#276 Glucosamine & Chondroitin: Natural remedies for osteoarthritis?
CLINICAL QUESTION
Does glucosamine and/or chondroitin improve pain for patients with osteoarthritis?
BOTTOM LINE
Glucosamine and chondroitin do not appear to be effective in higher-quality, larger and/or publicly funded studies. If studies at high risk of bias are included, at best ~10% more people will have meaningful reduction in pain with either treatment over 35-45% of people with placebo. There is reason to doubt the effectiveness of either treatments.
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EVIDENCE
Results statistically significant unless indicated.
- Glucosamine:
- 11 systematic reviews:1-11 glucosamine 1500mg/day versus placebo [2-25 randomized controlled trials (RCTs), 414-4963 patients]:
- Proportion of patients attaining meaningful pain reduction (generally ≥30% reduced pain) from two meta-analyses:
- Most recent meta-analysis (9 RCTs, 1643 patients).1After 4-156 weeks:
- 47% glucosamine versus 37% placebo, number needed to treat (NNT)=11.
- Other analysis found similar.2
- Most recent meta-analysis (9 RCTs, 1643 patients).1After 4-156 weeks:
- Proportion of patients attaining meaningful pain reduction (generally ≥30% reduced pain) from two meta-analyses:
- Change in 100-point pain scale: meta-analysis3 re-run by PEER. Baseline pain of 52, placebo reduced pain ~13, glucosamine reduced pain:
- Larger RCTs, same as placebo.
- Smaller RCTs, ~12 better than placebo.
- 11 systematic reviews:1-11 glucosamine 1500mg/day versus placebo [2-25 randomized controlled trials (RCTs), 414-4963 patients]:
- Chondroitin:
- 11 systematic reviews:1,3,4,10-17 chondroitin 800-1200mg/day versus placebo (6-18 RCTs, 362-4044 patients):
- Proportion of patients attaining meaningful pain reduction:
- Most recent analysis (9 RCTs, 2477 patients).1 After 12-48 weeks:
- 57% chondroitin versus 45% placebo, NNT=9.
- Other meta-analysis found no difference (1 RCT, 330 patients).12
- Most recent analysis (9 RCTs, 2477 patients).1 After 12-48 weeks:
- Proportion of patients attaining meaningful pain reduction:
- Change in 100-point pain scale: meta-analysis3 re-run by PEER. Baseline pain of 56, placebo reduced pain ~19, chondroitin reduced pain:
- Larger RCTs, ~4 better than placebo.
- Smaller RCTs, ~12 better than placebo.
- 11 systematic reviews:1,3,4,10-17 chondroitin 800-1200mg/day versus placebo (6-18 RCTs, 362-4044 patients):
- Combination:
- 6 systematic reviews:4,10-12,18 glucosamine/chondroitin combined versus placebo:
- Only one RCT examined meaningful pain reductions: effect similar to components alone.12
- Change in 100-point pain scale: not different from placebo.3,18
- 6 systematic reviews:4,10-12,18 glucosamine/chondroitin combined versus placebo:
- Limits: mostly knee osteoarthritis studied.1 No benefit of glucosamine or chondroitin over placebo in publicly funded1, high-quality, or larger RCTs.4,12
- Many meta-analyses report “standard mean differences” which are difficult to apply clinically and are not reported here.2,4,5,7,9-17
- Pain studies should consider both percentage of patients reaching meaningful improvement and changes in scale.
- Adverse events infrequently reported.
- Osteoarthritis online calculator19 or PEER simplified decision aid20 can assist with patient-informed decision making.
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I have always been skeptical of these supplements. Sometimes an orthopedic surgeon will start them and the patient buys into it and improves, but it’s good to know that is likely a result of good salesmanship as I had suspected.
glucosamine ineffective for OA pain