One billion by 2050: the OA roadmap and what it asks of general practice

Osteoarthritis is already one of the most common conditions managed in Australian general practice, affecting over two million Australians and sitting among the leading causes of disability in midlife and beyond. A new roadmap published in The Lancet and led by Curtin University Professor Andrew Briggs puts a number on where this is heading: one billion people affected globally by 2050, up from approximately 600 million today.

That projection is not fatalism — it is a brief for action. And the roadmap is explicit about what action looks like.

The burden is preventable, not inevitable

The roadmap identifies three strategic priorities for health systems: building national surveillance of the condition’s scale and cost; expanding integrated, person-centred care that sits within chronic disease management rather than as a specialty outlier; and slowing the condition’s progression by targeting the two major modifiable risk factors — excess body weight and joint injury.

Those two risk factors are worth pausing on. Unlike the fatalistic framing of osteoarthritis as “wear and tear that comes with age,” the roadmap is clear that a meaningful proportion of cases — and particularly cases in people younger than 65 — are driven by things that can be changed or prevented. Arthritis Australia notes that knees, hips, and hands are most commonly affected, with knee osteoarthritis strongly linked to prior injury and obesity.

Australia has a particular exposure here. The country has one of the highest rates of anterior cruciate ligament (ACL) injury in the world, driven partly by the volume of high-impact sport participation and by sport starting young. An ACL injury in your 20s substantially raises the risk of knee osteoarthritis in your 40s and 50s. The roadmap’s call for better post-injury rehabilitation and return-to-sport protocols is not abstract — it has a direct population-level payoff.

Where general practice fits

The roadmap argues that osteoarthritis is “inadequately integrated” into chronic disease care, and the evidence bears that out. The condition shares risk factors with type 2 diabetes, cardiovascular disease, and depression — conditions with which it frequently co-occurs — yet it is rarely managed within the same structured care framework.

What this looks like in practice: a woman in her late 40s presenting with hip or knee pain, fatigue, and difficulty with stairs is often told her X-ray shows “some early arthritis” and offered a referral for imaging, rather than a conversation about what research-supported management actually involves. That conversation — about weight management if relevant, about targeted land-based exercise, about physiotherapy, about activity modification — is the treatment. It takes time. It requires a chronic disease management plan and, often, allied health referral.

The RACGP guidelines for hip and knee osteoarthritis are being updated, with release expected in mid-2027. In the meantime, the evidence base supporting non-pharmacological management — particularly exercise and weight management — is substantial and consistent. Professor Briggs is direct about the therapeutic landscape: core treatment is “largely non-pharmacological,” and while promising disease-modifying agents are in development, there are currently no approved medicines that slow or halt the underlying disease process.

Both-and: the “just get on with it” problem

There is a tension worth naming here. The message that osteoarthritis is manageable and that lifestyle intervention makes a real difference is true and important. But the practical experience of many women in their 40s and 50s managing early osteoarthritis alongside work, caring responsibilities, and financial pressure is that the time, cost, and effort required to follow the research-supported pathway is substantial.

Physiotherapy visits cost money, exercise hurts when joints are inflamed, and weight management in the context of pain-limited mobility is genuinely hard. The roadmap’s ambition to integrate osteoarthritis into chronic disease care frameworks — with Medicare items that support GP management plans, allied health referrals, and multidisciplinary team care — would make a material difference if it translates into funded pathways rather than aspirational language.

The roadmap also calls for a shift in how clinicians talk about the condition. The framing of osteoarthritis as an inevitable accompaniment to ageing — something to be endured rather than managed — has a documented effect on whether patients engage with treatment at all. Reframing it as a condition with modifiable drivers and well-researched management options is not spin. It is an accurate description of what the evidence shows.

2 cents

If you are in your 40s and your joints are starting to tell you about it, this is worth taking seriously earlier than many people do. The “wait and see” approach — defer treatment until the pain is severe enough that it cannot be ignored — is not supported by the evidence, and it reduces the window in which lifestyle interventions make the biggest difference.

The one billion figure is stark. But it is also, in large part, a downstream consequence of decisions made decades earlier: how joint injuries are rehabilitated, how weight is managed, how early general practice gets involved. Those decisions are available now.

Verdict: yes — worth knowing about. The roadmap reflects established evidence and makes a credible case for treating osteoarthritis with the same chronic disease seriousness as diabetes or cardiovascular disease.

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Sources cited

1. New roadmap to tackle osteoarthritis burden — newsGP, RACGP
2. Osteoarthritis — Arthritis Australia
3. Osteoarthritis — Australian Institute of Health and Welfare