletal Injuries        
    Open Wound of Neck : 874
    Open Wound of Other and Unspecified Sites, Except Limbs : 879
    Contusion of Trunk : 922
    Contusion of Upper Limb : 923
    Contusion of Lower Limb and of Other and Unspecified Sites : 924
    Crushing Injury of Trunk : 926
Other Musculoskeletal Conditions        
    Other Salmonella Infections : 3
    Rat-bite Fever : 26
    Meningococcal Infection : 36
    Rubella : 56
    Other Arthropod-borne Diseases : 88
    Early Syphilis, Symptomatic : 91
    Other Forms of Late Syphilis, with Symptoms : 95
    Yaws : 102
    Late Effects of Tuberculosis : 137
    Malignant Neoplasm of Other and Ill-defined Sites : 195
    Secondary Malignant Neoplasm of Other Specified Sites : 198
    Other Malignant Neoplasms of Lymphoid and Histiocytic Tissue : 202
    Multiple Myeloma and Immunoproliferative Neoplasms : 203
    Other Benign Neoplasm of Connective and Other Soft Tissue : 215
    Neoplasm of Uncertain Behavior of Other and Unspecified Sites and Tissues : 238
    Neoplasms of Unspecified Nature : 239
    Disorders of Parathyroid Gland : 252
    Disorders of Lipoid Metabolism : 272
    Disorders of Mineral Metabolism :  275
    Hereditary Hemolytic Anemias : 282
    Organic Sleep Disorders : 327
    Mononeuritis of Lower Limb and Unspecified Site : 355
    Peritonitis and Retroperitoneal Infections : 567
    Other Cellulitis and Abscess : 682
    Other and Unspecified Congenital Anomalies : 759
    Late Effects of Injuries to Skin and Subcutaneous Tissues : 906
    Certain Early Complications of Trauma : 958
    Complications Peculiar to Certain Specified Procedures : 996
    Personal History of Other Diseases : V13
    Organ or Tissue Replaced By Transplant : V42
    Organ or Tissue Replaced By Other Means : V43
    Other Postprocedural States : V45
    Problems with Head, Neck, and Trunk : V48
    Fitting and Adjustment of Other Device : V53
    Convalescence and Palliative Care : V66
    Follow-up Examination : V67
    Special Screening Examination for Bacterial and Spirochetal Diseases : V74

Spine        
    Special Symptoms or Syndromes, NEC : 307
    Migraine : 346
    Trigeminal Nerve Disorders : 350
    Nerve Root and Plexus Disorders : 353
    Dentofacial Anomalies, Including Malocclusion : 524
    Pain and Other Symptoms Associated with Female Genital Organs : 625
    Menopausal and Postmenopausal Disorders : 627
    General Symptoms : 780
    Symptoms Involving Skin and Other Integumentary Tissue : 782
    Symptoms Involving Head and Neck : 784
    Symptoms Involving Respiratory System and Other Chest Symptoms : 786
    Symptoms Involving Digestive System : 787
    Other Symptoms Involving Abdomen and Pelvis : 789
    Injury to Other Cranial Nerve(s) : 951
    Injury to Nerve Roots and Spinal Plexus : 953
Arthritis and Joint Pain        
    Gonococcal Infections : 098
    Other Venereal Diseases : 099
    Other and Unspecified Infectious and Parasitic Diseases : 136
    Other and Unspecified Disorders of Metabolism : 277
    Purpura and Other Hemorrhagic Conditions : 287
    Other Paralytic Syndromes : 344
    Mononeuritis of Upper Limb and Mononeuritis Multiplex : 354
    Inflammatory and Toxic Neuropathy : 357
    Other and Ill-defined Cerebrovascular Disease : 437
    Other Peripheral Vascular Disease : 443
    Polyarteritis Nodosa and Allied Conditions : 446
    Other Disorders of Arteries and Arterioles : 447
    Psoriasis and Similar Disorders : 696
Osteoporosis        
    Due to small sample sizes, no additional codes were included in the expansive analysis.       
Musculoskeletal Injuries        
    Open Wound of Neck : 874
    Open Wound of Other and Unspecified Sites, Except Limbs : 879
    Contusion of Trunk : 922
    Contusion of Upper Limb : 923
    Contusion of Lower Limb and of Other and Unspecified Sites : 924
    Crushing Injury of Trunk : 926
Other Musculoskeletal Conditions        
    Other Salmonella Infections : 3
    Rat-bite Fever : 26
    Meningococcal Infection : 36
    Rubella : 56
    Other Arthropod-borne Diseases : 88
    Early Syphilis, Symptomatic : 91
    Other Forms of Late Syphilis, with Symptoms : 95
    Yaws : 102
    Late Effects of Tuberculosis :  137
    Malignant Neoplasm of Other and Ill-defined Sites : 195
    Secondary Malignant Neoplasm of Other Specified Sites : 198
    Other Malignant Neoplasms of Lymphoid and Histiocytic Tissue : 202
    Multiple Myeloma and Immunoproliferative Neoplasms : 203
    Other Benign Neoplasm of Connective and Other Soft Tissue : 215
    Neoplasm of Uncertain Behavior of Other and Unspecified Sites and Tissues : 238
    Neoplasms of Unspecified Nature : 239
    Disorders of Parathyroid Gland : 252
    Disorders of Lipoid Metabolism : 272
    Disorders of Mineral Metabolism : 275
    Hereditary Hemolytic Anemias : 282
    Organic Sleep Disorders : 327
    Mononeuritis of Lower Limb and Unspecified Site : 355
    Peritonitis and Retroperitoneal Infections : 567
    Other Cellulitis and Abscess : 682
    Other and Unspecified Congenital Anomalies : 759
    Late Effects of Injuries to Skin and Subcutaneous Tissues : 906
    Certain Early Complications of Trauma : 958
    Complications Peculiar to Certain Specified Procedures : 996
    Personal History of Other Diseases : V13
    Organ or Tissue Replaced By Transplant : V42
    Organ or Tissue Replaced By Other Means : V43
    Other Postprocedural States : V45
    Problems with Head, Neck, and Trunk : V48
    Fitting and Adjustment of Other Device : V53
    Convalescence and Palliative Care : V66
    Follow-up Examination : V67
    Special Screening Examination for Bacterial and Spirochetal Diseases : V74