Osteoarthritis is among the most common pathological conditions in skeletal collections and is the most frequent musculoskeletal disorder in contemporary populations. Jurmain (1991) has previously published in this journal a brief review of skeletal perspectives on osteoarthritis. Subsequent studies by osteologists and medical researchers have added considerably to understanding of the aetiology and patterning of osteoarthritis. Thus, it is timely to present an updated review that expands and supports conclusions discussed in the earlier review. In short, osteoarthritis aetiology is multifactorial, with age being the main influence on the onset and severity of osteoarthritis. Genetic influences also play a large role in the severity of osteoarthritis, especially in the lower limbs. Weight, although playing a significant role for modern populations, seems to have had very minimal effects on prehistoric populations. Sex differences may often be a consequence of hormones, body size and anatomy, rather than activity related. Finally, intense activity starting at a young age still may influence osteoarthritis, especially in the upper limbs. Future directions discussed include within-body comparisons, animal studies, and examining patterns in large populations. Copyright © 2007 John Wiley & Sons, Ltd.