Temporal trends and future projections of hip/knee osteoarthritis burden attributable to metabolic risk in women of reproductive age (1990–2021): A multidimensional analysis across 204 countries and territories

Background : Osteoarthritis (OA) is a leading cause of disability worldwide, with women of reproductive age being particularly vulnerable to hip/knee OA (HOA/KOA) due to metabolic risks (e.g., obesity, high BMI). Leveraging Global Burden of Disease (GBD 2021) data, this study systematically analyzed the metabolic risk-attributable burden of HOA/KOA among women aged 15–49 years across 204 countries and territories from 1990--2021, with projections to 2050. Methods : Data on disability-adjusted life years(DALYs), years livedwith disability (YLDs), and age-standardized rates (ASRs) for HOA/KOA in women of reproductive age were extracted from the GBD 2021. The analyses were stratified by the sociodemographic index(SDI). Time series models (ARIMA, exponential smoothing) were employed to forecast disease burden trends (2022–2050), and decomposition analysis quantified contributions from population growth, aging, and epidemiological changes. Results : Global trends : From 1990--2021, DALYs for HOA and KOA in women of reproductive age increased by 169% and 202%, respectively, with ASRs increasingby 24.5% and 41.2%, respectively. Regional disparities : Low-SDI countries exhibited the fastest case growth (HOA: +298%, KOA: +574%), whereas high-SDI regions had the highest absolute burden (HOA cases accounted for 16.5% of all HOA cases globally). Metabolic risk drivers : Population growth (HOA: 48.9%, KOA: 46.6%) and increasing incidence rates (HOA: 47.7%, KOA: 48.5%) were the primary contributors. Projections : By 2050, ARIMA models predicted HOA/KOA cases to surge by 58.7% and 80.3%, respectively, whereasexponential smoothing indicated slower but significant growth. Conclusions : Metabolic risk drivesa substantial increasein the HOA/KOA burden among women of reproductive age, with the fastest growth occurring in low- and middle-SDI countries. High-SDI regions should prioritize chronic disease management, whereas low-SDI areas require enhanced community screening and health education. Early OA screening should be integrated into prepregnancy care systems, supported by multisectoral collaboration under the UN Sustainable Development Goals. Future research must elucidate the molecular mechanisms of metabolic riskand refine community-based interventions to mitigate disease progression. Trial registration IHME 18525360727@163.com