Glucosamine May Not Slow Osteoarthritis Progression

A new study suggests that, contrary to popular belief, glucosamine may not slow the progression of knee osteoarthritis.

Glucosamine is a natural compound that is part of healthy cartilage. Glucosamine supplements are widely used to treat osteoarthritis. Several earlier studies support this use, but these studies used x-rays to measure joint damage caused by knee osteoarthritis.

The latest study, presented at the 73rd Annual Scientific Meeting of the American College of Rheumatology, used MRI scanners to assess cartilage damage in 201 patients with mild-to-moderate knee osteoarthritis. Participants were randomly assigned to receive either 1,500 milligrams of glucosamine or placebo daily. Cartilage damage of both knees was assessed at baseline and six months later.

Results showed no difference in the progression of cartilage damage between the glucosamine and placebo groups. Researchers also noted that there was no difference in cartilage synthesis between the two groups.

However, the results may be limited because researchers used the hydrochloride form of glucosamine as opposed to the sulfate form, which is more often studied. Overall, research on the use of glucosamine for osteoarthritis of the knee is inconclusive.

For more information about glucosamine and its uses, please visit Natural Standard’s Foods, Herbs & Supplements database.

Comments

[CB]

Why would the researchers use glucosamine hydrochloride over the more popular and more researched glucosamine sulfate form? According to the Natural Standard Web site, glucosamine sulfate has a Grade A efficacy in terms of treating knee osteoarthritis. However, the monograph also states that nearly all the studies with statistically significant results used glucosamine sulfate supplied by a single European manufacturer (Rotta Research Laboratorium). So even though the evidence shows its benefits, you can’t really tell if glucosamine from other manufacturers yield the same results.

[TMP]

I feel this topic must be researched further. I have many patients taking glucosamine for osteoarthritis. I was surprised to see the study didn’t test glucosamine with chrondroitin. I remember reading that for glucosamine to be absorbed efficiently, it was recommended to be taken with chrondroitin. This is similar to the relationship between calcium and vitamin D. I would like to see more studies done with the sulfate form and with and without chrondroitin.

[Anon]

Are there other natural products with more evidence for use? What about safety profile, and how do they compare to prescription drugs? I heard that Zostrix can really help, but it may sting.

[karina gordin]

I would like to comment on a version of glucosamine that is now available for pets and might soon become available for humans as well. The product is called N-Butyryl Glucosamine, or Anabu (TM). Glucosamine (GlcN) is generally utilized as a nutraceutical compound by arthritis patients. (GlcNBu) is a synthetic analog of glucosamine and is a member of a novel class of carbohydrate-based drugs.

In animal study of streptococcal cell wall-induced inflammatory arthritis, N-butyryl glucosamine was shown to inhibit subchondral bone loos, while preserving or enhancing bone mineral density. In terms of insulin, it was shown in an in vitro and animal study that a variety of glucosamine derivatives modulate insulin secretion by influencing pancreatic islet cells.

Generally, in animal study, N-butyryl glucosamine has a rapid but low absorption rate. In animal study it was demonstrated that even following ovariectomy, glucosamine may stimulate tibial cartilage and bone growth in rats.

The effect of food following oral administration of GlcNBu did not significantly affect bioavailability. N-butyryl glucosamine (GlcNBu) is a highly water soluble N-acylated analog of the amino sugar glucosamine. GlcNBu has no chromophore and bears an alkyl chain.

Dr. Tassos Anastassiades, a researcher with the Canadian Arthritis Network (CAN) discovered and patented the glucosamine derivative Anabu™

[Sadie]

Another study (the GAIT trial) tested the effects of glucosamine and chondroitin (each alone and together) against the control of prescription Celebrex for pain associated with knee osteoarthritis. Celebrex is traditionally used to treat knee pain caused by osteoarthritis, so researchers wanted to see if glucosamine with or without chondroitin was as good as or better than Celebrex. They basically found out that glucosamine plus chondroitin was effective only in the population subset of patients with moderate-to-severe osteoarthritis pain. However, there were flaws of this trial as well, which still leave us without conclusive evidence.

[nutrition sportive]

You have provided good information about glucosamine. I only know that glucosamine is a natural compound that is found in healthy cartilage. It plays a major role in formation and maintenance of healthy cartilage. It is widely known for its ability to promote joint flexibility.

[IP]

I have also heard about using the combination of glucosamine and chondroitin. So when I went to the Natural Standard website to read more about osteoarthritis, it said that acupuncture has Grade A evidence in the treatment of osteoarthritis. Perhaps this is another option for patients. According to the monograph, there has been a lot of research regarding acupuncture and osteoarthritis, especially in the knee, hip and cervical areas. They say the evidence is strong enough now to recommend trying acupuncture in osteoarthritis of the knee.

[RF]

I always wondered why the majority of these osteoarthritis studies always studied osteoarthritis of the knee. What is it about osteoarthritis at the knee that makes it different than osteoarthritis in other areas of the body? After reading through the monograph on the Natural Standard Web site, it actually says that knee osteoarthritis tends to respond better than other osteoarthritic joints to any treatment. It also says that it’s possible that the make-up and structure of the knee joint plays a role. Now that makes me wonder, what is it about the knee joint that’s different from other joints in the body? And how does structure play a role if we’re dealing with chemicals?

[estelle]

Like some of you, I am surprised by the use of the hydrochloride formulation instead of the sulfate and the absence of chondroitin. In school we learn that the sulfate has more evidence and that the combination is more effective. My grandpa swears by the combo product. It seems to do wonders for him, so I would like to see more research done to investigate its effects. Also does anyone know how long it takes to see effects? This study was for 24 weeks, so maybe longer studies could determine whether this therapy is effective.

[Grace Caulfield]

I think this topic needs further investigation. There are a lot of people out there who believe in glucosamine and chondroitin for joint relief. They need to do a study with the more popular form of these. And shouldn’t they be in the liquid form?

[SK]

I wonder how glucosamine compares to acetaminophen or aspirin for the treatment of osteoarthritis. If the sulfate form is the most commonly used form of glucosamine, then I wonder if these findings can be applicable, as the study focuses on the hydrocholride form.

[Sally]

Many people come into the pharmacy to buy glucosamine and chondroitin supplements. I have noticed that these products are extremely pricey, so if they are not effective in treating osteoarthritis, lots of people are wasting their money. However, a lot of people don't care what the evidence is; they swear by this natural supplement and really believe it helps them. A recommendation I usually make at the pharmacy is that if they really want to try it, go ahead, it won't do any harm. But if you don't start to see (or feel) effects from it within a few weeks, then you should just discontinue it because it probably isn't going to work.

[PJ]

CB, My initial reaction to this article was exactly the same as yours. It doesn't make any sense that they used the hydrochloride form of glucosamine instead of the sulfate form. Because the hydrochloride form was never proven effective, it makes sense that this study did not show any benefit in cartilage from using this supplement. We still don't know the effects that glucosamine sulfate has on the damaged cartilage. I would like to see another well-designed trial using MRI to evaluate cartilage damage with the glucosamine sulfate form.

[mona]

A lot of attention is usually given to studies or products that are found to possibly be effective for a certain condition or ailment, but I think studies like these, where something is found ineffective, are also important to pay attention to as well. People spend a lot of time and money on therapies that may sometimes be fruitless (although I know the placebo effect may be beneficial if nothing else).

From working in a pharmacy, I see people purchase glucosamine all the time for knee osteoarthritis, and some of them have mentioned that they don’t even know if its working for them, but they’re willing to try it if there is chance that it’s effective, and of course, there are some that feel it has done wonders for their OA. I’m hoping that it is effective since so many people use it, and I’ve heard OA can be quite debilitating, but if it’s not, people should be made aware of that as well.

[YJ]

Most clinical trials or studies about glucosamine are not consistent with its formulation and dosage (sulfate vs. hydrochloride/ tablet vs. liquid/ daily vs. three times a day). Resources provided by natural standard state that glucosamine preparations in the U.S may vary in quality among different manufacturers, so it is hard to compare this outcome to other studies.

For your information, bioavailability of oral glucosamine (26%) is about the same whether it is sulfate or hydrochloride form. But it is not clear that different dosing (500mg 3 times a day vs. 1500mg daily) or different formulation (tablet vs. solution) would be matter in terms of bioavailability. There are no direct studies measuring the percentages of bioavailability of glucosamine solution vs. pill, capsule or powder forms of glucosamine.

[CD]

I am surprised to see these results also. It is too bad that information in this field is constantly changing and we cannot have solid answers. I recommend this product a lot and believe that it must have benefits. People need to remember too that when starting this, it will be quite some time before they see results that may be a good reason to have kept the study going longer. I also thought that glucosamine alone was sufficient and really all that was needed (as opposed to buying it with chondroitin). I would really like to see a better trial lasting longer (at least one year) to see the true results that supposedly time brings with this supplement!

[Maddie]

Another option for people with knee osteoarthritis who are not satisfied with conventional care is acupuncture. According to Natural Standard’s database, acupuncture has strong scientific evidence supporting its use for knee osteoarthritis. If people are looking for new options, this is an alternative therapy that may be worthwhile.

[Sammy]

This study focuses on just one form of glucosamine. I think it would be interesting to compare the liquid and capsule forms to see if similar results are observed with both forms.

[mindy]

If the results of this study are valid and there truly is “no difference in the progression of cartilage damage between glucosamine and placebo groups,” then a lot of patients may be disappointed since such a large number of people take glucosamine + chondroitin to help slow the progression of osteoarthritis (OA). Even my mom started taking it because she started experiencing the early signs of knee OA, and she had heard that glucosamine + chondroitin could help slow its progression. She asked me what I thought before she purchased it, and I told her a lot of people use it, but evidence on its efficacy is conflicting. She still thought it would be worth a try, which I think is a mentality shared by most people who use it.

[TI]

To respond to the question whether there are other natural products that can potentially slow down the progression of osteoarthritis with a low risk of serious adverse effects, there is a relatively new product on the market called Relamine that is a combination of chondroitin and glucosomine sulfates with primorine.

Oxidative stress has been linked with the onset of neurodegenerative and inflammatory disorders. Primorine is a combinaton of products that supposedly are able to reduce the stress of highly reactive carbonyl compounds, which are produced under conditions of oxidative stress. Therefore, release of this product theoretically is based on the fact that combining the well-studied glucosomine and chondroitin with the oxidative stress reducer will help slow down the disease progression in those who are willing to try something new.

However, there have been no studies done to demonstrate efficacy of this combination in osteoarthritis, though side effects profile appears to be low.

[steve]

In addition to addressing the problem through nutritional supplementation, topical application of natural anti-inflammatories can be quite valuable. You can use topically applied herbs that are anti-rheumatic and reduce inflammation. There are some like devil's claw, celery seed and poke root that work well.

I found a roll-on lotion that I like that has NO MENTHOL but has herbs for pain relief and herbs to reduce inflammation. I like it and have given it to a few friends who really like it too. It's called Joint Relief, and I got it from a place called Nature's Rite. You might want to give it a try.

[KO]

Although, I find it quite possible that glucosamine may not slow osteoarthritis progression, I feel that more research needs to be done to come to such a conclusion and that the researchers conducting this study could have done a couple things differently to help prove the validity of this study. First of all, like many others, I am surprised that they used glucosamine hydrochloride rather than the more commonly used sulfate form. In addition, I think it would have been a good idea if the study used both glucosamine and chondroitin as their intervention since many patients take these two together, and it’s been thought that taking both has better efficacy than taking either one alone.

[Nina]

Glucosamine appears to be save; however, none of the glucosamine trials in the U.S. seem to have come forward with conclusive evidence for the benefit of osteoarthritis. Results cannot support the claim of glucosamine slowing the degeneration or relieving the pain of osteoarthritis. This may be due to the heterogeneity of products studied, biases of the industry or too small sample sizes.

The only known formulation of glucosamine sulfate that has shown efficacy is a patented formulation and prescription drug by Rottapharm in Europe. The key distinction of this product seems to be the stabilization of different glucosamine sulfate molecules, resulting in higher plasma glucosamine levels. Glucosamine sulfate might actually be effective, but in order to initiate new trials, products on the marked need to be investigated for their quality.

[EH]

From my understanding, glucosamine sulfate combined with chondroitin sulfate results in a more absorbable formula, offering support for joints and cartilage and is more powerful together than either ingredient alone. I would therefore love to see another study using glucosamine in its sulfate form combined with chondroitin instead.

I have also noticed a number of glucosamine supplements on the market containing a relatively high amount of sodium (around 10% daily intake per 500 mg capsule) when they are stabilized with sodium chloride. It is thus advisable to pick one that is bound to potassium, especially for individuals concerned about salt intake.

[HJ]

SK,

According to Natural Standard's Web site, glucosamine is one of the principal substrates used in the biosynthesis of macromolecules that comprise articular cartilage, such as glycosaminoglycans, proteoglycans and hyaluronic acid. It is believed to play a role in cartilage formation and repair.

On the other hand, acetaminophen or ibuprofen is used to relieve pain or swelling. I hope this is helpful.