The sustainable development goals (SDGs) of the United Nations are focused on regional development and ecological security. Based on these SDGs, quantitative regional landscape ecological risk assessment is significant to realize regional sustainable development. This study took the central mountainous area (CMA) of Hainan Island as the research area, and combined SDGs and a patch-generating land-use simulation (PLUS) model to analyze multi-scenario land-use change and landscape ecological risk simulation. The study results show that the low ecological risk areas are located in the central hinterland of the CMA, and the high ecological risk areas are located on the northern and southern edges, with strong disturbances from human activities. The construction land in the CMA expanded drastically from 2010 to 2018, mainly invading forestland and grassland, leading to landscape fragmentation, which was the main cause of the increased ecological risk in the CMA landscape. The future multi-scenario simulations for SDGs show that under the scenario of natural development and economic development, the construction land and water area will significantly expand and the forest land will be dramatically reduced. Under the ecological protection scenario, the expansion of construction land will be restrained, and the area of forest land will increase. The results showed that the landscape ecological risks in the three simulated scenarios would be higher than in 2018, but the increase in the landscape ecological risks under the ecological protection scenario would be relatively slight. Forest land plays an essential role in maintaining the ecological security of the CMA. The expanding construction land in the CMA has led to landscape fragmentation and increased ecological risk. Therefore, it is necessary to protect the forest land in the CMA. In addition, construction and development should be limited in high-risk areas. Although the adoption of the ecological conservation scenario favors regional sustainability, it is still necessary to improve ecological protection policies such as ecological compensation to ensure the realization of other SDGs.