To identify plasma markers associated with an increased risk of radiographic knee osteoarthritis (OA) progression using a metabolomics approach.Study participants were from the Multicenter Osteoarthritis Study (MOST) and were categorized into two groups based on the presence of baseline radiographic OA. Subjects in group 1 had unilateral knee OA and subjects in group 2 had bilateral knee OA. Progression was defined as ≥ a half-grade worsening in joint space width at 30-month follow-up. For group 1, a participant progressed when their OA knee showed radiographic progression and the contralateral knee developed OA; for group 2, a participant progressed when both knees with OA showed radiographic progression. Metabolomic profiling was performed on plasma samples collected at baseline and logistic regression was performed to test the association between each metabolite and knee OA progression after adjustment for age, sex, BMI, and clinic site. Significance was defined as p0.0003 in the combined analysis.234 progressors (57 in group 1 and 177 in group 2) and 322 non-progressors (206 in group 1 and 116 in group 2) were included in analyses. Among 157 metabolites studied, we found that odds of progression were 1.46 times higher per standard deviation (SD) increase of phenylalanine level (95% CI: 1.20 -1.77, p=0.0001) in the combined analysis. Sex specific analysis showed that an association was seen in women (p=0.0002) but not in men.Our data suggest that phenylalanine might be a novel plasma marker for higher risk of bilateral radiographic knee OA progression in women.