Osteoarthritis is the most common form of arthritis and it is one of the leading causes of disability in all elderly populations. It results in enormous societal burden, including the need for joint replacement at an annual cost to the community of billions of dollars. Two factors that predicate the formulation of a treatment strategy for an individual with "early" osteoarthritis include the risk for toxicity from long duration of exposure to pharmaceuticals and the desirability of a treatment with the potential to reduce the rate of disease progression. These considerations favor approaches that avoid or minimize chronic pharmaceutical use in favor of safer interventions, especially ones where current evidence suggests the potential of a disease-modification effect. These should include socio-behavioral interventions that promote weight optimization and exercise, consideration of orthotics, general dietary recommendations to increase vitamin D and C intake, and an emphasis towards topical or intermittent use of pharmaceutical agents rather than long term nonsteroidal anti-inflammatory drug use.