Annual caucus addresses musculoskeletal disparities
Musculoskeletal healthcare disparities are real. As the population of the United States becomes more diverse, addressing the impact of these disparities is critical to improving the health of our nation. With that in mind, the National Caucus on Arthritis and Musculoskeletal Health Disparities, sponsored by Movement Is Life (MIL), convenes each year in Washington, D.C., to focus on improving the musculoskeletal health of those who are disproportionately affected by obesity and osteoarthritis (OA), namely women, African Americans, and Hispanics and Latinos. MIL emphasizes the role of physical activity and movement in improving these conditions.

Impact on women of color
A 2008 analysis conducted by the Women's Health Initiative assessed risk factors for an ethnically diverse cohort of women. Their findings demonstrated that OA was more likely to develop in African-American and Hispanic and Latino women than in Caucasian-American women.

African-American and Hispanic and Latino women also face significantly higher disability and physical limitations related to OA and higher levels of obesity and obesity-related illnesses than Caucasian women. A Centers for Disease Control and Prevention study revealed that age-adjusted rates of obesity were 47.8 percent for African Americans, 42.5 percent for Hispanics and Latinos, and 32.6 percent for Caucasians. Among the female population, 56.6 percent of African-American women and 41.4 percent of Hispanic and Latino women were obese, compared to 32.8 percent of Caucasian women.

A vicious cycle
Joint pain from musculoskeletal conditions can be the start of a vicious cycle. Pain limits mobility, resulting in decreased physical activity and weight gain. Just 10 extra pounds translates into an additional 30 to 60 pounds of weight on knee joints, further stressing the joints and leading to the development of OA. The resultant obesity also contributes to the development of heart disease, hypertension, and diabetes. Depression often follows, further compromising the patient's quality of life. Moreover, the overall poor health of these individuals makes them less-than-optimal candidates for potential surgical interventions such as joint replacement.

Advocating for change
The MIL's mission is to dramatically decrease racial and ethnic disparity in musculoskeletal health by promoting mobility to improve the quality of life of all women, particularly African-American and Hispanic and Latino women. The 2016 MIL Caucus was held on Nov. 10–11, with its highest attendance to date. The 2-day event highlighted activities that identify, test, and deliver programs that make measureable progress on critical factors driving musculoskeletal disparities. Patient stories, similar to those on the AAOS A Nation in Motion website, illustrated how lack of movement leads to progressive obesity, knee OA, and the development of comorbid conditions.

Discussions and workshops focused on the strategies, tactics, and accomplishments of the MIL's multidisciplinary coalition of orthopaedic surgeons, primary care physicians, nurses, community and religious leaders, and policymakers. Topics such as health literacy, cultural competence, and unconscious bias were also addressed.

The orthopaedic surgeon's role
The Latino population is the fastest growing population in the United States. By 2034, non-Hispanic Caucasians will no longer comprise the majority of the U.S. population. As orthopaedic surgeons, we must prepare for this increased diversity in our patients. Treatments will have to be tailored to the disproportionate disease burden and take into account comorbidities of high-risk orthopaedic patients.

Obesity is associated with poor nutritional status, which may increase the risk of wound healing problems, surgical site infections, and diabetes. In 2015, the AAOS released a position statement, "The Impact of Obesity on Bone and Joint Health," developed by the AAOS Communications Cabinet. It states, "The AAOS believes that orthopaedic surgeons and patients should maintain an open dialogue about the detrimental effects of obesity on musculoskeletal health, and the increased risks of obesity on orthopaedic pre- and postsurgical complications and inferior outcomes."

As orthopaedic surgeons, we have the opportunity to play a valuable role in breaking the vicious cycle of obesity, immobility, and OA. We must have conversations with patients about lifestyle modifications and weight control when developing their treatment plans.

Laura M. Bruse, MD, chairs the AAOS Women's Health Issues Advisory Board and is a past-president of the Ruth Jackson Orthopaedic Society (RJOS). Alexandra E. Page, MD, chairs the AAOS Health Care Systems Committee and is a member of the RJOS board of directors.

MIL's orthopaedic surgeon leaders
Since its inception in 2010, the MIL Caucus has been chaired by Mary I. O'Connor, MD. Long-standing steering committee members include Ramon L. Jimenez, MD; Michael L. Parks, MD; James E. Wood Jr, MD; Ronald W. Baker, MD; Thomas Green, MD, Melvyn A. Harrington, MD; Tamara N. Huff, MD; Randall C. Morgan Jr, MD, MBA; Charles Nelson, MD; William A. J. Ross Jr, MD; Erick Santos, MD, and Augustus A. White III, MD.

At the 2016 MIL Caucus, AAOS members presented two posters: "Arthritis, Obesity, and Mobility: Are Females at Greater Risk?" (Laura M. Bruse, MD), and "Females, Knee Arthritis, and Joint Replacement Surgery: Do Orthopaedic Surgeons Consider a Patient's Sex as a Factor when Treating Patients?" (Cordelia W. Carter, MD; Caroline Hu, BS; Dr. Bruse; and Elizabeth G. Matzkin, MD).

References:

1. Wright NC, Kershner Riggs G, Lisse J, et al: Self-reported osteoarthritis, ethnicity, body mass index, and other associated risk factors in postmenopausal women: Results from the women's health initiative. J Am Geriatr Soc 2008;56(9):1736–1743.
2. U.S. Department of Health and Human Services: The Surgeon General's Vision For A Healthy and Fit Nation 2010.
3. Ogden CL, Carroll MD, Kit BK, Flegal KM: Prevalence of childhood and adult obesity in the United States, 2011–2012. JAMA 2014;311(8):806–814.
4. Movement Is Life: A Catalyst for Change.
5. Lynch CS, Chang JC, Ford AF, Ibrahim SA: Obese African-American women's perspectives on weight loss and bariatric surgery. J Gen Intern Med 2007;22(7):908–914.
6. Movement is Life Caucus: Welcome. Zimmer Biomet, Inc. Accessed August 24, 2015.
7. Start Moving Start Living: Website. http://startmovingstartliving.com/
8. AAOS Position Statement: The Impact of Obesity on Bone and Joint Health. Available at
9. Additional AAOS resources on culturally competent care