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Glucosamine Alone Not Effective for OA PDF Print E-mail
Written by David. R. Seaman, D.C., M.S.   

Since 2001, four long-term studies have examined the utility of glucosamine and/or chondroitin supplementation versus placebo in patients suffering from osteoarthritis (OA) of the knee (1-4). One long-term study compared glucosamine sulfate with placebo in patients with OA of the hip (5). To date, there has yet to be a trial with glucosamine/chondroitin for spinal OA, although one case history has been published (6).

Most often we hear news pieces on the outcomes of these studies, which can be confusing to practitioners and patients alike. Details about the effectiveness are often not clearly characterized. In general, supplementation with glucosamine/chondroitin reduces pain by about 20%, which is really not very dramatic.

The most recent study was published in October 2008 (4) and was an extension of the Glucosamine/Chondroitin Arthritis Intervention Trial (GAIT) (3), in which glucosamine and chondroitin were originally supplemented for six months. Subjects in the second phase of GAIT took glucosamine/chondroitin for an additional 18 months. The outcome measure in this study was joint space narrowing. It turned out that there was no significant difference between glucosamine, chondroitin, Celebrex or placebo in slowing joint space narrowing (4), which has led to media reports about the ineffectiveness of glucosamine/chondroitin for OA.

Doctors, patients and supplement manufacturers are often upset by less than impressive outcomes with glucosamine supplementation.

Doctors, patients and supplement manufacturers are often upset by less than impressive outcomes with glucosamine supplementation. I actually expect poor outcomes and am quite surprised if a mono-therapy such as 1500 mg of glucosamine has an appreciable impact on a chronic condition such as OA of any joint(s). The National Institute of Arthritis and Musculoskeletal and Skin Diseases provide a detailed booklet on OA, which is available from its Web site (www.niams.nih.gov). One of the key factors mentioned in modulating OA expression is weight loss. This is an important issue and is never adequately characterized in the various glucosamine trials or related news commentaries.

I am 6’ 2” tall and weigh 170 pounds. My body mass index (BMI) is 21.8. If I weighed 200 lbs my BMI would be 25.7, and at 245 pounds my BMI would be 31.5. The values for normal weight are 18.5-24.9. One is considered overweight if the BMI is 25-29.9, and values of 30 or greater reflect obesity.

Research has clearly demonstrated that both obesity and osteoarthritis are conditions associated with chronic inflammation.

It is difficult for me to imagine weighing 75 pounds more than my present weight; however that would put me at the average BMI of the GAIT subjects (3), except that the mean age of the subjects was 59 years and 64% were women with a BMI of 31.7. So I try to visualize myself at age 60 with an additional 75 pounds of fat on my body, and I find it extremely difficult to believe that 1.5 grams of glucosamine and 1.2 grams of chondroitin (1/2 teaspoon) will do anything at all for my aches and pains or prevent my knee joint space from narrowing.

Interestingly, the study that demonstrated the best outcomes in terms of pain reduction and joint space protection involved subjects with average age of 62 years with a BMI of about 25.7, which means they were just barely overweight (2). The study with the next best outcome involved 66 year-old subjects with an average BMI of 27.3 (1).

I suggest pursuing an anti-inflammatory lifestyle that includes appropriate exercise, and a diet that focuses on lean meats, fresh fish, skinless chicken, vegetables, fruit and nuts. (8,9)


 

A recent study endeavored to determine factors that could predict success with glucosamine sulfate in the treatment of knee osteoarthritis. Not surprisingly, a lower BMI turned out to be a predictor (7).

While glucosamine/chondroitin as a single treatment can be very effective for some individuals, it is likely that patients will more effectively reduce their OA pains and preserve joint space if they take glucosamine/chondroitin and lose weight. I suggest pursuing an anti-inflammatory lifestyle that includes appropriate exercise, and a diet that focuses on lean meats, fresh fish, skinless chicken, vegetables, fruit and nuts. (8,9)

Research has clearly demonstrated that both obesity and osteoarthritis are conditions associated with chronic inflammation. A detailed article on each subject is available at www.deflame.com. (10)

  1. Reginster JY, Deroisy R, Rovati LC, et al. Long-term effects of glucosamine sulphate on osteoarthritis progression: a randomised, placebo-controlled clinical trial. Lancet. 2001; 357:251-56.
  2. Pavelka K, Gatterova J, Olejarova M, Machacek S, Giacovelli G, Rovati LC. Glucosamine sulfate use and delay of progression of knee osteoarthritis: a 3-year, randomized, placebo-controlled, double-blind study. Arch Intern Med. 2002; 162:2113–23.
  3. Clegg DO, Reda DJ, Harris CL et al. Glucosamine, chondroitin sulfate, and the two in combination for painful knee osteoarthritis. New Eng J Med 2006; 354:795-808.
  4. Sawitzke AD, Shi H, Finco MF et al. The effect of glucosamine and/or chondroitin sulfate on the progression of knee osteoarthritis. Arthritis Rheum. 2008;58:3183-91.
  5. Rozendaal RM, Koes BW, van Osch G et al. Effect of glucosamine sulfate on hip osteoarthritis a randomized trial. Ann Intern Med. 2008;148:268-277.
  6. van Blitterswijk WJ, van de Nes JC, and Wuisman PI. Glucosamine and chondroitin sulfate supplementation to treat symptomatic disc degeneration: Biochemical rationale and case report. BMC Complementary and Alternative Medicine 2003, 3:2.
  7. Bennett AN, Crossley KM, Brukner PD, Hinman RS. Predictors of symptomatic response to glucosamine in knee osteoarthritis: an exploratory study. Br J Sports Med 2007;41:415–419.
  8. Cordain L, Eaton SB, Sebastian A et al. Origins and evolution of the western diet: health implications for the 21st century. Am J Clin Nutr. 2005;81:341-54.
  9. Franco OH, Bonneux L, de Laet C, Peeters A, Steyerberg EW, Mackenbach JP. The Polymeal: a more natural, safer, and probably tastier (than the Polypill) strategy to reduce cardiovascular disease by more than 75%. Brit Med J 2004; 329:1447-50.