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Weekly MSK Literature Review Template
Week of January 11-18, 2025
Alex Bendersky
January 11, 2026
Monday: Healthcare System Preparedness for Aging Population
Main Points
By 2030, all baby boomers will be over 65, representing 1 in 5 Americans, with the 65+ population projected to grow from 58 million to 82 million by 2050
The 85+ population will nearly triple from 6.5 million to 17.3 million, representing the fastest-growing demographic segment requiring the most intensive care coordination.
64% of adults 65+ currently live with two or more chronic conditions, accounting for 94% of Medicare spending and driving complex care needs
The U.S. faces severe workforce shortages: up to 139,000 physicians and 1.2 million nurses projected to be lacking by 2030, with the existing workforce itself aging (one-third of nurses over 50, half of physicians over 55)
Hospital capacity has declined dramatically, with beds per capita dropping from 4.5 (1980) to 2.4 (2018), while infrastructure receives a D+ grade, and $750 billion is wasted annually due to system inefficiencies.
Geographic maldistribution creates a growing rich-poor divide, with affluent urban areas attracting scarce clinicians while rural and low-income communities face widening access gaps.
Clinical Significance
This analysis reveals that the U.S. healthcare system is structurally unprepared for the demographic shift already underway, with implications for MSK care delivery, given that musculoskeletal conditions are among the most prevalent chronic conditions in older adults. The workforce shortage, capacity constraints, and fragmented care coordination will disproportionately impact older adults with MSK conditions who require longitudinal, multidisciplinary care. Healthcare systems must urgently redesign care models, expand workforce pipelines, and invest in integrated delivery systems to meet the rising demand for MSK services among aging populations.
Citation
Jones, C. H., & Dolsten, M. (2024). Healthcare on the brink: Navigating the challenges of an aging society in the United States. npj Aging, 10, 22. https://doi.org/10.1038/s41514-024-00148-2
Tuesday: Economic Burden of Diabetes
Main Points
The total economic burden of diagnosed diabetes reached $412.9 billion in 2022, comprising $306.6 billion in direct medical costs and $106.3 billion in indirect productivity losses.
Diabetes accounts for 1 in every 4 U.S. healthcare dollars, with 61% directly attributable to the condition itself.
Individuals with diabetes incur 2.6 times higher medical expenditures than those without diabetes, averaging $19,736 per year, of which $12,022 is directly attributable to diabetes.
Indirect costs include 338,526 premature deaths in 2022, with presenteeism contributing $35.8 billion, disability-related employment loss adding $28.3 billion, and lost productivity from premature mortality accounting for $32.4 billion.
Despite stable prevalence at approximately 8.5%, inflation-adjusted direct medical costs have risen 7% since 2017 and 35% since 2012, driven by demographic aging and therapeutic advances.
Clinical Significance
The substantial economic burden of diabetes has direct implications for MSK care delivery, as diabetes is a major comorbidity in MSK patient populations that complicates treatment, delays healing, increases infection risk, and worsens surgical outcomes. The rising per-capita costs and productivity losses underscore the need for integrated care models that address both metabolic and musculoskeletal health simultaneously. MSK providers must incorporate diabetes screening, management coordination, and complication prevention into routine practice to optimize outcomes and reduce system-wide costs.
Citation
Parker, E. D., Lin, J., Mahoney, T., Ume, N., Yang, G., Gabbay, R. A., ElSayed, N. A., & Bannuru, R. R. (2024). Economic costs of diabetes in the U.S. in 2022. Diabetes Care, 47, 26–43. https://doi.org/10.2337/dci23-0085
Wednesday: Projected Chronic Disease Burden Through 2050
Main Points
Using a multi-state population model with 20 years of longitudinal data, researchers project that adults aged 50+ will grow 61% from 137 million to 221 million by 2050
Adults 50+ with at least one chronic condition will nearly double from 71.5 million to 142.7 million (99.5% increase), while those with multimorbidity will grow 91% from 7.8 million to 15.0 million.
By 2050, 47.8% of all adults 50+ will have at least one chronic condition, and multimorbidity prevalence will rise from 2.38% to 5.02%
The steepest increases occur in adults 80+, with a 244% increase in those with one chronic condition and 203% increase in multimorbidity.
Racial patterns show high chronic disease burden across all groups: 64.6% of non-Hispanic Whites, 61.5% of non-Hispanic Blacks, and 64.5% of Hispanics/other races projected to have at least one chronic condition by 2050
Gender patterns reveal women will constitute the majority with one chronic condition, while men will slightly dominate the multimorbidity population.
Clinical Significance
These projections have profound implications for MSK care infrastructure and delivery models, as musculoskeletal conditions frequently co-occur with other chronic diseases and complicate treatment plans. The dramatic growth in multimorbidity, particularly among adults 80+, signals that MSK providers will increasingly manage patients with complex, interacting conditions requiring coordinated, whole-person care rather than single-disease approaches. Healthcare systems must invest in primary care capacity, chronic disease prevention programs, workforce training in geriatric MSK care, and technology platforms that support care coordination across multiple conditions and providers.
Citation
Ansah, J. P., & Chiu, C.-T. (2023). Projecting the chronic disease burden among the adult population in the United States using a multi-state population model. Frontiers in Public Health, 10, 1082183. https://doi.org/10.3389/fpubh.2022.1082183
Thursday: Food Is Medicine and Cardiometabolic Health
Main Points
Poor diet is responsible for 45% of U.S. cardiometabolic deaths, 70% of new diabetes cases globally, and contributes to $1.1 trillion in annual U.S. economic losses from poor nutrition and food insecurity.
Food Is Medicine (FIM) interventions, including medically tailored meals, medically tailored groceries, and produce prescriptions, represent a shift toward clinically integrated, reimbursable, evidence-based food treatments delivered alongside nutrition counseling and culinary education.
Evidence from quasi-experimental and pre/post studies demonstrates consistent improvements in food security, diet quality, glucose control, blood pressure, body weight, self-management, mental health, and healthcare utilization, with medically tailored meals showing signals of cost savings through reduced hospitalizations and emergency visits.
FIM addresses nutrition security, access to foods that prevent and treat disease, and targets structural inequities affecting food-insecure, low-income, rural, and racially marginalized populations disproportionately affected by cardiometabolic disease
An emerging ecosystem enables FIM’s growth: EHR-based screening for food insecurity, new Medicaid and Medicare waivers supporting food benefits, integration with SNAP/WIC/school meals, expansion of medical nutrition education, partnerships with community organizations, and digital tools for delivery and tracking.
Clinical Significance
FIM represents a paradigm shift highly relevant to MSK care, as poor nutrition contributes to obesity, diabetes, and inflammatory conditions that complicate MSK outcomes, delay healing, and increase surgical complications. By integrating food-based interventions into clinical workflows, MSK providers can address upstream social determinants of health that drive both cardiometabolic and musculoskeletal disease burden. The evidence for improved chronic disease control, reduced healthcare utilization, and potential cost savings suggests FIM could enhance MSK treatment outcomes while addressing health equity gaps in vulnerable patient populations who experience disproportionate MSK disability.
Citation
Mozaffarian, D., Aspry, K. E., Garfield, K., Kris-Etherton, P., Seligman, H., Velarde, G. P., Williams, K., & Yang, E. (2024). “Food Is Medicine” strategies for nutrition security and cardiometabolic health equity. Journal of the American College of Cardiology, 83(8), 843–864. https://doi.org/10.1016/j.jacc.2023.12.023
Friday: Global Economic Impact of Overweight and Obesity
Main Points
In 2019, overweight and obesity (OAO) cost the world 2.19% of global GDP, with per-capita costs ranging from $20 in Africa to $872 in the Americas and from $6 in low-income countries to $1,110 in high-income countries.
By 2060, the global economic burden of OAO is projected to rise to 3.29% of GDP, with costs quadrupling in high-income countries and increasing 12-25 times in low- and middle-income countries.
The majority of economic burden comes from indirect costs, premature mortality (the largest contributor), absenteeism, and presenteeism, reflecting obesity’s link to 28 major chronic diseases.
Counterfactual modeling demonstrates that reducing OAO prevalence by 5% annually would save $429 billion per year globally, while holding prevalence at 2019 levels would save $2.2 trillion per year.
Low- and middle-income countries face the steepest growth in OAO prevalence and economic burden, driven by rapid urbanization, dietary shifts, and rising non-communicable disease prevalence in health systems least equipped to absorb the costs.
Clinical Significance
Obesity is a critical driver of MSK disease burden, contributing to osteoarthritis, low back pain, joint degeneration, surgical complications, and poor rehabilitation outcomes. The projected economic impact, particularly the massive indirect costs from productivity losses, underscores that obesity is not simply a lifestyle issue but a systemic threat requiring population-level interventions. For MSK care delivery, this analysis supports the business case for integrating weight management, nutritional support, and behavioral health services into routine care, as addressing obesity upstream can reduce MSK disease incidence, improve treatment outcomes, and generate substantial cost savings through reduced disability and improved workforce participation.
Citation
Okunogbe, A., Nugent, R., Spencer, G., Powis, J., Ralston, J., & Wilding, J. (2022). Economic impacts of overweight and obesity: current and future estimates for 161 countries. BMJ Global Health, 7, e009773. https://doi.org/10.1136/bmjgh-2022-009773
Weekly Themes & Strategic Insights
1. Convergence of Demographic Aging and Chronic Disease Burden
The simultaneous aging of the population (Jones & Dolsten) and near-doubling of adults 50+ with chronic conditions by 2050 (Ansah & Chiu) creates an unprecedented demand surge for healthcare services. MSK conditions are among the most prevalent in older adults, meaning musculoskeletal care will be central to managing this demographic transition. The 244% increase in adults 80+ with chronic conditions signals that geriatric MSK care, addressing frailty, falls, mobility, and function, must become a core competency rather than a subspecialty niche.
2. Multimorbidity as the New Normal in MSK Patient Populations
Multiple studies (Ansah & Chiu, Parker et al., Jones & Dolsten) document explosive growth in multimorbidity, with diabetes, obesity, and cardiovascular disease frequently co-occurring with MSK conditions. By 2050, nearly half of adults 50+ will have multiple chronic conditions, fundamentally changing the MSK patient profile from single-condition orthopedic cases to complex, whole-person care requiring coordination across medical, surgical, and rehabilitation teams. Traditional MSK care models designed for otherwise-healthy surgical candidates are obsolete; integrated, multidisciplinary approaches are essential.
Mozaffarian et al.'s Food Is Medicine framework and Okunogbe et al.'s analysis of obesity’s economic impact both emphasize that structural factors, food insecurity, poverty, built environment, systemic inequity- drive chronic disease burden more powerfully than individual behaviors. Jones & Dolsten document widening geographic disparities in access. For MSK care, this means that clinical interventions alone are insufficient; addressing nutrition, housing, transportation, and community resources is necessary to achieve equitable outcomes and reduce the disproportionate MSK disability burden in vulnerable populations.
4. Economic Imperative for Prevention and Upstream Intervention
The staggering costs documented across all five studies, $412.9 billion for diabetes, $1.1 trillion for poor nutrition, 2.19% of global GDP for obesity, $750 billion wasted in U.S. healthcare, demonstrate that the current reactive, treatment-focused model is economically unsustainable. Counterfactual modeling (Okunogbe et al.) shows that even modest reductions in chronic disease prevalence generate massive savings. For MSK care, this supports investment in preventive services, lifestyle medicine, prehabilitation, and early intervention programs that address modifiable risk factors before they progress to disabling conditions requiring expensive surgical or long-term management.
5. Workforce and Capacity Crisis Threatening Access to Care
Jones & Dolsten’s documentation of severe workforce shortages (1.2 million nurses, 139,000 physicians by 2030) combined with the explosive growth in chronic disease burden (Ansah & Chiu) and declining hospital capacity, creates a supply-demand mismatch that will disproportionately impact MSK services. Physical therapy, orthopedic surgery, pain management, and rehabilitation services all depend on adequate workforce pipelines and infrastructure. Without urgent action to expand capacity, train providers in geriatric and complex care, and implement efficiency-enhancing technologies, access to MSK care will deteriorate, particularly in rural and underserved communities.
6. Integrated Care Models and Technology as Essential Enablers
The fragmentation documented by Jones & Dolsten, the coordination challenges inherent in multimorbidity (Ansah & Chiu), and the need for food-based interventions to be clinically integrated (Mozaffarian et al.) all point toward the same solution: care models that break down silos, coordinate across conditions and settings, and use technology to enhance efficiency. For MSK care, this means investing in platforms that support team-based care, enable remote monitoring and digital therapeutics, integrate social determinants screening, facilitate referrals to community resources, and provide decision support for managing patients with multiple interacting conditions.
Implications for MSK Care Delivery, Technology, and Strategy
Population Health and Risk Stratification: The dramatic growth in multimorbidity and the concentration of costs among high-complexity patients demand sophisticated risk stratification tools that identify MSK patients with metabolic, nutritional, and social risk factors requiring enhanced support and coordination to prevent complications and reduce utilization.
Integrated Care Delivery Models: Traditional MSK care models must evolve toward team-based, coordinated approaches that address the whole person, incorporating primary care, endocrinology, nutrition, behavioral health, and social services, particularly for older adults and those with multiple chronic conditions who cannot be successfully treated through episodic, single-condition interventions.
Prevention and Lifestyle Medicine: The economic data supporting upstream intervention, particularly for obesity and nutrition, justifies expanding MSK service lines to include prehabilitation, weight management, medical nutrition therapy, exercise medicine, and behavioral health support that address modifiable risk factors before they progress to disabling MSK conditions.
Workforce Development and Capacity Planning: Healthcare systems must immediately expand MSK workforce pipelines, train existing providers in geriatric and complex care, implement team-based models that leverage non-physician clinicians, and deploy digital health tools that enhance efficiency and extend provider capacity to meet rising demand from aging populations.
Health Equity and Social Determinants: MSK programs must systematically screen for food insecurity, housing instability, transportation barriers, and other social needs, establish partnerships with community-based organizations, and integrate Food Is Medicine and other social care interventions to address the structural drivers of poor outcomes in vulnerable populations.
Technology Investment Priorities: Health systems should prioritize EHR enhancements for care coordination, digital therapeutics for remote monitoring and self-management support, telehealth for access expansion, AI-powered decision support for complex patients, and platforms that integrate clinical and social care to manage the growing population of older adults with multimorbidity.
Payment Model Innovation: The shift toward value-based care and the evidence for cost savings from preventive interventions create opportunities for MSK providers to negotiate alternative payment models that reward population health management, care coordination, and prevention rather than volume-based fee-for-service that incentivizes reactive, procedure-focused care.
Strategic Positioning for Demographic Transition: Forward-thinking MSK organizations will differentiate themselves by building geriatric expertise, investing in integrated care infrastructure, partnering with payers on risk-bearing arrangements, and positioning as preferred partners for managing the complex, high-cost populations that will dominate the healthcare landscape through 2050.
Bottom line: The convergence of rapid demographic aging, explosive growth in multimorbidity, rising economic burden of chronic disease, persistent health inequities, and severe workforce shortages demands fundamental transformation of MSK care delivery from episodic, procedure-focused models toward integrated, preventive, team-based approaches that address the whole person and the social determinants driving outcomes. Organizations that fail to adapt will face declining access, worsening outcomes, and unsustainable costs, while those that invest now in workforce development, care coordination, lifestyle medicine, and health equity will be positioned to thrive in the new demographic reality.
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