Indian Journal of Orthopaedics

: 2006  |  Volume : 40  |  Issue : 3  |  Page : 200--201

Bone and Joint Decade (BJD) 2000 - 2010

Satish Goyal 
 Consulting Orthopaedic Surgeon, Jalna, India

Correspondence Address:
Satish Goyal
Consulting Orthopaedic Surgeon, Jalna

How to cite this article:
Goyal S. Bone and Joint Decade (BJD) 2000 - 2010.Indian J Orthop 2006;40:200-201

How to cite this URL:
Goyal S. Bone and Joint Decade (BJD) 2000 - 2010. Indian J Orthop [serial online] 2006 [cited 2020 Jan 19 ];40:200-201
Available from:

Full Text


The launch of the WHO supported BJD 2000 - 2010 is culmination of the efforts put in by numerous experts and visionaries to curb the growing but under recognized menace of the rheumatic and musculoskeletal diseases (RMSD). These disorders inclusive of their traumatic disorders, inclusive of their traumatic aetiology, predominantly contribute to the global morbidity and impaired quality of life (QOL).

After having effectively reduced mortality through worldwide control of numerous communicable infectious diseases, the WHO has now begun to increasingly focus on the non communicable diseases. The cardiac disorders and cancers have preoccupied the health planners for reasons obviously connected to human longevity. But having realized that reduction in mortality must be matched with improved QOL, the WHO has now declared support to one of the most ambitious global program, the WHO-BJD 2000 - 2010.

Initiated by the medical faculty of the Swedish University at Laud, the inaugural consensus meeting was held in April 1998 to set up an international BJD International steering group/ committee (ISC). Prof Lars Lidgren, a distinguished Orthopaedic surgeon from Sweden, is the chairman of the ISC.

United Nationals Secretary General Kofi Annan has officially welcomed the WHO BJD initiative and appealed to the World Community while stating that there are effective ways to prevent or treat these disabling conditions. But we must act on them (RMSD) now.

The BJD is actually an umbrella organization of over 750 patient and professional organizations in the world concerned with bone and joint disorders. It is endorsed by the International League of Associations for Rhematology (ILAR) and its components in Asia Pacific (APLAR), and rest of the World. Numerous national organizations, including the Indian Orthopaedic Association and the Indian Rheumatology Association, have been listed amongst the organizations supporting the BJD movement. Over 17 Governments have endorsed the WHO BJD project. The Governemt of India has endorsed by " Ministry of Health & Family Welfare, Governemt of India" leter No- s. 11025 / 30/ 2000 - MH/IH Dated 18 th April 2001.

The BJD has decided to predominantly target the five disorders amongst the many that constitute RMSD. These are rheumatoid arthritis (RA), osteoarthritis (OA), osteoporosis, spinal disorders and severe limb trauma.

Background information

Arthritis accounts for over 50% of all chronic conditions in persons aged 60 years and above. In over 25% of the latter community, OA of the knees and spine causes dominant pain and disability. Back pain one of the commonest cause of seeking medical consultation, is the second leading cause of sick leave from work. 10 - 20% of population visit the doctor for all kinds of soft tissue rheumatism and trauma related musculo-skeletal disorders and the latter are often related to occupational overuse & / misuse.

There are about 12 million cases of rheumatic heart disease (RHD) reported annually all over the world. It must be added that RHD is caused by rheumatic fever arthritis, which if diagnosed early and treated appropriately is curable- Rheumatic fever, a preventable disorder, continues to be a major courage of young population in the developing countries.

It is anticipated that based on current trends, road traffic accidents (RTA), already in epidemic proportions would complete with cardiac & vascular disorders and cancers to be amongst the 3 leading causes of human mortality and morbidity by 2020. Almost, 700, 000 people are killed globally by RTA, which are estimated to be the tenth leading cause of death (World Health Report, 1999). 25% of the health expenditure in the developing countries is expected to be spent on trauma related care by the year 2010. fragility fractures due to osteoporosis, have doubled in the last decade, and it is estimated that over 40% of all women over the age of 50 years (as women are more likely to suffer from osteoporosis after menopause) will suffer from from an osteoporotic fracture.

Prof. Lars Lidgren, in his inaugural BJD address in Geneva in Jan 2000, stated that the number of hip fractures will further rise from 1.7 million in 1990 to 6.3 million by 2050 unless aggressive preventive programs are started. During the same inaugural meet, Dr. Gro Harlem Brudtland, Director General, WHO stated that "the increased life expectancy recorded in recent decades, together with changes in lifestyle and diet have lead to a rise in non communicable diseases (NCD), also in the developing countries. NCD now cause nearly 40% of all deaths in the developing countries, where they affect younger people than in industrialized countries. "The latter highlights the significance of NCD and programs like the BJD for the World.

The Indian Scenario & Data

Prof TK Shanmugasundaram (Chennai, Orthopaedic surgeon), Dr. Arvind Chopra (Pune, rheumatologist), Dr. A Mittal (Delhi, Endocrinologist), and Prof D Mohan (IIT Delhi, Bioengineer and Safety Expert), were invited to participate in the inaugural BJD meet and workshop in Geneva in Jan 200. this workshop of about 70 experts from various disciplines focused on the existing global and regional data on RMSD and outlined the future strategy.

Considering the geography, diversity and the RMSD problems in the Indian subcontinent, the epidemiological data is rather sparse.

The data from ongoing WHO initiated Indian COPCORD (Community Oriented Program for Control of Rheumatic Diseases) project in village Bhigwan (Dist Pune) was listed in the BJD global data inventory. Dr. Arvind Chopra presented the results of the Bhigwan project. The project is an ongoing study since 1996 and is looking at several epidemiological clinical and immunogenetic issues in RMSD. It was recognized during the inaugural WHO BJD meeting of experts that the Bhigwan COPCORD was representative of the South East Asian I scenario and had amply demonstrated that (i) besides the 5 major RMSD entitles under focus, soft tissue rheumatism problems (STR) is the predominant problem in community. It was reported by almost 55% of the rural patients in Bhigwan. And thus STR needs inclusion in the BJd agenda (ii) the Bhigwan model was ideal for prospective studies of RA and other RMSD in the developing countries and this was adopted by the WHO workshop.

Prof. Shanmugasundaram presented statistics on spinal disorders including spinal injuries and tuberculosis based on his hospital experience in Madras. Dr. Mittal expressed his concern on the lack of technology did not allow precise diagnosis the disease was rampant. Osteoporosis was often associated with vitamin D deficiency. Prof. D Mohan, Incharge of a WHO collaborating centre on transportation injuries and prevention, cited his socio economic cultural data from village surveys carried out in North India, and further highlighted the aetiology and prevention of limb trauma. Besides road traffic accidents he also emphasized the need to curb agriculture related trauma in the developing countries.

The BJD Strategy

The key goal is summed up in its slogan "keep people moving"

(1) Raise awareness of the growing burden of RMSD on society: this will be done through translation of the epidemiological global burden of RMSD into financial costs. This will be further communicated to the national decision makers in different countries, who will then devise methods and means to reduce the RMSD burden to society by shifting indirect to direct health care costs.

(2) Promote prevention of RMSD and empower patients through education campaigns: The BJD national action networks (NAN), in close liaison with the national Government health authorities and agencies and the International BJD Steering Group will design public awareness and education campaigns. Patients must be empowered to participate in their own health care.

(3) Advance research in prevention diagnosis and treatment of RMSD, including rheumatic disorders. It is expected to triple the existing research funding during the decade.

(4) Improve diagnosis and treatment of RMSD: The specific goal would be to influence the medical schools and colleges to impart a better and practical training program, of at least 6 months to the undergraduates. The diagnostic and treatment skills of the GP need to be improved. Similar proposals will be made for other medical groups engaged in care of RMSD.

Finally, it is hoped that at the end of the current decade there will be 25% reduction in expected increase in joint destruction by arthritis, osteoporotic fractures, severely injured people and indirect health cost for spinal disorders. The BJD India-National Action Network (NAN Committee)

In close liaison with the ISC, a NAN committee for India has been proposed and accepted. The BJD India : NAN was officially inaugurated in Pune in November 2000. the Committee at present consists of Prof TK Shanmugasundaram (Chairman), Prof D Mohan (CO - Ordinator), Dr Arvind Chopra (Secretary), Dr A Mittal, Prof SS Babhulkar (President, IOA, Dr. Mahendranath (President Elect, IRA), Dr Satish Goyal (Consulting Orthopaedic Surgeon, Jalna), Mr PC Nahar (Mission Orthritis India, Pune), Col. (Dr) Anil K Sharma (Armed Forces Medical Services). The committee will expand in time to include representations from other national associations and organizations concerned with the issues of the BJD. NAN India hopes to accomplish the aims of the global BJD. A dialogue is ongoing with the government and other concerned national associations and agencies to promote the activities of the WHO - BJD in India.