Noriko Yoshimura | Department of Preventive Medicine for Locomotive Organ Disorders, 22nd Century Medical and Research Center, University of Tokyo, Japan
Citation: EMJ Rheumatol. 2026; https://doi.org/10.33590/emjrheumatol/69IMV6V9
You were recently awarded the International Osteoporosis Foundation Committee of Scientific Advisors (IOF CSA) Medal of Achievement at the World Congress on Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (WCO-IOF-ESCEO) Congress 2026. What do you believe has been the most impactful contribution of your work to the field?
I am deeply honoured to receive this award from IOF CSA. Looking back, I believe the most impactful aspect of my work has been demonstrating, through large-scale population-based studies, that musculoskeletal diseases are not simply inevitable consequences of ageing, but major determinants of disability, loss of independence, and healthy life expectancy.
Through epidemiological studies, such as the ROAD study, we were able to clarify the prevalence, incidence, and secular trends of osteoarthritis and osteoporosis across a wide age range in the general population, including middle-aged and older adults. Importantly, these conditions affect not only pain and physical function, but also social participation and quality of life.
Another important contribution of our work has been demonstrating that musculoskeletal diseases should not be viewed as isolated disorders. Through long-term longitudinal follow-up, we found that osteoarthritis, osteoporosis, sarcopenia, spinal disorders, metabolic factors, and cognitive decline are closely interconnected and together influence mobility, frailty, and overall health outcomes in ageing populations.
I also believe our work helped strengthen the concept that prevention and early intervention should be central goals in musculoskeletal health. In rapidly ageing populations such as Japan, preserving mobility is essential not only for physical function, but also for maintaining independence, cognitive health, social participation, and healthy longevity.
The award recognises your pioneering work in epidemiology and prevention of musculoskeletal disorders. Why do you think prevention has historically been under-emphasised in this field?
Historically, musculoskeletal disorders were often regarded as unavoidable age-related conditions rather than preventable diseases. Compared with illnesses associated with high mortality, such as cardiovascular disease or cancer, musculoskeletal diseases were sometimes underestimated because they primarily cause disability rather than death.
Another challenge is that prevention research requires long-term population follow-up and large cohort studies, which are resource-intensive and take many years to generate evidence. For a long time, the field also focused mainly on structural changes visible on imaging, while less attention was paid to early functional decline, lifestyle factors, or modifiable risk factors.
However, as societies age worldwide, the importance of prevention is becoming increasingly clear. We now recognise that maintaining musculoskeletal health is closely linked not only to mobility, but also to frailty prevention, cognitive function, social engagement, and overall healthy ageing. This broader perspective is becoming increasingly important for sustainable healthcare systems.
Your work on large-scale population studies, such as the ROAD study, has been widely influential. What are the most important insights these studies have provided into the burden of osteoarthritis and osteoporosis?
One of the most important contributions of the ROAD study was clarifying the prevalence, incidence, and secular trends of osteoarthritis and osteoporosis across a broad age spectrum in the general population, including middle-aged and older adults.
Another key insight from the ROAD study was that musculoskeletal diseases should not be viewed as isolated conditions. Our findings highlighted the importance of understanding musculoskeletal health from a more integrated and life-course perspective, particularly in rapidly ageing societies such as Japan. In this context, the ROAD study may also provide important insights for other countries facing similar demographic transitions.
Osteoarthritis is often described as a ‘degenerative’ condition with limited disease-modifying options. Based on your research, do you think this perception needs to change?
Yes, I believe this perception is gradually changing.
Osteoarthritis has traditionally been viewed as a simple ‘wear-and-tear’ disease, but growing evidence suggests that it is a complex whole-joint disorder involving not only cartilage degeneration, but also inflammation, bone changes, muscle weakness, biomechanics, metabolic factors, and systemic ageing processes.
Importantly, osteoarthritis is highly heterogeneous. Different patients may have different underlying mechanisms and progression patterns. This means we may need more personalised approaches for prevention and treatment.
I also think the field is moving toward recognising earlier and potentially modifiable stages of disease. Even if we do not yet have definitive disease-modifying therapies, there is increasing opportunity to intervene before severe disability develops.
Have any of your latest data changed how we should think about the progression or early detection of osteoarthritis?
Recent findings suggest that we should think about osteoarthritis progression more broadly than structural joint damage alone.
For example, early functional decline, muscle weakness, pain symptoms, spinal alignment, reduced physical activity, and metabolic abnormalities may all contribute to progression before advanced radiographic changes appear. This highlights the importance of identifying individuals at risk at an earlier stage.
Another important point is that osteoarthritis progression is not uniform. Some individuals remain stable for many years, while others experience relatively rapid decline. Understanding these different trajectories may help us develop more targeted preventive strategies in the future.
Overall, I believe we are moving toward a more integrated understanding of osteoarthritis that connects imaging findings with physical function, metabolic health, cognitive ageing, and broader health trajectories across the life course.
Reflecting on this year’s WCO-IOF-ESCEO Congress, what do you see as the most important emerging themes in osteoporosis and musculoskeletal research?
One of the most important themes emerging from this year’s WCO-IOF-ESCEO Congress was the growing recognition that musculoskeletal health should be considered a central component of healthy ageing. Preserving mobility is increasingly understood not only as a matter of physical function, but also as a key determinant of independence and quality of life in older adults.
Another important development is the rapid advancement of technologies such as AI, imaging analysis, and large-scale longitudinal cohort studies. These approaches are providing new opportunities to better understand disease risk, progression, and heterogeneity, and may contribute to earlier detection and more precise preventive strategies in the future.
At the same time, I believe an important future challenge is to better understand the interactions among musculoskeletal disorders, metabolic health, physical performance, frailty, and cognitive ageing, rather than continuing to study each condition separately.
Although research in these areas has advanced significantly, our understanding remains fragmented. Developing a more integrated perspective on healthy ageing will be essential in rapidly ageing societies.
Lastly, if you could change one thing in how musculoskeletal diseases are currently managed globally, what would it be?
If I could change one thing, it would be shifting the focus from reactive treatment to earlier prevention across the life course.
In many healthcare systems, intervention begins only after pain, fracture, or severe mobility limitation has already developed. By that stage, restoring full function can be difficult.
I believe we need a greater emphasis on maintaining musculoskeletal health earlier in life through physical activity, nutrition, risk assessment, and early identification of functional decline. Preventing disability before it becomes irreversible should be a global priority.
Ultimately, I believe musculoskeletal health should be recognised not simply as the absence of joint or bone disease, but as a fundamental foundation for maintaining independence, cognitive and social function, and healthy longevity throughout the life course.
