An Australian-led international collaboration has developed a roadmap to tackle the growing burden of osteoarthritis.
Australian researchers are leading international calls for an overhaul of osteoarthritis prevention and care, warning that health systems are failing to address one of the fastest-growing causes of disability.
The Curtin University-led team, which brought together 22 experts from 18 countries, has published a global health policy roadmap in The Lancet, saying osteoarthritis must be recognised as a major chronic disease and integrated into existing primary care and chronic disease services.
The roadmap, co-created by a multidisciplinary group including people with lived experience, warned that osteoarthritis remained largely invisible in national health policies despite affecting approximately 600 million people worldwide, with cases projected to approach one billion by 2050.
Lead author Professor Andrew Briggs, from Curtin University’s School of Allied Health, said health systems were poorly equipped to manage the growing burden, particularly in low- and middle-income countries.
“Osteoarthritis faces an image problem – it’s perceived and dismissed in communities as an unavoidable part of ageing with limited management options, it is not integrated into service models for chronic diseases, and remains largely invisible in national health policies,” Professor Briggs said.
“The scale of the burden of osteoarthritis demands a health policy response that recognises and measures the burden, integrates osteoarthritis care with other conditions, and targets prevention through excess body weight and joint injury control measures.”
The roadmap drew on international evidence to propose three strategic priorities:
- Recognise and respond to osteoarthritis through national data on its burden and cost and by writing musculoskeletal health into national policy;
- Scale up high-quality, affordable, person-centred care, including by integrating osteoarthritis into primary and chronic disease care and changing how the condition is talked about; and
- Slow its growth by targeting excess body weight and joint injury, including workplace and sport-related injuries.
The authors said the roadmap was intended to guide policymakers, health service managers, clinicians, and civil society organisations, with recommendations adaptable to different healthcare systems and economic settings.
They argued that osteoarthritis was frequently excluded from national non-communicable disease policies despite sharing risk factors with cardiovascular disease, diabetes, and other chronic conditions.
The paper also highlighted the limitations of international health targets that prioritised premature mortality while largely overlooking conditions responsible for substantial disability.
Australian co-senior author and rheumatologist Professor Lyn March, from the Kolling Institute and Global Alliance for Musculoskeletal Health, said the disability burden attributable to osteoarthritis had increased by 65% between 1990 and 2023.
That represented one of the largest increases among more than 350 conditions tracked by the Global Burden of Disease study.
“We need health systems to recognise osteoarthritis as a major chronic disease,” Professor March said.
“This means efforts in measuring the burden and communicating that burden to policy makers so that care models can be scaled up, allowing people to access evidence-based care that is affordable and appropriate for their individual needs, irrespective of where they live.”
The paper reported a global age-standardised osteoarthritis prevalence of 6909 cases per 100,000 people in 2023, based on Global Burden of Disease modelling covering 204 countries.
However, country-level data were available from only 42 countries, highlighting the limitations of existing surveillance systems.
The authors warned that the future burden would be disproportionately concentrated in low- and middle-income countries, with the number of people developing potentially preventable osteoarthritis projected to increase by up to 200% over the next three decades in some disadvantaged regions.
They also identified substantial gaps between recommended osteoarthritis management and the care patients receive.
In Australia, the CareTrack study found that only 43% of osteoarthritis care encounters met best-practice standards in 2009-10.
The paper also cited Australian general practice data involving 6565 GPs and 9196 patient encounters over an 11-year period, which found that first-line non-pharmacological management remained underused.
Only 23% of encounters involved lifestyle management, while imaging was used in 25%, medications in 74%, opioids in 15%, and surgical referrals in 13%.
The authors said these findings illustrated the persistent evidence-practice gap and the need to strengthen primary care delivery of guideline-recommended treatment.
Related
Co-senior author and fellow rheumatologist Professor David Hunter, from the University of Sydney, said there was an opportunity to shift osteoarthritis management away from low-value interventions and towards prevention, early management, and strategies that helped patients maintain function.
“This starts with reframing how people think about and respond to osteoarthritis,” Professor Huner said.
“Descriptions like ‘bone on bone’ or ‘wear and tear’ are outdated and often drive disengagement in care.
“Instead, reframing osteoarthritis symptoms as not inevitably progressive and modifiable can better support people to participate in their care.
“Although there are currently no disease-modifying drugs for osteoarthritis, we do know there are effective ways to help people manage osteoarthritis, but too many people are still receiving care that does not reflect the best available evidence.”
The roadmap recommended replacing language that presents osteoarthritis as inevitable or relentlessly progressive with messaging that encouraged patients to remain active and participate in evidence-based management.
It also called for a reduction in the use of interventions that lacked evidence of benefit or carried unnecessary risks, including opioids, knee arthroscopy, and injections such as hyaluronic acid and platelet-rich plasma.
Instead, the authors advocated greater access to exercise, education, weight management, and other non-pharmacological interventions, delivered through integrated primary and community care services.
They noted that osteoarthritis frequently coexisted with other chronic diseases, making integrated care particularly important.
A meta-analysis cited in the paper, involving more than 1.6 million participants across 16 countries, found that 67% of people with osteoarthritis had at least one other chronic condition, compared with 56% of those without osteoarthritis.
Almost one-quarter of people with osteoarthritis had three or more chronic conditions.
The authors argued that incorporating osteoarthritis into existing chronic disease management could improve health outcomes across multiple conditions while making care more accessible and cost-effective.
Prevention was another major focus of the Australian-led roadmap.
The authors identified excess body weight and joint injury as two of the most important modifiable risk factors for knee osteoarthritis, citing evidence that together they accounted for 14% of the risk of incident radiographic knee osteoarthritis.
They also reported estimates attributing 73 million osteoarthritis cases and close to AUD$50 billion in global healthcare costs to high BMI in 2019.
However, the paper acknowledged that although observational and modelling evidence supported weight control as a potential primary prevention strategy, trials directly testing whether weight management prevents osteoarthritis had not yet been completed.
Professor Briggs said preventing joint injuries, particularly anterior cruciate ligament injuries among young Australians, offered another opportunity to reduce future disease burden.
“Supporting healthy weight, preventing joint injuries in young people, and improving access to evidence-based care could make a real difference to the number of people living with osteoarthritis in the future,” he said.
The roadmap also recommended occupational injury prevention programs and collaboration across disease groups to address shared risk factors.
The economic burden provided another reason for governments to act, with the paper reporting that osteoarthritis accounted for approximately 1-2.5% of GDP in countries with established market economies.
The authors cited modelling estimating the global economic burden of osteoarthritis at almost AUD$430 billion in 2021, although they cautioned that the assumptions underpinning that estimate might not apply consistently across countries.
Professor George Milne, from the University of Western Australia’s School of Physics, Mathematics and Software Engineering, who contributed lived experience to the collaboration, said osteoarthritis could have profound consequences for everyday activities and quality of life.
“Living with osteoarthritis changes more than just your joints. It can change what you do, where you go and how you think about your future,” he said.
“What I would want people to understand is that osteoarthritis is not just a normal part of getting older that you should have to accept. People living with it need to feel heard, supported and confident that there are things they can do to manage their condition.”
Arthritis Australia CEO Louise Hardy said the roadmap reinforced the importance of giving patients better information and access to appropriate care.
“For too long, people living with osteoarthritis have been told to simply put up with the pain or accept that their condition is an unavoidable part of ageing,” she said.
Professor Briggs said osteoarthritis had become “hidden in plain sight” despite its growing impact on individuals, health systems, and economies.
“That mindset needs to change if we’re serious about tackling a condition that is affecting hundreds of millions of people and is on track to affect almost one billion by 2050.”
