OBJECTIVE: To examine the relationship between health-related quality of life (HRQOL) and health service use among older adults with osteoarthritis (OA). METHODS: Subjects were 9,043 Medicare-enrolled survey respondents with a prior International Classification of Diseases, Ninth Revision code for OA. Analyses examined the relationship of 5 Centers for Disease Control and Prevention HRQOL items (general health, mental health, pain, activity limitation, and sleep) to physician visits, prescription analgesic or antiinflammatory use, and arthroplasty during 1 year of followup. RESULTS: In analyses controlling for demographic and health-related variables, greater pain frequency was associated with increased odds of visiting a physician, using analgesic or antiinflammatory drugs, and having arthroplasty (P < 0.001). Poorer general health was associated with increased odds of analgesic or antiinflammatory use but decreased odds of arthroplasty (P < 0.01). More days of activity limitation and poor mental health were associated with decreased odds of analgesic or antiinflammatory use (P < 0.01). CONCLUSION: These HRQOL variables, especially pain frequency, can be valuable tools for estimating future health care use among older adults with OA.