Musculoskeletal research is entering a more urgent period as funding disruptions ripple across the U.S. research ecosystem, even as MSK conditions remain one of the largest and most costly sources of disease burden nationwide, according to Lee Grossman, CEO of the Orthopaedic Research and Education Foundation.
“It’s one of my favorite topics, but it’s been the dominant topic of 2025, for OREF, and certainly will be for the foreseeable future,” Mr. Grossman told Becker’s.
He said MSK disease plays an outsized role in disability, chronic illness and healthcare spending, but continues to receive disproportionately low research investment compared to other major disease areas. In his view, that chronic underfunding is slowing progress and contributing to siloed science and limited collaboration across the field.
“There’s always been this incredible disparity between the burden of disease that MSK causes,” he said. “It’s about a trillion dollars a year. It’s 5% of our GDP.”
A crisis built on a long-standing disparity
Mr. Grossman said musculoskeletal disease is often treated as an inevitable part of aging rather than a public health priority, even though it drives downstream complications that affect nearly every area of medicine. Reduced mobility, he said, is frequently a precursor to obesity, diabetes, cardiovascular disease and depression.
That widespread prevalence, he added, has not translated into research support. Mr. Grossman said MSK remains among the least funded major disease areas, and that the imbalance has persisted for decades.
OREF was founded in 1955 by orthopedic leaders who believed clinical research needed a dedicated funding engine independent of commercial influence. Today, the organization funds a broad range of MSK research priorities, but Mr. Grossman said the broader funding environment has made the gap harder to ignore.
“Last year, with the current funding and the disruption that was happening on all levels of research funding, what was always a bad situation really became a crisis,” he said.
Taking the lead as funding disruptions accelerate
OREF’s independence has allowed it to continue funding musculoskeletal research even as uncertainty grows across federal and institutional budgets, Mr. Grossman said. At the same time, he emphasized that the organization’s work is rooted in collaboration across the MSK ecosystem.
As funding pressures intensified, Mr. Grossman said OREF reached out to more than 60 peer groups to encourage a coordinated response. While many organizations were interested in partnering, he said no one was positioned to organize the effort at scale.
“It was very important to our board that somebody does that,” he said.
To move the conversation forward, OREF convened a summit in Chicago in December that brought together professional societies, patient advocacy organizations, industry stakeholders and leaders from the National Institute of Arthritis and Musculoskeletal and Skin Diseases, who underscored the urgency of the issue.
Why awareness may matter more than any single policy change
Mr. Grossman said elevating MSK research will take more than incremental funding increases or isolated initiatives. In his view, it will require a broader shift in how musculoskeletal conditions are perceived across healthcare and policy circles.
“It starts with awareness and not accepting,” he said.
MSK conditions are often treated as nonemergent and routine, even though they shape how patients age, work and maintain independence. Greater attention, he said, would also increase pressure on policymakers, legislators and regulators to address research funding.
Mr. Grossman compared the current moment in MSK research to his earlier work in nonprofit advocacy. Before joining OREF, he served as president and CEO of the Autism Society of America for 11 years and said transformational change often follows sustained public attention.
“When I first became president of the Autism Society in 2000, autism was considered a rare children’s disorder,” he said.
He added that professional associations have competing priorities, and research may not always rise to the top of member concerns.
“When you ask them what’s most important to them, research kind of might make the top five,” he said.
The real-world consequences of chronic underinvestment
The most visible consequences of limited MSK research are not abstract or long-term. They show up in outcomes, mortality risk and the cost of care for common, high-volume conditions, Mr. Grossman said.
Osteoporosis, he added, remains one of the clearest examples. He pointed to fracture-related mortality in older adults as an issue that should command far more national attention.
“If a person over 65 fractures their femur or their shoulder as a result of osteoporosis, their mortality rate of two years is higher than most cancers,” he said.
He said the same is true for postoperative joint infection, which can carry serious mortality risk. “The mortality rate of that, in a lot of cases, is 12%,” he said.
Osteoarthritis, he added, illustrates how the system absorbs massive cost without solving the root problem. “We spend $350 billion a year treating osteoarthritis,” he said.
By the time many patients reach surgery, they have already cycled through primary care, rheumatology, physical therapy and multiple appointments, generating cost, time and prolonged pain.
“Once the patient gets to the operating room, they’ve been to their [primary care physician], maybe to a rheumatologist, they’ve been through physical therapy, they’ve been to an orthopedic surgeon and back into physical therapy,” he said.
Mr. Grossman said better research investment could accelerate progress in prevention, mitigation and earlier intervention, potentially delaying or avoiding surgery in some cases.
“And perhaps, in some cases, even find a cure,” he said.
The silo effect and why collaboration breaks down
Limited research dollars can prevent investigators from expanding projects or connecting work across institutions, leading to fragmentation even among high-performing teams.
“With this pittance of research dollars that are available, it creates silos,” Mr. Grossman said.
He said he has seen that dynamic firsthand in emerging areas like biologics, where researchers across institutions can unknowingly pursue overlapping work without coordination. In his view, the lack of collaboration slows progress and makes breakthroughs harder to scale.
Mr. Grossman also cautioned that heavy reliance on industry-funded research can raise concerns about independence, even when the work itself is valuable.
“I’m not against industry money,” he said. “But when the majority of the research is done that way, it comes across as being unbiased, not independent.”
A national priority beyond orthopedics
Mr. Grossman said the push to elevate MSK research should be framed as a national healthcare issue, not simply a professional priority within orthopedics. In his view, improving overall healthcare outcomes will require treating musculoskeletal health as foundational and investing in it accordingly.
“Our nation’s healthcare will not improve unless MSK research becomes a priority,” he said.
He cited the experience of service members as a clear example of what is at stake, saying that 70% leave the military with a chronic musculoskeletal condition, and that MSK injury is the top reason for medical discharge.
For Mr. Grossman, those numbers reflect why MSK research should be treated as a national health priority.
