Key Points• The pharmacologic management of osteoarthritis (OA) is primarily targeted at managing symptoms, and there are several classes of agents in current use. Many of these agents, though effi cacious, are associated with adverse events.• Over time, the complement of adverse events under investigation has broadened, expanding from gastrointestinal (GI) events to also include cardiovascular (CV) and neurological events.• Pharmacologic management in OA is challenging, especially in older adults particularly due to comorbidities, different causes of pain, and a high rate of polypharmacy. In addition, while OA is treated as a homogeneous diagnostic category, there is evidence to suggest otherwise. This has implications for the pharmacologic management of OA and design of drug trials.212