Osteoarthritis as a Clinical Marker of Cardiovascular-Kidney-Metabolic Multimorbidity: A Population-Based Cohort Study in China

Yue Zou¹Yanyan Zhang¹Xiujiang Sun¹Wenbo Zhao²Guodong Zhang^1*

• ¹Yantaishan Hospital - North Campus, Yantai, China
• ²Fudan University, Shanghai, China

Background Cardiovascular-kidney-metabolic (CKM) multimorbidity is increasingly recognized as a major global health concern. Although osteoarthritis (OA) is traditionally viewed as a degenerative joint condition, recent evidence suggests it may reflect systemic inflammation and metabolic dysfunction. However, its role as a potential clinical marker of CKM multimorbidity remains unclear. Methods This population-based cohort study included 1,842 participants with osteoarthritis from a community registry in China. CKM multimorbidity was defined as the sequential development of cardiovascular disease (CVD), chronic kidney disease (CKD), and type 2 diabetes mellitus (T2DM). Participants were followed for incident CKM events. Logistic regression models estimated odds ratios (ORs) for new-onset, double, and triple CKM outcomes. A multi-state model was applied to assess progression trajectories between disease stages. Results Over the study period, 32.6% of participants developed at least one CKM condition, 27.1% progressed to double CKM, and 5.4% developed triple CKM. Higher osteoarthritis burden was associated with increased risk of CKM multimorbidity. Adjusted ORs (95% CI) for new-onset, double, and triple CKM were 2.64 (2.33–3.00), 2.40 (2.11–2.72), and 1.49 (1.21–1.84), respectively. Multi-state modeling confirmed that osteoarthritis Conclusion Osteoarthritis is strongly associated with the onset and progression of CKM multimorbidity. As a clinically observable and common condition, OA may serve as an early indicator for identifying individuals at heightened risk of multi-organ metabolic decline. These findings support the integration of OA status into risk stratification frameworks for CKM disease prevention and management.