Chondroitin Sulfate
Chondroitin sulfate is used for osteoarthritis symptoms. Effect sizes are often modest and product quality varies.
Overview
What is chondroitin sulfate?
Chondroitin sulfate is a compound known as a glycosaminoglycan that is found in hyaline cartilage.
Chondroitin sulfate is hydrophilic allowing it to aid in the hydration and mechanical support of joints.
Most people take chondroitin supplements with glucosamine to support joint health and to treat osteoarthritis, however there is limited reliable evidence for either supplement.
Some studies have found that chondroitin may act faster than glucosamine to prevent joint space narrowing, with benefits found at 2 years instead of 3 years.
Other supplements including type II collagen, curcumin and green-lipped mussel extract appear to have a greater clinical effect or relevance compared to chondroitin sulfate.
Dosage
A typical dose of chondroitin sulfate is 800–1200 mg per day, taken either as single dose or as 2–3 separate doses.
Studies have used a dose of 1200 mg per day (3 × 400 mg) for up to 2 years.
Effect graph
Effect heatmap
SupplementDEX Database
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Database Snapshot
Most chondroitin sulfate research is concentrated in a handful of conditions.
- Osteoarthritis accounts for 32 of 32 studies (100%).
Dietary Sources
Dietary sources
Whilst chondroitin supplements are derived from bovine (cow) cartilage, shark cartilage and pork cartilage, supplements are the easiest way to intake chondroitin sulfate in meaningful quantities.
Safety
Chondroitin sulfate is generally safe and well tolerated at a dose of 1500 mg per day.
Dose windows
Short-term
Use of chondroitin sulfate is well tolerated at the recommended dosages.
Long-term
Use of chondroitin sulfate is well tolerated at the recommended dosages. Dosages of up to 2 g per day have been used for up to 6 years in studies.
Special populations
Pregnancy & breastfeeding
AvoidThere is insufficient information on chondroitin supplementation in pregnant and lactating women. Usage should be avoided in these populations.
Children
AvoidThere is insufficient information on chondroitin supplementation in children. Supplementation should be avoided.
Other notes
Rare side effects including nausea, gastrointestinal discomfort and vomiting may occur in some people. Market Report: Poor. Significant variability in quality exists. While many products meet label claims, inconsistencies have been noted in third-party testing. Consumer Reports found that 7/16 popular glucosamine and chondroitin supplements did not meet label claims. An examination[34] of 25 European chondroitin and glucosamine supplements by multiple analytical methods (including high performance chromatography, nuclear magnetic resonance, capillary electrophoresis) found low ingredient quality from multiple animal origins and contamination by keratan sulfate. Only 3 out of 10 products exhibited in vitro behaviour similar to the pharmaceutical chondroitin sulfate product. A study[35] from the Czech Republic found that only 4 out of 10 chondroitin supplements were accurate to the label. The primary concerns involve poor dissolution, underdosing, low purity and contamination. Consumers are advised to choose products with third-party verification for optimal quality assurance.[36][37]
Frequently Asked Questions
Takeaway
Chondroitin supplements are commonly marketed for osteoarthritis and knee pain but most studies only find an inconsistent and weak benefit for joint pain and function.
In studies that do find a benefit for joint function, chondroitin may act faster than glucosamine, and can prevent joint space narrowing after 2 years instead of 3 years.
Other supplements including collagen, curcumin, green lipped mussel extract and boswellia serrata are more effective for those with symptoms of osteoarthritis including knee pain and function.
References
Sources37 references
SupplementDEX uses only high-quality sources to determine supplement effectiveness.
SupplementDEX Database · Osteoarthritis
32 references1.SupplementDEX Database: Osteoarthritis — Evaluation of efficacy and safety of glucosamine sulfate, chondroitin sulfate, and their combination regimen in the management of knee osteoarthritis: a systematic review and meta-analysis2024
A 2024 meta-analysis of 25 RCTs found chondroitin sulfate reduced pain and improved function versus placebo, glucosamine reduced joint space narrowing, and combined therapy did not significantly improve symptoms.
2.SupplementDEX Database: Osteoarthritis — Chondroitin sulfate and glucosamine combination in patients with knee and hip osteoarthritis: A long-term observational study in Russia2023
In 1,102 knee and hip osteoarthritis patients followed up to 64 weeks, long-term glucosamine plus chondroitin improved pain, function, quality of life, and reduced NSAID use in routine care.
3.SupplementDEX Database: Osteoarthritis — 2019 American College of Rheumatology/Arthritis Foundation Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee2020
The 2019 ACR/Arthritis Foundation guideline conditionally recommends chondroitin sulfate for hand osteoarthritis and advises shared decision-making for other osteoarthritis treatments.
4.SupplementDEX Database: Osteoarthritis — Efficacy of Chondroitin Sulfate in Patients with Knee Osteoarthritis: A Comprehensive Meta-Analysis Exploring Inconsistencies in Randomized, Placebo-Controlled Trials2019
A meta-analysis of 18 knee osteoarthritis trials found chondroitin sulfate reduced pain and improved function, with more consistent benefits in low-bias pharmaceutical-grade preparations.
5.SupplementDEX Database: Osteoarthritis — An updated algorithm recommendation for the management of knee osteoarthritis from the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO)2019
The 2019 ESCEO knee osteoarthritis algorithm recommends non-pharmacological care throughout disease management and assigns graded recommendations to available pharmacologic options.
6.SupplementDEX Database: Osteoarthritis — Effect of glucosamine and chondroitin sulfate in symptomatic knee osteoarthritis: a systematic review and meta-analysis of randomized placebo-controlled trials2018
A meta-analysis found glucosamine and chondroitin each reduced pain on visual analog scales in knee osteoarthritis, but their combination did not significantly improve WOMAC scores.
7.SupplementDEX Database: Osteoarthritis — Effects of glucosamine in patients with osteoarthritis of the knee: a systematic review and meta-analysis2018
A meta-analysis of 18 glucosamine RCTs found marginally favorable pain effects in knee osteoarthritis, though WOMAC function improvements were small and not significant.
8.SupplementDEX Database: Osteoarthritis — Dietary supplements for treating osteoarthritis: a systematic review and meta-analysis2018
A meta-analysis of 69 osteoarthritis supplement trials found chondroitin and glucosamine produced only small, clinically unclear pain reductions, while collagen and curcumin showed larger short-term effects.
9.SupplementDEX Database: Osteoarthritis — Pharmaceutical-grade Chondroitin sulfate is as effective as celecoxib and superior to placebo in symptomatic knee osteoarthritis: the ChONdroitin versus CElecoxib versus Placebo Trial (CONCEPT)2017
In 604 knee osteoarthritis patients over 6 months, pharmaceutical-grade chondroitin sulfate 800 mg/day was as effective as celecoxib and superior to placebo for pain and function.
10.SupplementDEX Database: Osteoarthritis — Combined Treatment With Chondroitin Sulfate and Glucosamine Sulfate Shows No Superiority Over Placebo for Reduction of Joint Pain and Functional Impairment in Patients With Knee Osteoarthritis: A Six-Month Multicenter, Randomized, Double-Blind, Placebo-Controlled Clinical Trial2017
In 164 knee osteoarthritis patients, 6 months of combined chondroitin sulfate and glucosamine did not significantly reduce pain or functional impairment versus placebo.
11.SupplementDEX Database: Osteoarthritis — Chondroitin sulfate efficacy versus celecoxib on knee osteoarthritis structural changes using magnetic resonance imaging: a 2-year multicentre exploratory study2016
In a 24-month MRI trial of 138 knee osteoarthritis patients, chondroitin sulfate 1,200 mg/day slowed medial cartilage volume loss versus celecoxib 200 mg/day.
12.SupplementDEX Database: Osteoarthritis — A consensus statement on the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO) algorithm for the management of knee osteoarthritis-From evidence-based medicine to the real-life setting2016
An ESCEO consensus statement reviewed real-world evidence supporting pharmaceutical-grade glucosamine sulfate and chondroitin sulfate as first-line symptomatic slow-acting drugs for osteoarthritis.
13.SupplementDEX Database: Osteoarthritis — Combined chondroitin sulfate and glucosamine for painful knee osteoarthritis: a multicentre, randomised, double-blind, non-inferiority trial versus celecoxib2016
In 606 patients with painful knee osteoarthritis, combined chondroitin and glucosamine was non-inferior to celecoxib for pain and function over 6 months.
14.SupplementDEX Database: Osteoarthritis — Chondroitin for osteoarthritis2015
A Cochrane review of 43 trials found chondroitin modestly improved osteoarthritis pain and function versus placebo, though evidence quality was often low and heterogeneous.
15.SupplementDEX Database: Osteoarthritis — Effectiveness and safety of Glucosamine, chondroitin, the two in combination, or celecoxib in the treatment of osteoarthritis of the knee2015
A meta-analysis of 54 trials (16,427 patients) found glucosamine, chondroitin, and celecoxib each beat placebo for pain and function, with celecoxib ranking highest for symptom relief.
16.SupplementDEX Database: Osteoarthritis — Glucosamine and chondroitin for knee osteoarthritis: a double-blind randomised placebo-controlled clinical trial evaluating single and combination regimens2015
In 605 knee osteoarthritis patients over 2 years, glucosamine plus chondroitin reduced joint space narrowing versus placebo, but no group showed significant symptomatic benefit over placebo.
17.SupplementDEX Database: Osteoarthritis — Equivalence of a single dose (1200 mg) compared to a three-time a day dose (400 mg) of chondroitin 4&6 sulfate in patients with knee osteoarthritis. Results of a randomized double blind placebo controlled study2013
In 353 knee osteoarthritis patients, a single 1,200 mg daily chondroitin dose was equivalent to 400 mg three times daily and superior to placebo for symptoms over 3 months.
18.SupplementDEX Database: Osteoarthritis — Effect of 12 months treatment with chondroitin sulfate on cartilage volume in knee osteoarthritis patients: a randomized, double-blind, placebo-controlled pilot study using MRI2012
In a 48-week pilot of 43 knee osteoarthritis patients, chondroitin sulfate showed a trend toward less cartilage volume loss on MRI versus placebo, but between-group differences were not significant.
19.SupplementDEX Database: Osteoarthritis — Effect of the novel low molecular weight hydrolyzed chicken sternal cartilage extract, BioCell Collagen, on improving osteoarthritis-related symptoms: a randomized, double-blind, placebo-controlled trial2012
In 80 osteoarthritis patients over 70 days, BioCell Collagen 2 g/day reduced pain and improved physical function versus placebo.
20.SupplementDEX Database: Osteoarthritis — Symptom-modifying effect of chondroitin sulfate in knee osteoarthritis: a meta-analysis of randomized placebo-controlled trials performed with structum(®)2012
A meta-analysis of Structum chondroitin trials found a modest 6 mm reduction in activity pain on visual analog scales versus placebo after 3–6 months.
21.SupplementDEX Database: Osteoarthritis — Symptomatic effects of chondroitin 4 and chondroitin 6 sulfate on hand osteoarthritis: a randomized, double-blind, placebo-controlled clinical trial at a single center2011
In 162 hand osteoarthritis patients, chondroitin 4 and 6 sulfate 800 mg/day for 6 months improved hand pain and function versus placebo.
22.SupplementDEX Database: Osteoarthritis — Chondroitin sulphate reduces both cartilage volume loss and bone marrow lesions in knee osteoarthritis patients starting as early as 6 months after initiation of therapy: a randomised, double-blind, placebo-controlled pilot study using MRI2011
In 69 knee osteoarthritis patients with synovitis, 800 mg/day chondroitin for 6 months reduced cartilage volume loss and bone marrow lesions versus placebo.
23.SupplementDEX Database: Osteoarthritis — Effect of glucosamine or chondroitin sulfate on the osteoarthritis progression: a meta-analysis2010
A meta-analysis of six long-term trials found glucosamine after 3 years and chondroitin after 2 years significantly slowed minimum joint space narrowing in knee osteoarthritis.
24.SupplementDEX Database: Osteoarthritis — Effectiveness of chondroitin sulphate in patients with concomitant knee osteoarthritis and psoriasis: a randomized, double-blind, placebo-controlled study2010
In 129 knee osteoarthritis patients with psoriasis, 800 mg/day chondroitin sulfate for 3 months improved knee pain and function versus placebo without worsening psoriasis.
25.SupplementDEX Database: Osteoarthritis — Structure-modifying effects of chondroitin sulfate in knee osteoarthritis: an updated meta-analysis of randomized placebo-controlled trials of 2-year duration2010
An updated meta-analysis of three 2-year RCTs found chondroitin sulfate significantly reduced joint space narrowing rate by 0.13 mm versus placebo in knee osteoarthritis.
26.SupplementDEX Database: Osteoarthritis — Long-term effects of chondroitins 4 and 6 sulfate on knee osteoarthritis: the study on osteoarthritis progression prevention, a two-year, randomized, double-blind, placebo-controlled trial2009
In 622 knee osteoarthritis patients over 2 years, 800 mg/day chondroitin sulfate significantly slowed joint space narrowing and reduced pain faster than placebo.
27.SupplementDEX Database: Osteoarthritis — Glucosamine, chondroitin sulfate, and the two in combination for painful knee osteoarthritis2006
In 1,583 patients with knee osteoarthritis, glucosamine and chondroitin alone or combined did not beat placebo overall for pain relief; combined therapy helped in the moderate-to-severe pain subgroup.
28.SupplementDEX Database: Osteoarthritis — Chondroitins 4 and 6 sulfate in osteoarthritis of the knee: a randomized, controlled trial2005
In 300 knee osteoarthritis patients over 2 years, 800 mg/day chondroitin sulfate halted joint space narrowing versus progressive loss in the placebo group.
29.SupplementDEX Database: Osteoarthritis — Efficacy of a combination of FCHG49 glucosamine hydrochloride, TRH122 low molecular weight sodium chondroitin sulfate and manganese ascorbate in the management of knee osteoarthritis2000
In 72 patients with mild-to-moderate knee osteoarthritis, a glucosamine, chondroitin, and manganese combination improved pain and function versus placebo over 6 months.
30.SupplementDEX Database: Osteoarthritis — Glucosamine, chondroitin, and manganese ascorbate for degenerative joint disease of the knee or low back: a randomized, double-blind, placebo-controlled pilot study1999
In 34 men with knee or low-back degenerative joint disease, glucosamine, chondroitin, and manganese for 16 weeks modestly relieved knee symptoms versus placebo.
31.SupplementDEX Database: Osteoarthritis — Chondroitin sulfate: S/DMOAD (structure/disease modifying anti-osteoarthritis drug) in the treatment of finger joint OA1998
In 119 finger osteoarthritis patients, chondroitin sulfate 1,200 mg/day for up to 3 years reduced progression to erosive finger joint disease versus placebo.
32.SupplementDEX Database: Osteoarthritis — Comparison of the antiinflammatory efficacy of chondroitin sulfate and diclofenac sodium in patients with knee osteoarthritis1996
In 146 knee osteoarthritis patients, chondroitin sulfate matched diclofenac for symptom relief over 3 months, with benefits persisting up to 3 months after stopping treatment.
Dosing
1 reference33.(Chondroitin dose 1200 mg, 2 years)External source
Safety
4 references34.(European chondroitin and glucosamine supplement quality)External source
35.(Czech Republic chondroitin label accuracy). See external sourceExternal source
36.Consumer Reports: facts about joint supplements. See external sourceExternal source
37.(Supplement quality, third-party verification)External source