This study aims to investigate the impact of sarcopenia, osteopenia, and osteosarcopenia on the risk of developing osteoarthritis (OA) in individuals with prediabetes. We collected and analyzed data from five National Health and Nutrition Examination Surveys (NHANES) conducted between 2001 to 2006, 2013 to 2014, and 2017 to 2018. The study population consisted of participants who self-reported having OA and those who had bone mineral density and skeletal muscle mass index (SMI) measured using dual-energy X-ray absorptiometry (DXA). We employed weighted multinomial logistic regression models and restricted cubic splines to examine the relationship between osteosarcopenia and the risk of OA in prediabetic individuals. Individuals with prediabetes exhibited a greater susceptibility to osteosarcopenia compared to those with normal glucose tolerance (NGT). In adults with prediabetes, muscle mass index (SMI) was independently associated with bone mineral density (BMD). Furthermore, both sarcopenia and osteopenia were positively correlated with osteoarthritis (OA) within the prediabetic population. Notably, the presence of osteosarcopenia in prediabetes significantly increased the risk of developing OA compared to the presence of either sarcopenia or osteopenia alone. In adults with prediabetes, osteopenia and sarcopenia are risk factors for OA, and the combination of sarcopenia and osteopenia further increases the prevalence of OA.