Glucosamine

A meta-analysis of 25 studies (9 Glucosamine Sulfate [GS], 13 Chondroitin Sulfate [CS], 3 GS + CS) found that chondroitin sulfate improved pain and function, and glucosamine reduced joint space narrowing. The combination treatment did not significantly improve joint space narrowing, knee pain or physical function. [10525]

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.

A meta-analysis of RCTs found adding glucosamine or glucosamine plus chondroitin to exercise did not significantly improve knee osteoarthritis outcomes beyond exercise alone.

In a 6-month observational study of 123 hand osteoarthritis patients, adding prescription glucosamine sulfate 1500 mg/day to conventional therapy improved pain and function versus usual care alone.

In an RCT of 128 knee osteoarthritis patients, celecoxib plus glucosamine hydrochloride improved pain and function scores more than celecoxib alone.

The 2019 ACR/Arthritis Foundation guideline conditionally recommends chondroitin sulfate for hand osteoarthritis and advises shared decision-making for other osteoarthritis treatments.

A systematic quality analysis of European glucosamine and chondroitin supplements found wide variability in labeled content and biological activity across marketed products.

The 2019 ESCEO knee osteoarthritis algorithm recommends non-pharmacological care throughout disease management and assigns graded recommendations to available pharmacologic options.

A meta-analysis of 18 glucosamine RCTs found marginally favorable pain effects in knee osteoarthritis, though WOMAC function improvements were small and not significant.

A meta-analysis of 47 long-term randomised controlled trials (duration ≥12 months) found that glucosamine sulfate had an inconsistent effect for pain and joint space narrowing. Celecoxib and glucosamine sulfate were associated with inconsistent benefits for pain. For joint space narrowing, glucosamine had the greatest association with improvement, followed by strontium ranelate and chondroitin sulfate. [10526]

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.

A study of 174 patients with knee osteoarthritis and moderate-to-severe knee pain found that a combination of glucosamine and chondroitin sulfate was no better than placebo for reducing pain after 6 months. [10527]

In a 6–7 year factorial RCT of 245 overweight women (ages 50–60), lifestyle intervention and oral glucosamine sulfate did not significantly reduce incident knee osteoarthritis versus control.

In 606 patients with painful knee osteoarthritis, combined chondroitin and glucosamine was non-inferior to celecoxib for pain and function over 6 months.

In the PROOF study of 407 overweight women (ages 50–60), neither diet-exercise program nor glucosamine sulfate 1500 mg/day significantly prevented radiographic knee osteoarthritis over follow-up.

A systematic review and network meta-analysis of 31 studies found that glucosamine was beneficial for knee pain and similarly effective to diacerein. Glucosamine carried a lower risk of adverse gastrointestinal side effects compared to diacerein. Neither treatment slowed progression of joint space narrowing in knee osteoarthritis. [10528]

A 2-year study including 605 patients (36% obese) with chronic knee pain and joint space narrowing found that neither glucosamine sulfate (1500 mg/day) or chondroitin sulfate (800 mg/day) improved pain or joint space width compared to placebo after 1 year. A combination of 1500 mg/day glucosamine sulfate and 800 mg/day chondroitin sulfate reduced joint space narrowing by 50% compared to placebo after 2 years. [10529]

In an RCT of 1120 knee OA patients over 16 weeks, glucosamine/chondroitin capsules or sachets three times daily and once daily all similarly reduced pain versus glucosamine hydrochloride/chondroitin.

A Cochrane review of 43 trials found chondroitin modestly improved osteoarthritis pain and function versus placebo, though evidence quality was often low and heterogeneous.

A meta-analysis of 25 trials including 3458 participants found that glucosamine sulfate but not glucosamine hydrochloride had an inconsistent but small benefit for pain, with inconsistent benefits in part due to the use of different glucosamine brands/products. The high-quality studies in the meta-analysis with low risk of bias showed little to no benefit for pain. [10530]

In a 24-week RCT of 201 adults with chronic knee pain, oral glucosamine did not slow MRI-measured cartilage loss versus placebo.

A meta-analysis of 19 trials including 3159 participants found that glucosamine sulfate did not improve knee pain after 6 months but may improve knee function when taken for longer than 24 weeks. [10531]

In a 16-week RCT of 40 Japanese adults with knee OA, a glucosamine-chondroitin-quercetin supplement did not significantly improve WOMAC pain scores versus placebo.

In a 2-year RCT of 662 knee OA patients, glucosamine, chondroitin, and their combination did not reduce joint space narrowing or pain more than celecoxib or placebo.

A meta-analysis of 2 studies found that 1500 mg/day glucosamine sulfate had a small to moderate protective effect on joint space narrowing after 3 years but no effect after 1 year of supplementation. [10039]

A network meta-analysis of RCTs (3803 patients) found glucosamine and chondroitin did not produce clinically meaningful pain relief in hip or knee osteoarthritis versus placebo.

In a double-blind RCT of 250 adults with chronic low back pain and lumbar OA, glucosamine 1500 mg/day for 6 months did not reduce pain-related disability versus placebo.

A 24-week study of 56 patients found that glucosamine sulfate (1500 mg/day for 12 weeks) improved resting knee pain at 8-16 weeks (16 weeks = 4 weeks post-treatment), reduced pain during movement at 12-16 weeks and improved physical function at weeks 8-20, but not week 24. Glucosamine sulfate consumption was associated with reduced consumption of analgesic drugs (Acetaminophen or NSAIDs). [10532]

In a 2-year RCT of 222 hip OA patients, glucosamine sulfate 1500 mg/day did not slow joint space narrowing or improve symptoms in the overall cohort or predefined subgroups.

An editorial review concluded evidence remained insufficient to recommend glucosamine sulfate routinely for osteoarthritis symptom or structure modification.

In an 18-month RCT of 142 women with knee OA on home exercise, adding glucosamine or risedronate did not improve pain or function beyond exercise alone.

In a 2-year RCT of 222 hip OA patients, glucosamine sulfate 1500 mg/day did not reduce symptoms or slow joint space narrowing versus placebo.

Randomized double-blind placebo-controlled trial (with acetaminophen as side comparator) demonstrating that glucosamine sulfate significantly reduced knee osteoarthritis symptoms over placebo. A 6-month study including 318 patients with moderate knee osteoarthritis (~11 Lequesne Score) given either acetaminophen (3 g/day) or glucosamine sulfate (1500 mg/day) found that only glucosamine sulfate had a significant benefit for osteoarthritis symptoms compared to placebo treatment. Glucosamine sulfate significantly reduced Lequesne score by 3.1 points versus 1.9 with placebo. Acetaminophen reduced Lequesne score by 2.7 points but this was not statistically significant (P=0.18). [10534]

In a 12-month RCT of 89 older adults with knee OA, glucosamine/chondroitin 1500/1200 mg added to exercise did not improve physical function or pain beyond exercise and placebo.

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.

A review of 2 randomised controlled studies including 414 patients with knee osteoarthritis found that 1500 mg/day glucosamine sulfate reduced disease progression (joint space narrowing) by 54% compared to placebo. Both studies lasted 3 years. [10535]

A manufacturer-funded review of studies found that a dose of around 1,500 mg/day glucosamine sulfate taken for up to 3 years had inconsistent benefits for pain, with greater benefits found in Rotta preparation of glucosamine and no benefit from non-Rotta preparation. Rotta preparations were found in two studies to slow progression of osteoarthritis of the knee. In a total of four studies, Rotta preparation was shown to be superior to NSAIDs in two studies and equivalent in the other two. [10536]

A combination of two independent, three-year randomised controlled studies examined the effects of glucosamine sulfate in a total of 414 patients (319 postmenopausal women). Postmenopausal women taking placebo experienced an average joint space narrowing of -0.33 mm whilst there was no change in women taking glucosamine sulfate after 3 years. [10537]

In a double-blind RCT, a topical cream containing glucosamine sulfate, chondroitin sulfate, and camphor did not significantly reduce knee osteoarthritis pain versus placebo.

In an 8-week double-blind RCT of 63 knee OA patients, a topical glucosamine-chondroitin preparation reduced VAS pain scores more than placebo.

A 3-year study of 202 patients with mild-to-moderate knee osteoarthritis (average joint space narrowing width ~ 4mm, Lequesne index score < 9 pts) found that 1500 mg/day glucosamine sulfate slowed progression of joint space narrowing and improved symptoms of pain and stiffness. Around 30% to 40% of patients took acetaminophen (500 mg) at or above the average of once every 3 days, without any effect on joint structure or osteoarthritis symptoms. [10538]

A 6-month study including 80 patients with osteoarthritis of the knee found glucosamine sulfate (1500 mg/day) did not affect global assessment of knee pain compared to placebo. [10539]

A 3-year randomized trial showing that long-term glucosamine sulfate slowed radiographic knee osteoarthritis progression and improved symptoms versus placebo. A 3-year study of 212 patients with knee osteoarthritis found that 1500 mg glucosamine sulfate per day slowed joint space narrowing compared to placebo. There was minimal joint space loss in 106 patients taking glucosamine sulfate (-0.06 mm, 95% CI -0.22 to 0.09) compared to placebo (-0.31 mm, -0.48 to -0.13) after 3 years. [10540]

A 60-day study including 89 patients found that 1500 mg/day glucosamine sulfate was not significantly effective for reducing pain at rest and during walking exercise. The patients were sourced from a Veterans’ medical centre. [10541]

In 72 patients with mild-to-moderate knee osteoarthritis, a glucosamine, chondroitin, and manganese combination improved pain and function versus placebo over 6 months.

In 34 men with knee or low-back degenerative joint disease, glucosamine, chondroitin, and manganese for 16 weeks modestly relieved knee symptoms versus placebo.

A 4-week study of 178 patients with knee osteoarthritis given either 1500 mg/day glucosamine sulfate or 1200 mg/day ibuprofen found similar reductions in pain after 2 and 4 weeks. Dropout rates were greater in the group taking ibuprofen (10%) compared to glucosamine (0%). [10542]

A 4-week study of 200 hospitalised patients with knee osteoarthritis given either 1500 mg/day glucosamine sulfate or 1200mg/day ibuprofen found similar benefits in pain reduction after 2 weeks. However, after one week of supplementation, only around 28% of those taking glucosamine sulfate had a reduction in pain compared to 48% in those taking ibuprofen. Glucosamine sulfate was better tolerated with a 700% reduction in dropout rates and had a 500% reduction in adverse events. [10543]

In a 6-week double-blind RCT of 155 knee OA outpatients, intramuscular glucosamine sulfate was at least as effective as oral glucosamine and superior to placebo for pain and function.