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Does Glucosamine Chondroitin Help knee and Joint Pain Due to Osteoarthritis?

October 09 2010

Glucosamine Chondroitin is the most popular supplement for joint pain. But does it really help?

What is osteoarthritis?

  • Osteoarthritis: Osteoarthritis (OA) is the most common form of arthritis that can affect the hands, hips, shoulders and knees. In OA, the cartilage that protects the ends of the bones breaks down and causes pain and swelling
  • .

glucosamine chondroitin for osteoarthritis pain

Why use Glucosamine & Chondroitin?

  • Glucoasmine Basics: Glucoasmine and Chondroitin are the building blocks of your cartilage and hence is believed to make up for the loss of cartilage.
  • Dosage: It can come in combination with other supplements (such as chondroitin), or by itself in the form of glucosamine hydrochloride or sulphate.  The usual dose recommended on packages is 1500 mg per day or 500 mg three times a day.

Why study again if it is already being used?

  • Benefits: The studies have been conflicting. Studies which shows a benefit used small sample size and had methodological flaws. 
  • No Benefits: Larger studies with sound methodology shows no or small benefits.

What were the major study points?

  • Meta-analysis: It basically combines the results from a number of studies done on the same topic. It is kind of like a study of studies. So 3 studies of with 10, 50, 100 will be one big study of 160 subjects.
  • High Quality: All the studies selected were methodologically superior, large scale and blinded which wasn’t the case of previous reviews. Out of 58 studies, only 10 (3803 subjects) made it to the analysis based on the inclusion criteria. Each study had to have atleast 200 patients.
  • Outcomes: The study looked at pain and joint space width (smaller joint space means more cartilage build up).

Trials compared chondroitin sulphate, glucosamine sulphate, glucosamine hydrochloride, or the combination of any two with placebo or head to head.Hence the name network meta-analysis.

Practical Applications?

  • Chondroitin, glucosamine, and their combination do not have any beneficial effect on joint pain or on joint space narrowing. Or just basically they don’t work for joint pain due to osteoarthritis.
  • The supplement is not harmful and hence people who get some benefits can keep taking it if they have the money.
  • The industry-sponsored trials (Rotta brand) showed better results in pain and function than industry-independent trials. Guess why is that?
  • These results are consistent with the recent Cochrane Review 2009 on glucosamine and osteoarthritis

Reference 1
Reference 2

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Karky | Mon October 11, 2010  

Good article. I’ve always wondered why so many people use glucosamine with the lack of evidence supporting it.

anoop | Tue October 12, 2010  

Thanks karky.

Large part of the reason is there were a few reviews which looked at small, methodologically poor,and industry-sponsored trials and found it to be beneficial.The large multi-center trial by NIH showed no significant difference.

There is a big study undergoing which will be out by 2011 to see if there is any long term benefit in moderate to severe pain. Let’s see what it says.

Mark Young | Tue October 12, 2010  

Nice work Anoop!

I have to admit that I personally have recommended glucosamine given the mixed nature of the studies, but never really looked at them in depth myself.

Perhaps, given this information, I should stop.  Mind you, I’ve heard about the notion of “responders” and “non-responders” with this supplement. 

What are your thoughts on this?

Anoop | Wed October 13, 2010  

Thanks Mark for the comment!

And great question. In the GAIT trial, there was a sub set with moderate to severe pain who had significant pain relief compared to the placebo. But this is just preliminary and we need more studies to see if this is true. The LEGS study is looking into this(first results will come out in Nov 2011).

It is pretty clear now that, if we include all the studies low quality and the industry-sponsored, there is a benefit.But if you look high quality and industry independent studies(like GAIT, glucosamine doesn’t work.

The authors of this meta-analysis were pretty strong in saying that none of the future studies will show any benefit with glucosamine and health insurance shouldn’t pay for it(in UK it is covered). It seems like a closed chapter to them.

Mark Young | Wed October 13, 2010  

Thanks Anoop! 

It seems I’ll be able to save people a few bucks from here forward.

anoop | Sun October 17, 2010  

Your welcome, Mark!

If you put some aspirin in Glucosamine bottle, they will get the same pain releif, I guess.

Inthe GAIT stuyd, they extended the study for 2 more years in interested particpants to find the effect on joint space width. But they didn’t find any difference after 2 yrs either.

MetroEast Beast | Mon October 18, 2010  

Great article Anoop!

Joe Cannon MS CSCS | Tue October 19, 2010  

As always another good review Anoop. One thing I would add would be glucosamine sulfate vs. glucosamine HCL. Most commercial products contain the HCL version despite the fact that most research has used glucosamine sulfate. The NIH in the GAIT study a few yrs ago found the HCL version pretty much not effective. While two recent studies of glucosamine sulfate found similar results,when in doubt I’d still recommend the sulfate version for those with mild forms of the disorder until more is known.
Here is a related post I did on my site recently about glucosamine
http://supplement-geek.com/glucosamine-4-facts-you-dont-know/


Joe

TPT | Thu October 21, 2010  

Did you guys see this study? 


Osteoarthritis Cartilage. 2010 Jan;18(1):34-40. Epub 2009 Jul 15.

Glucosamine but not ibuprofen alters cartilage turnover in osteoarthritis patients in response to physical training.
Petersen SG, Saxne T, Heinegard D, Hansen M, Holm L, Koskinen S, Stordal C, Christensen H, Aagaard P, Kjaer M.

Institute of Sports Medicine Copenhagen, Faculty of Health Sciences, Bispebjerg Hospital, University of Copenhagen, Denmark. sp12@bbh.regionh.dk

Abstract
OBJECTIVE: To investigate changes in levels of serum cartilage oligomeric matrix protein (COMP) and urine c-telopeptide of type-2 collagen (CTX-II) as markers for cartilage turnover in patients with osteoarthritis (OA) of the knee, in response to muscle strength training in combination with treatment with glucosamine, ibuprofen or placebo

TPT | Thu October 21, 2010  

Osteoarthritis Cartilage. 2010 Jan;18(1):34-40. Epub 2009 Jul 15.

Glucosamine but not ibuprofen alters cartilage turnover in osteoarthritis patients in response to physical training.
Petersen SG, Saxne T, Heinegard D, Hansen M, Holm L, Koskinen S, Stordal C, Christensen H, Aagaard P, Kjaer M.

Institute of Sports Medicine Copenhagen, Faculty of Health Sciences, Bispebjerg Hospital, University of Copenhagen, Denmark. sp12@bbh.regionh.dk

Abstract
OBJECTIVE: To investigate changes in levels of serum cartilage oligomeric matrix protein (COMP) and urine c-telopeptide of type-2 collagen (CTX-II) as markers for cartilage turnover in patients with osteoarthritis (OA) of the knee, in response to muscle strength training in combination with treatment with glucosamine, ibuprofen or placebo.

DESIGN: A 12-week double blind, placebo controlled, randomized study.

METHOD: Thirty-six elderly patients with bilateral tibiofemoral knee OA determined by radiography were randomly assigned to treatment with glucosamine (n=12), ibuprofen (n=12) or placebo (n=12) during 12 weeks of strength training of both legs with focus on the quadriceps muscle. Strength tests (5 repetition maximum), blood and urine sampling were performed before and after the training period. Serum COMP and urinary CTX-II were measured by enzyme-linked immunosorbent assay (ELISA).

RESULTS: All three groups increased their muscle strength following 12 weeks of strength training (P<0.001). Serum COMP levels were reduced in the glucosamine-treated group after the training period (P=0.012), whereas they did not change in the two other groups. Glucosamine reduced COMP statistically significant compared to both placebo and ibuprofen; the mean reduction with glucosamine was 13% vs placebo (P=0.0378) and 17% vs ibuprofen (P=0.0122). Urinary CTX-II levels did not change significantly in any of the three experimental groups.

CONCLUSION: Serum COMP decreased significantly over the 12-week training period when treatment with glucosamine was added to the training regimen. This suggests an effect by glucosamine on the response of the OA cartilage to a period of joint loading in humans with knee OA.

Copyright 2009 Osteoarthritis Research Society International. Published by

Anoop | Fri October 22, 2010  

HI TPT,

Thanks for the study.

They measured COMP. It is a classic example of surrogate measures. We don’t know if this decrease in COMP will translate to less pain and greater function in people with OA.

Jeunx | Fri April 01, 2011  

Hi, Anoop!

I’ve just had the result of my my (R) knee x-ray: Osteoarthritis, Subchondral Sclerosis.  Our company doctor advised me to consume Flexxbon.  But given study you mentioned, it is not necessary.  Are there any other remedies and/or recommended exercises?  I don’t feel any pain btw.

Thank you.

MetroEast Beast | Fri April 01, 2011  

I recommend you consult an athletic trainer for the proper strengthening routine.  Rest, Ice, Compression, Elevate, and Rehab.  You need to build up the supporting muscles around the knee.  I’ve also found recently that barefoot walking may have some minor benefits to the small stabilizers as well.

Anoop | Sat April 02, 2011  

Hi Jeunx,

If you don’t have pain, forget about the whole thing!You will see a lot of weirds stuff on scans which has no relation to pain or future pain. I am sure if you x-rayed or imaged your spine, you will see a lot of problems too.

Jeunx | Sat April 02, 2011  

Hi MetroEast Beast.

Yes, I plan to visit Rehab doctor for consultation. Thank you!

========================================
Hi Anoop.

Thank you, do you really think so? What about the popping sound my knee makes?

Anoop | Sat April 02, 2011  

Hi Jeunx,

There changes are just normal part of ageing. did you read about my pain article? There are hundreds of studies showing abnormal imaging in ur knees and low back t o have no correlation with pain. Nor does it predict future pain.

The more you worry about this images, the more you will raise the threat level in the brain and increase the chances of getting pain. Clicking sounds is ok.

I have news: our body is full of dysfunctions.

Jeunx | Sun April 03, 2011  

Hi again, Anoop!

I get what you’re saying: thought creates form hehe.  Will read about the pain article you wrote.

Thanks again for your time and assurance.  Best regards.

Anoop | Sun April 03, 2011  

Hi Jeunx,

It is more than that Jeunx. You should read the article and if you have any questions, ask in the comment section.

And you will have some I am sure!

What do you think?

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