The risk of incident radiographic knee osteoarthritis (OA) over 5 years differed depending on an individual’s body composition (as determined by whole body dual energy x-ray) in a longitudinal cohort (n = 1,653). Sarcopenia was not associated with an increased risk of knee OA in men (relative risk (RR) 0.66, 95% CI 0.34–1.30) or in women (RR 0.96, 95% CI 0.62–1.49). By contrast, obesity was associated with an increased risk of knee OA in men (RR 1.73, 95% CI 1.08–2.78) and both obesity and sarcopenic obesity were associated with an increased risk of knee OA in women (obesity RR 2.29, 95% CI 1.64–3.20; sarcopenic obesity RR 1.91, 95% CI 1.17–3.11).