Researchers discovered that osteoarthritis (OA), previously thought to be a degenerative joint disease, is highly linked to the development and progression of cardiovascular-kidney-metabolic (CKM) multimorbidity. The research concluded that OA can be a clinically visible early predictor for recognizing persons at high risk of multi-organ metabolic deterioration. The study was published inFrontiers in Endocrinologyjournal by Yoe Zou and colleagues. The population-based cohort investigation was performed in China and involved 1,842 patients with osteoarthritis from a community register. The objective was to determine if OA was able to predict the development and progression of CKM multimorbidity. CKM outcomes were defined as new-onset disease (single condition), double multimorbidity (two conditions), and triple multimorbidity (all three conditions: CVD, CKD, and T2DM). Incident CKM events were followed in the participants, and risk associations were examined using logistic regression models. In addition, a multi-state model was used to monitor progression trajectories between pairs of stages of multimorbidity. The results indicated a considerable burden of CKM outcomes in individuals with OA. Over the follow-up period: 32.6% incurred at least one CKM condition (new-onset). 27.1% progressed to double CKM. 5.4% developed triple CKM. Statistical analysis showed that a greater burden of osteoarthritis was associated with greater odds of multimorbidity of CKM. The adjusted odds ratios (ORs) with 95% confidence intervals (CIs) were as follows: New-onset CKM: OR 2.64 (95% CI: 2.33–3.00). Double CKM: OR 2.40 (95% CI: 2.11–2.72). Triple CKM: OR 1.49 (95% CI: 1.21–1.84). The multi-state model also corroborated that OA participants had a quicker and more probable progression pattern from single to double and triple CKM states than those without notable OA burden. The present study proved that osteoarthritis was significantly linked with the development as well as worsening of cardiovascular-kidney-metabolic multimorbidity. Being a prevalent and clinically evident disease, OA could potentially be used as an early indicator to select patients with increased risk for multi-organ metabolic deterioration. Including OA in CKM risk factors might enhance preventive treatment and care measures in the general population. Zou, Y., Zhang, Y., Sun, X., Zhao, W., & Zhang, G. (2025). Osteoarthritis as a clinical marker of cardiovascular-kidney-metabolic multimorbidity: a population-based cohort study in China. Frontiers in Endocrinology, 16, 1660319.https://doi.org/10.3389/fendo.2025.1660319