Escalating Burden of Osteoarthritis Among Asian Women: Regional Trends, BMI-Attributable Disability, and Projections to 2050

Abstract

Background Osteoarthritis (OA) imposes a substantial and growing burden on women in Asia, yet comprehensive sex-specific and subregional analyses that incorporate causal inference and long-term forecasting remain limited. Objective This study quantified the burden of OA among Asian women from 1990 to 2023, characterized spatiotemporal patterns, projected trends to 2050, and evaluated the causal role of high body mass index (BMI). Methods Using Global Burden of Disease 2023 data, we extracted age-standardized incidence (ASIR), prevalence, and disability-adjusted life-year rates for women across Asian regions and countries. Temporal trends were assessed with estimated annual percentage change and joinpoint regression. Future burden was forecasted using Bayesian age-period-cohort (BAPC) models and exponential smoothing (ETS) models. The proportion of OA disability attributable to high BMI was calculated. Two-sample Mendelian randomization (MR) used sex-combined East Asian BMI and mixed-ancestry OA genome-wide association study (GWAS) data. Results In 2023, female ASIR was highest in East Asia (658.85 per 100,000) and Central Asia (613.07 per 100,000), while other Asian subregions were below the global female ASIR. Age-specific incidence peaked at 50–59 age group across all sub-regions. Asian regions showed faster long-term increases than the global average, although most exhibited deceleration after 2020. Projections indicate that by 2050, the ASIR of OA in females will decline across all regions. The high BMI attributable fraction of OA disability rose markedly, reaching 29.0% in Western Asia. The reported multiplicative random-effects inverse-variance-weighted (IVW) MR estimate was an odds ratio (OR) of 1.21 (95% CI, 1.14–1.28) per standardized unit of genetically predicted BMI. Conclusions Asian women experience a high, heterogeneous, and escalating OA burden with a significant peak occurring in the 50–59 age group. High BMI is a potentially modifiable causal risk factor. Region- and sex-specific prevention strategies focused on weight management and joint health for the 50–59 age group are urgently required to mitigate projected incidence by 2050.