Osteoarthritis imposes a substantial public health burden on postmenopausal women in China's aging population. This study assessed its temporal trends, anatomical distribution, and projected future burden.

Data were extracted from the Global Burden of Disease Study 2023 database for Chinese postmenopausal women aged 55 years and above from 1990 to 2023. Disease burden indicators including disability-adjusted life years (DALYs), incidence, and prevalence were analyzed across nine age groups and four anatomical sites (hand, hip, knee, and other). Average annual percentage changes (AAPCs) were calculated using log-linear regression models. Attribution analyses quantified the contribution of high body mass index (BMI) to hip and knee osteoarthritis burden. Autoregressive integrated moving average (ARIMA) models were employed to project disease burden through 2050.

Osteoarthritis Burden Overview Among Postmenopausal Women in China, 1990-2023

From 1990 to 2023, the absolute numbers of DALYs, incidence, and prevalence for osteoarthritis among postmenopausal women in China demonstrated substantial increases across all age groups. The comprehensive burden indicators stratified by age groups are presented in Table 1, displaying both absolute numbers and age-standardized rates with their corresponding AAPCs.

For DALYs, the absolute numbers increased dramatically across all age strata. In the 55-59 years age group, DALYs surged from 178,748.6 (95% UI: 85,691.2-385,946.8) in 1990 to 589,857.1 (95% UI: 280,698.7-1,284,796.6) in 2023, with an AAPC of 4.15% (95% CI: 3.73-4.57%). The age-standardized rate increased from 863.5 per 100,000 population to 994.1 per 100,000 population, with an AAPC of 0.76% (95% CI: 0.64-0.88%). Notably, the oldest age group (95+ years) exhibited the highest AAPC for absolute numbers at 9.29% (95% CI: 9.19-9.39%), with DALYs escalating from 684.5 (95% UI: 348.6-1,427.3) to 12,965.4 (95% UI: 6,588.4-26,951.0). However, the age-standardized rates across all age groups showed relatively modest increases, with AAPCs ranging from 0.67% to 0.82%.

Incidence patterns revealed similar upward trajectories. The 55-59 years age group experienced an increase from 365,328.0 (95% UI: 283,976.0-470,139.5) cases in 1990 to 1,194,511.1 (95% UI: 916,855.7-1,524,211.4) cases in 2023, with an AAPC of 4.16% (95% CI: 3.74-4.58%). The incidence rate rose from 1,764.8 to 2,013.2 per 100,000 population, with an AAPC of 0.77% (95% CI: 0.65-0.89%). The 95+ years age group again demonstrated the highest growth rate in absolute numbers (AAPC: 8.73%, 95% CI: 8.58-8.88%), though the age-standardized rate increases were more modest across all strata (AAPCs: 0.15-0.77%).

Prevalence data showed the most substantial absolute burden, with the 55-59 years age group increasing from 5,218,976.6 (95% UI: 4,405,069.4-6,059,559.6) in 1990 to 16,830,681.0 (95% UI: 14,279,222.9-19,623,088.1) in 2023, representing an AAPC of 4.06% (95% CI: 3.65-4.48%). The prevalence rate increased from 25,211.8 to 28,366.6 per 100,000 population, with an AAPC of 0.68% (95% CI: 0.56-0.79%). The temporal trends for absolute numbers and age-standardized rates are illustrated in Figure 1A and Figure 1B, respectively, demonstrating consistent upward trajectories across all indicators and age groups from 1990 to 2023.

Anatomical Site-Specific Burden: Subgroup Analysis

Subgroup analyses by anatomical sites revealed distinct burden patterns across different osteoarthritis subtypes. As shown in Figure 2A, DALYs rates stratified by anatomical location demonstrated that knee osteoarthritis consistently imposed the highest burden across all age groups throughout the study period, with rates ranging from approximately 650 to 950 per 100,000 population. Hand osteoarthritis exhibited the second highest burden, with rates progressively increasing with age, reaching over 500 per 100,000 population in the oldest age groups. Hip osteoarthritis demonstrated the lowest burden among the major subtypes, with rates generally below 100 per 100,000 population across all age strata.

Incidence rate trends by anatomical site are depicted in Figure 2B, revealing that hand osteoarthritis showed the highest incidence rates, ranging from approximately 200 to 550 per 100,000 population across different age groups. Knee osteoarthritis incidence rates demonstrated considerable fluctuation over the study period, particularly in younger age groups, with rates varying between 500 and 1,500 per 100,000 population. Hip osteoarthritis maintained relatively stable incidence rates, generally below 150 per 100,000 population.

Prevalence rate patterns are illustrated in Figure 2C, with knee osteoarthritis exhibiting the highest prevalence rates, exceeding 25,000 per 100,000 population in most age groups. Hand osteoarthritis prevalence showed progressive increases with age, reaching approximately 20,000 per 100,000 population in the oldest age groups. Hip osteoarthritis maintained the lowest prevalence rates among major subtypes, typically below 3,000 per 100,000 population across all age strata.

High BMI Attribution Analysis for Hip and Knee Osteoarthritis

Attribution analyses revealed progressive increases in the proportion of DALYs attributable to high BMI for both hip and knee osteoarthritis from 1990 to 2023. As demonstrated in Figure 3, the overall attribution proportion increased from approximately 13% in 1990 to approximately 23% in 2023 for both subtypes combined. Detailed age-stratified attribution data are presented in Table 2, showing that for hip osteoarthritis in the 55-59 years age group, the proportion attributable to high BMI increased from 23.29% in 1990 to 32.69% in 2023. However, this proportion decreased with advancing age, declining to 10.72% in the 95+ years age group by 2023. Similarly, knee osteoarthritis exhibited an increase from 22.95% to 32.43% in the 55-59 years age group, with proportions decreasing to 10.59% in the oldest age group. Across all age groups, younger postmenopausal women consistently demonstrated higher attributable burdens from high BMI compared to their older counterparts.

Projections to 2050

ARIMA model projections indicated continued increases in osteoarthritis burden through 2050. Projections for absolute numbers are presented in Figure 4A, showing that total DALYs are expected to increase from 2,871,687.4 (95% CI: 2,396,496.1-3,346,878.6) in 2030 to 3,951,510.5 (95% CI: 3,173,837.4-4,729,183.7) by 2050. Rate projections are illustrated in Figure 4B, with DALYs rates projected to rise from 1,287.2 (95% CI: 1,198.2-1,376.2) per 100,000 population in 2030 to 1,441.2 (95% CI: 1,292.1-1,590.3) per 100,000 population in 2050. Table 3 summarizes key projection milestones, indicating sustained increases in absolute burden across all three indicators through mid-century. Notably, while DALYs and incidence showed progressive growth in both absolute numbers and rates, prevalence rates demonstrated declining trends despite absolute number increases, reflecting the predominant influence of demographic aging. The widening confidence intervals in longer-term projections reflect increasing uncertainty inherent in extrapolative forecasting.

Osteoarthritis burden among postmenopausal women in China has increased dramatically and is projected to continue rising, with high BMI representing an increasingly important modifiable risk factor requiring targeted public health interventions.