Musculoskeletal health: Tackling a critical piece of the ageing puzzle

SINGAPORE - The ability to walk, work and live independently depends on a healthy musculoskeletal system. Functioning as the body’s engine, it turns energy into movement and underpins longevity and quality of life.

It is an integrated network of bones, muscles, joints, ligaments and tendons that work in synchrony to provide structural support and enable movement.

Musculoskeletal disorders affect more than a billion people globally, making them the leading cause of non-fatal disability worldwide.

In Singapore’s rapidly ageing society, conditions like osteoarthritis, osteoporosis and chronic low back pain create mounting burdens of disability and healthcare utilisation.

Beyond pain, loss of function and reduced quality of life, decreased mobility and loss of independence often increase the risks of metabolic diseases such as diabetes, poorer mental health like depression, and social isolation. 

Beyond the healthcare costs, there are significant and profound economic and societal impacts.

As Singapore is a small city-state devoid of natural resources, its people are its greatest asset. Work-related musculoskeletal diseases and other ergonomic problems are estimated to cost the economy $3.5 billion annually.

This comprises direct costs, including medical expenditures, and, more critically, indirect costs from lost productivity and absenteeism. 

Despite their massive burden and costs, musculoskeletal diseases often receive less recognition than other disease groups, such as cardiovascular or cancer, because they are not a major cause of mortality and are commonly viewed as an inevitable part of ageing.  

Not just part of getting older 

Many elderly people assume that the aches and pains they feel are just part of ageing. “Lao liao lah” or “old already” is a commonly heard phrase, reflecting the perception that normal “wear and tear” of the body has taken place. 

We must distinguish normal ageing – the gradual biological deterioration of muscle mass, joint cartilage and bone density – from musculoskeletal diseases like osteoarthritis and osteoporosis.

They are often seen as two sides of the same spectrum, but the “disease” side is usually associated with significant pain, loss of function and reduced quality of life.

There are also known risk factors that increase one’s chances of being on the “disease” side of the spectrum instead of just normal ageing. Many of these risk factors are modifiable, such as physical inactivity, obesity, repetitive injuries, psychosocial stress and poor sleep. 

Unfortunately, preventing musculoskeletal diseases is challenging for two key reasons.

First, many of these potentially modifiable risk factors accumulate silently over time. While each risk factor may seem minor on its own, together they can cause significant harm over time.

Second, early deterioration of muscles, joints and bones often goes unnoticed as the body adjusts to compensate for the damage. By the time symptoms appear, significant damage has likely already occurred. Communicating the risk is challenging when the threat seems far away, the benefits take time to appear and changing daily habits is hard.  

Taking a life-course approach 

These challenges are not unique to musculoskeletal conditions as many chronic diseases, such as diabetes and hypertension, face similar issues and challenges.

Unfortunately, musculoskeletal diseases have traditionally been managed through an episodic, reactive, disease-centric model that focuses on quick “fixes” like medication, injections and surgery. 

However, there has been a gradual shift globally. Musculoskeletal diseases are increasingly recognised as chronic conditions, requiring early prevention, lifestyle modification and long-term management because there is rarely a quick cure. 

A life-course approach to musculoskeletal health – not just disease – is thus essential. Interventions must begin early to build peak muscle and bone health, which is often reached around age 30 before gradually declining.

This is achieved through weight-bearing and resistance-training activities such as squats, push-ups and lunges, as well as adequate consumption of protein, calcium and vitamin D. Avoiding sedentary behaviour and early injury is also important. 

From midlife onwards, the focus shifts to maintaining function, preserving as much reserves as possible, and slowing deterioration.

Occupational exposures such as repetitive strain and prolonged sitting, as well as poor lifestyle choices like physical inactivity, poor nutrition, smoking, and excessive alcohol leading to obesity, can accelerate deterioration of the musculoskeletal system. 

In the later years, the natural decline in the system can be compounded by physical inactivity, other chronic diseases such as diabetes, and social isolation. Adequate strength and balance training in a supportive social environment can significantly slow the decline.

When musculoskeletal disease sets in, care often becomes resource-intensive and treatment such as surgery can be costly. As the saying goes: “An ounce of prevention is worth a pound of cure.”  

Singapore’s experience in tackling chronic diseases, such as the War on Diabetes focusing on nutrition, physical activity and early detection, provides a solid foundation. However, while these efforts have generally addressed the same broad lifestyle risk factors such as physical activity and nutrition, the emphasis on musculoskeletal health has been lacking.

Initiatives like the National Step Challenge focus on aerobic activity by increasing step counts, but good musculoskeletal health also requires additional resistance training and weight-bearing exercises. On the nutrition front, beyond reducing sugar and salt intake, there is a need for adequate protein consumption to support muscle growth – an often overlooked requirement in our predominantly carbohydrate-heavy diet.     

Towards a stronger, more mobile Singapore 

National strategies such as RIE2030 (Research, Innovation and Enterprise 2030) and recent major initiatives like Healthier SG and Age Well SG have placed strong emphasis on healthy ageing and longevity.

Central to these efforts is the narrowing of the gap between healthspan and lifespan, with musculoskeletal health identified as a critical enabler of independence, mobility and quality of life, particularly in later years.

In transforming the healthcare system, we must shift from a disease-based approach towards a more holistic, health-centred model.

This involves redesigning care pathways to emphasise early intervention, and integrating services across community, primary and specialist care.

A key effort is to incorporate musculoskeletal health indicators such as physical performance and body composition into routine health screenings. Simple measures like gait speed and grip strength have already been shown to be highly predictive of mortality and morbidity across a wide range of conditions, yet they remain under-used.

Targeted research and innovation investments can also accelerate the translation of discoveries from bench to bedside. With advancements in movement analytics, technology and artificial intelligence, precision diagnostics and targeted therapeutics for the musculoskeletal system are now within reach and can be made widely accessible.

However, true transformation of musculoskeletal health cannot be through healthcare alone. The 2023 National Mental Health and Well-Being Strategy demonstrates a whole-of-government strategy in tackling the growing mental health burden, a path that musculoskeletal health can follow.

From a young age, our education system should build musculoskeletal health literacy, incorporating movement and ergonomic principles to establish preventive habits that last a lifetime. Workplaces are another critical frontier, where comprehensive occupational health programmes, ergonomic work environments, and robust employee wellness initiatives can reduce absenteeism, improve productivity and enhance well-being. For seniors, community-based frailty and fall prevention programmes remain key.

Across every life stage and all of society, we must continue to spread the message that “Movement is Medicine”, creating a culture and mindset in which physical activity is essential for health.   

As Singapore enters super-aged society status in 2026, musculoskeletal diseases must no longer remain the “silent” epidemic. Behind every fall, every fracture and every chronic ache is a fast-growing burden that threatens longevity, mobility, independence and quality of life.

The time to act is now – to get all stakeholders moving in concert to prevent disability, extend active years, and keep our nation on its feet strong and well into the future.