Musculoskeletal Disorders in Postmenopausal Women Are Rising Worldwide

From 1990 to 2021, the global burden of musculoskeletal disorders (MSDs) among postmenopausal women (PMW) grew significantly, and 2045 projections indicate this trend will continue, according to a comprehensive analysis using Global Burden of Disease 2021 data.1

Published in Arthritis Research & Therapy, this study is the first of its kind to systematically quantify the prevalence and disability-adjusted life years (DALYs) of MSDs in the growing population of PMW, which has gone from making up 13.75% to 20% of the total female population in the past 30 years.

Researchers looked at 6 major types of MSDs to determine global, regional, and national patterns: osteoarthritis (OA), lower back pain, neck pain, rheumatoid arthritis (RA), gout, and other musculoskeletal disorders (OMSKDs). In 2021 alone, the global prevalence of MSDs in PMW reached over 210 million cases with nearly 45 million DALYs. Among all MSDs, OA and lower back pain were the leading contributors to disease burden.

OA Burden Tripled for Postmenopausal Women

Age-standardized DALY rates and prevalence increased across most conditions studied from 1990 to 2021, showing a significantly higher burden of MSDs for PMW compared with premenopausal women. Based on DALYs, the prevalence of OA was 3.1 times higher, gout was 2.9 times higher, and RA was 1.2 times higher for PMW. These disparities reflect the biological and hormonal shifts that occur after menopause, particularly estrogen decline, which accelerates joint degeneration and inflammation.2

Half of all PMW are projected to have OA by 2045. | Image credit: InsideCreativeHouse – stock.adobe.com

“These changes render the musculoskeletal system of older women more vulnerable, leading to higher rates of joint pain, functional impairment, and reduced mobility,” the authors said, calling out the sparsity of research on PMW.1 “There is a critical need for comprehensive, global epidemiological studies that address MSDs in PMW. Such research would be invaluable in understanding the full scope of these health risks and in developing targeted preventive and therapeutic strategies.”

MSD Prevalence by Region

High-income regions such as North America, Asia Pacific, and Western Europe saw the most pronounced increases in MSD prevalence and DALYs between 1990 and 2021. In the US, gout and OA showed up at especially high rates, driven by dietary patterns, sedentary lifestyles, and aging, according to the authors. Gout DALYs were notably highest in North America, where the disease's burden has grown rapidly despite being less common than lower back pain or OA.

Globally, lower back pain remains the top contributor to MSD-related DALYs, particularly in East Asia, South Asia, and Sub-Saharan Africa. However, the burden of OA is projected to surpass lower back pain in the coming decades due to rising obesity, aging populations, and earlier diagnoses.

Socioeconomic disparities were also evident. High sociodemographic index (SDI)-regions carried the heaviest MSD burdens, particularly for OA and gout, and middle-SDI regions showed slower gains in prevention and treatment. RA, however, declined slightly in high-SDI regions, which the authors attributed to therapeutic advancements like biologic disease-modifying drugs.

Future Prevalence of MSDs

From 2021 to 2045, the prevalence of MSDs is projected to increase across the board:

• RA, from 7.1 million to nearly 14 million
• OA, from 278.5 million to 553.3 million
• Lower back pain, from 176.8 million to 278.5 million
• Neck pain, from 43.2 million to 83.3 million
• Gout, from 10.6 million to 21.2 million
• OMSKDs, from 116.4 million to 313.5 million

Age-standardised prevalence rates showed varying trends between disease type. Over the next 25 years, the model projected these changes in cases:

• Gout to slightly decrease from 1347 to 1345
• Lower back pain to decrease from 22,461 to 19,545
• RA to increase from 906 to 989
• Neck pain to increase from 5660 to 6076
• OA to increase from 35,345 to 38,585
• OMSKDs to increase from 14,804 to 19,293

Based on these forecasts, the authors predict that about half of all PMW will suffer from OA in the next 20 years. OA had the most significant increase in prevalence and DALY rates among the MSD types, particularly in adults older than age 75 who reached higher levels.

“OA, as the leading MSD in PMW, continues to rise with age, and it is regarded as an inevitable ‘nightmare’ for every postmenopausal woman,” the authors said. “Gout progresses slowly, but the significant growth trend in high-SDI regions, particularly in the United States, warrants serious attention.”

Addressing the Needs of PMW

The study highlights the urgent need for tailored prevention strategies and early intervention policies to address the complex drivers of MSDs in older women. These include promoting healthy diet and lifestyle choices, hormone regulation, and access to rheumatologic care. Despite the lack of research on the topic, one study underscored the importance of evaluating obesity more precisely in patients with osteoarthritis.3 It found that a higher weight-adjusted waist index—a measure the researchers said better captures abdominal fat and muscle quality than traditional metrics like body mass index—was significantly associated with increased all-cause and cardiovascular mortality in patients with osteoarthritis. Enhanced screening and public health infrastructure are also essential in low– and middle-income regions to reduce underdiagnosis and late-stage disability.

In the US alone, osteoporosis-related fractures account for more annual hospitalizations among women than heart attack, stroke, or breast cancer, according to a 2020 publication of The American Journal of Managed Care®.4 The condition affects 10.2 million individuals nationally, 80% of whom are women, and results in over 2 million fractures each year with costs projected to reach $25 billion by 2025. Despite this, fewer than 25% of PMW receive treatment or bone mineral density screening following a fracture. Although not focused on osteoarthritis, this study included PMW and underscores the overall need for earlier intervention to improve bone health in women to preserve their quality of life.

“Addressing the health needs of older women should be a priority for future public health strategies, particularly in the context of aging societies,” the current study authors wrote.1 “Strengthening the prevention, early detection, and management of MSDs will not only improve the quality of life for PMW but also alleviate the growing social and economic burden posed by these conditions.”

References

1. Tan J, Zhu Z, Wang X, et al. Global burden and trends of musculoskeletal disorders in postmenopausal elderly women: a 1990-2021 analysis with projections to 2045. Arthritis Res Ther. 2025;27(1):127. doi:10.1186/s13075-025-03587-8
2. Almeida M, Laurent MR, Dubois V, et al. Estrogens and androgens in skeletal physiology and pathophysiology. Physiol Rev. 2017;97(1):135-187. doi:10.1152/physrev.00033.2015
3. McCormick B. Higher weight-adjusted waist index tied to greater mortality risk in patients with osteoarthritis. AJMC®. April 23, 2025. Accessed June 23, 2025. https://www.ajmc.com/view/higher-weight-adjusted-waist-index-tied-to-greater-mortality-risk-in-patients-with-osteoarthritis
4. Patel J. Economic implications of osteoporotic fractures in postmenopausal women. Am J Manag Care. 2020;26(15 suppl):S311-S318. doi:10.37765/ajmc.2020.88549