OBJECTIVE: This study aimed to investigate whether exposure to multiple ambient air pollutants (PM METHODS: A total of 7,663 participants aged 45 years and older, drawn from the China Health and Retirement Longitudinal Study (CHARLS), were followed from 2011 to 2020. Individuals free of spinal osteoarthritis at baseline were included. Annual mean concentrations of PM RESULTS: During the median 7-year (IQR: 4-9 years) follow-up, 1,556 participants newly reported spinal osteoarthritis. After adjusting for confounders, each 10 μg/m CONCLUSION: This prospective study indicates that higher concentrations of particulate matter and traffic-related pollutants may contribute to an elevated risk of spinal osteoarthritis, particularly among women. These findings underscore the importance of incorporating musculoskeletal health into air quality management and highlight the value of targeted interventions-such as reducing ambient pollution and monitoring high-risk groups-to mitigate the burden of spinal osteoarthritis in rapidly urbanizing areas.