osteoarthritis in canada: stats, impact and resources
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osteoarthritis pain usually affects more than one joint. the most common joint site reported is the knee followed by the hand, back and hip.
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the pain, stiffness and swelling of osteoarthritis is considered an older person’s disease – something that happens to your joints with age that you just have to accept and carry on. but that perception is changing as the number of younger people with the diagnosis is growing, along with awareness that staying active and maintaining a healthy weight can play a significant role in prevention.
osteoarthritis is the most common form of arthritis. it happens when the protective cartilage that cushions the ends of your bones wears down, damaging your joints and getting worse over time. described as a chronic degenerative disease, the condition can affect any joint but most often impacts joints in your hands, hips, knees and spine that can change your gait and posture and lead to mobility issues and chronic pain.
as for the why behind osteoarthritis, research is filling in some of the unknowns. obesity puts people at high risk because the extra weight puts added stress on weight-bearing joints like your hips and knees, according to the mayo clinic. fat tissue produces proteins that can cause inflammation in and around your joints. also, repeated stress on joints from sports and joint injuries from sports or an accident, even those that happened years ago and healed, are factors for increased risk. some people inherit a genetic predisposition or are born with bone deformities or defective cartilage.
as the annals of translational medicine notes, certain metabolic diseases like diabetes and hypertension can put people at higher risk because they share many of the same mechanisms, such as inflammatory aging and oxidative stress that can damage bone and cartilage.
while medications can help control symptoms and surgery may be an option, adopting lifestyle changes like getting regular exercise, eating healthy and weight management have shifted the emphasis to prevention. september is arthritis awareness month, with arthritis society canada calling the disease a “serious urgent health crisis” that “devastates lives, steals moments, employment and mobility.”
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osteoarthritis stats in canada
osteoarthritis affects more than four million canadians, or about one in every seven adults, which is more than all other types of arthritis combined, according to arthritis society canada. about 15 per cent of canadians age 20-plus have osteoarthritis.
the charity released its burden of osteoarthritis in canada report in 2021 to look at the impact of osteoarthritis on canada and patients and their families. researchers pulled together data from multiple canadian population-based surveys.
the prevalence of osteoarthritis, or oa, rises with age, however, nearly one-third of people report being diagnosed before age 45. the average age of diagnosis is 50, but symptoms may have started earlier. and 52 per cent of people who have oa are younger than 65.
“this isn’t an old person’s disease, and when you bring up the changing of the demographic, we now know that about half of all new cases of osteoarthritis, certain people under the age of 55 and about one-quarter of all the people living with osteoarthritis worldwide are also under 55, based on some new research that’s come out in the past year using global burden of disease data. these are working age individuals,” says dr. lauren king, rheumatologist and clinician scientist at st. michael’s hospital in toronto and assistant professor at the university of toronto.
“these are individuals who still have kids who may be at home or are going to university. these are not people who we think of as older adults or the elderly affected by osteoarthritis. this is a huge part of the lifespan where people are affected by oa,” she says. “i think that’s such a critical thing to be aware of.”
oa is more common in women than men:
- 18 per cent of canadian women age 20-plus have oa
- 11 per cent of canadian men age 20-plus have oa
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the disease appears to favour women, particularly after menopause, with theories ranging from weight gain, anatomy of wider hips that can place a greater load on the outer portion of the knee, changing hormones and sports injuries like anterior cruciate ligament tears (common in soccer players) that are linked to higher risk of oa, notes the hospital for special surgery.
king, whose research focus is osteoarthritis, says there are challenges with prevalence estimates because so many people with oa don’t go to a physician for help, mainly because it doesn’t set off alarm bells for people in the same way that cancer, cardiovascular disease and diabetes do.
there’s the perception that you should just “deal with it,” king adds, and not complain about your joints. people often don’t seek care until it’s quite late and symptoms are severe. she says this happens “even though everyone keeps enumerating to me all of the things that it means they can’t do anymore, like ‘i’ve had to change this sport. i no longer go out and do this or see friends’ and it really tells me what a huge impact it has on people, their lives, their family members, their ability to work, their social participation.”
the majority of people with oa report that it impacts their lives in some way. regardless of age, people with oa experience pain, disability and other life-changing problems:
- more than 90 per cent have joint pain, stiffness or aching. the proportion of people reporting severe and frequent joint pain varies little across age groups
- oa pain usually affects more than one joint. the most common joint site reported is the knee followed by the hand, back and hip
- nearly two thirds (64 per cent) of people with oa say it limits them in getting a good night’s sleep, especially in women. women are also more likely to report severe and frequent fatigue
- more than three-quarters (77 per cent) of people report it has required them to reduce at least some of their day-to-day activities
- nearly half (42 per cent) of the working-age population with oa (20 to 64 years old) reports not being in the labour force or in school, compared to less than one fifth (19 per cent) of the general population. further, oa may require people to change the number of hours they work, the type of work, the way they carry out tasks, or to stop working altogether
- people with oa are more than twice as likely to say their general health isn’t good, compared to the general population
- more than two thirds (70 per cent) of people report having at least one other chronic condition, compared to 40 per cent among the general population. people with oa are also more likely to say their mental health isn’t good, compared to the general population. they are more likely to have been diagnosed with a mood or anxiety disorder in addition to oa.
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as king points out, the overall prevalence is going up because of our aging population, “but that’s one part of the story because we have now obesity, an epidemic of obesity, and people being overweight and having obesity at an early age. so that’s contributing to the early development of osteoarthritis. people are carrying extra weight starting when they’re children and teenagers.”
the prevalence of oa and its associated burden have increased in canada year-over-year and are projected to continue increasing because of population aging and rising rates of obesity, a leading risk factor for osteoarthritis, a study from the canadian primary care sentinel surveillance network found.
and self-reported weight data gathered from the 2022 canadian community health survey suggest that almost one in three canadians aged 18 and older had obesity in 2022, which is up from one in five people in 2003.
as the arthritis foundation notes, being overweight or having obesity makes the effects of oa more disabling. obese people with oa take more medications, walk more slowly, are less physically active and are at higher risk of becoming disabled. hand oa is approximately twice as common among people with obesity, and for a person who has obesity, once you have oa in one joint, you will likely develop it elsewhere. for example, people with obesity and oa in one knee are above five times more likely to develop oa in the other knee.
damage related to having obesity in oa is not limited to joints. the same fat-related inflammatory proteins that contribute to the development of oa are involved in heart disease, diabetes and depression.
here’s the catch: one of the main prevention strategies for heart and blood sugar problems is regular exercise, but that can be a challenge for people with painful oa and obesity who struggle to get enough physical activity. inflammation and lack of exercise are a double whammy, creating a cycle of weight gain, disability, depression and poor health. for those who can lose even 10 per cent of their body weight can cut arthritis pain in half and can also slow disease progression.
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impact of osteoarthritis on canadian society
the cost burden for individuals with oa and healthcare services is already significant as the leading cause of disability in canada. people lose employment income and at the same time spend on home renovations for accessibility, homecare services and rehab therapy, for example.
health science researchers worked with statistics canada to project the substantial cost burden of the disease in a 2015 report published in osteoarthritis and cartilage. they looked at costs associated with pharmacological and non-pharmacological treatments like physiotherapy, joint replacement surgery, as well as use of hospital resources and management of complications from treatment.
the authors note that direct costs are significant compared to other musculoskeletal diseases because of the high prevalence of disease and high use of associated resources. “a patient with oa, even in its early stages, consumes healthcare resources at almost double the rate of the general population without oa. at the same time, oa’s burden is escalating at a fast rate due to the considerable rise in obesity and population aging. “
their analysis revealed that from 2010 to 2031, the total direct cost will increase from $2.9 billion to $7.6 billion, an almost 2.6-fold increase. from the highest to lowest, the costs that will constitute the total direct cost in 2031 are hospitalization cost ($2.9 billion), outpatient services ($1.2 billion), alternative care and out-of-pocket cost categories ($1.2 billion), drugs ($1 billion), rehabilitation ($0.7 billion) and side-effect of drugs ($0.6 billion).
almost 95 per cent of the hospitalization cost was due to hip and knee joint replacement surgeries. while these procedures can be highly cost-effective for those with severe oa, studies have shown an increasing rate of the surgeries for people in less advanced stages who may not benefit because of higher failure rates and lower satisfaction.
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king is working with colleagues and patients to change the perception of surgery as the go-to solution, and promoting first-line treatments like exercise, physiotherapy and healthy eating for weight management that can relieve symptoms.
“there are people who feel like they surgery is the only answer and we know from research studies that even people who are on the waiting list for surgery when they’re offered first-line treatments such as exercise education about their arthritis and given some time to work with first-line options, they can feel a whole lot better,” she explains. “many of them will say, ‘you know what, i don’t need surgery.”
she also points out that while 80 per cent of people will have an excellent outcome after surgery, that still leaves 20 per cent who don’t fare as well.
“we really do need to make sure that we’re offering those first-line treatments to everyone,” she says.
king is about to launch a clinical trial in partnership with arthritis society canada to help people with type 2 diabetes and difficulty walking because of knee osteoarthritis – individuals who are at high risk of poor health outcomes and complications of their diabetes. participants will work one-on-one with physio and occupational therapists who have additional training in arthritis care.
“we’re going to see if by the comprehensive treatment of the osteoarthritis, we can work on setting goals around physical activity. if we can get people more active than the risk of cardiovascular disease likely comes down and the risk of diabetes complications likely goes down.”
resources and support for osteoarthritis in canada
the main associations representing osteoarthritis are:
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finding support, information and connecting with peers and professionals can improve health outcomes for people with osteoarthritis and their families. this is important for everyone, but younger people with oa have rising mental health concerns and life dissatisfaction. as the burden of osteoarthritis in canada report revealed:
- people with oa are more likely to have a body mass index (bmi) indicative of overweight or obesity compared to the general population. a pronounced difference is seen in young adults under 45
- while most people with oa have additional chronic conditions across all age groups, this is particularly striking in younger adults with oa compared to their peers in the general population
- younger adults with oa are the most likely to report life dissatisfaction compared to older adults with oa or the general population.
part of the solution is creating more awareness about osteoarthritis and its impact.
“right away with arthritis, people’s perception is it’s destined to get worse, and people fear disability,” says king. “but in fact, we know that for people with osteoarthritis, their symptoms may fluctuate over time, but for the most part remain quite stable. there are some who get worse and there are some who may feel better over time.”
early intervention, as with most disease, is important. king is also part of a global initiative to develop classification criteria for healthcare professionals to assess people with early knee symptoms to determine if they have oa compared to other conditions. the aim is for patients to be identified early and participate in clinical trials for the development of new treatments.
she’s hopeful about advances to come and values patient-focused care.
“it’s not as disease where there’s nothing that can be done when you get people set up with the right team around them, whether that’s family members for social support or a clinician to work with for therapeutic options, there are things that we can do to help people live their best life with arthritis and do the things that they want to do.”
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