BACKGROUND: Musculoskeletal (MSK) diseases represent a significant global public health challenge. Conducting comprehensive research on MSK diseases in China holds profound implications for public health. METHODS: This study utilized data from the Global Burden of Disease 2021 (GBD 2021) to analyze the incidence rate, prevalence rate, mortality rate, disability-adjusted life years (DALYs), years lived with disability (YLDs), and years of life lost (YLLs) of MSK diseases in China from 1990 to 2021. Trends were evaluated using annual percentage change (APC), average annual percentage change (AAPC), and estimated annual percentage change (EAPC). Future disease trends were predicted using the Bayesian Age-Period-Cohort (BAPC) model. RESULTS: China had the highest number of DALYs cases globally, totaling 30.4194 million. Low back pain (LBP) represented the largest burden, while hand osteoarthritis exhibited the fastest growth. Differences in disease burden were observed across various genders and age groups. Predictions indicate that between 2021 and 2030, the age-standardized DALYs rate in China will increase annually, reaching 1779.08 per 100,000 population by 2030. Environmental (occupational) factors had the most significant impact on the age-standardized DALYs rate, whereas renal dysfunction had the least impact. The SDI showed a moderately strong positive correlation with the age-standardized DALYs rate of MSK diseases. CONCLUSION: Over the past 20 years, the prevalence of MSK diseases in China has experienced a slight increase, while other epidemiological burden indicators have shown a downward trend. Projections indicate that the overall disease burden of MSK in China will continue to rise over the next decade, underscoring the need for early intervention strategies. Moreover, substantial differences in MSK disease burden across genders and age groups highlight the importance of developing targeted policy interventions to mitigate this burden.