Glucosamine

Supplementation in
Osteoarthritis
Josie Oleson
1st Year MS/DI
 Learning Objectives
•  Describe osteoarthritis (OA) and its global
burden
•  Describe glucosamine’s purpose in the
human body and its use in dietary
supplements
•  Review current literature in treatment of OA
with glucosamine
 Osteoarthritis
•  Most common form of arthritis1,3
•  Pathophysiology: gradual breakdown of
joint cartilage
o  Slowly exposes bone
o  Pain, decreased function, disability
o  Symptoms: joint stiffness, deformity, instability, crepitation1,2,3

•  Age is main risk factor

o  Other risk factors: female, overweight or obese3,4
 Impact of OA
•  2010 Global Burden of Disease: OA
ranked 11th in terms of years lived with
disability1
o  Moved up from 15th in 1990

•  Nutrition quality of life2:

o  75% of subjects with OA said diet impacts health
o  22.5% consulted a physician or RD about diet
o  17% made dietary changes after OA diagnosis
o  40% reported taking glucosamine supplements, with very
few having discussed this with their PCP
 Treatments
•  Goals: minimize pain and loss of joint
function3
•  Non-pharmacologic:
o  Physical therapy
o  Ambulation supports
o  Braces3

•  Pharmacologic:
o  NSAIDs
o  Acetaminophen
o  Opioid analgesics3

•  Surgical:
o  Joint replacement3
 Glucosamine Sulfate
•  Precursor to major component of joint cartilage and
surrounding fluid4-6
•  Supplement form intends to maintain/replenish
cartilage and surrounding fluid
 Glucosamine
Supplements
•  Formulations:
o  Glucosamine sulfate
o  Glucosamine hydrochloride
o  N-acetyl-glucosamine6

•  Dosing: 500 mg 3x/day4

•  Produced synthetically or using shells of
crustaceans6
•  Often used with chondroitin4,6,7
Current Evidence
 GAIT
•  Glucosamine/Chondroitin Arthritis Intervention
Trial
•  Compared effect of glucosamine, chondroitin,
glucosamine with chondroitin, celecoxib, or
placebo on knee OA for 24 weeks4
o  Celecoxib: 70% had ≥20% pain reduction
o  Placebo: 60% had ≥20% pain reduction
o  No significant differences between other treatment groups

•  Subset with moderate to severe knee OA4:

o  79% had ≥20% pain reduction with combination glucosamine and
chondroitin
o  Small sample size in this subset – not enough data to generalize
 OA Trial Bank
•  Pooled individual patient data from RCTs examining
glucosamine’s effect on OA pain and joint function
and structure
•  Measurements taken at 3-6 months and 1 year
•  Glucosamine no better than placebo for pain
reduction or improved joint function8

•  Study discusses lack of industry-sourced data

included in analysis
 Meta-analysis of RCTs
•  Examined efficacy and safety of
glucosamine, chondroitin, glucosamine with
chondroitin, celecoxib, or placebo on OA7
•  Results:
o  All treatments except placebo produced significantly reduced
pain
o  Celecoxib had 81% effectiveness7
•  Improved joint function
o  Glucosamine with chondroitin had 74% effectiveness7
•  Significant slowing in joint space width compared to placebo
•  Improved joint function
 RCT
•  Examined effectiveness of glucosamine or
glucosamine with diacerin on OA5
o  Diacerin: interleukin-1 inhibitor, used mostly in Europe and Asia

•  Results:
o  Treatments not significantly different from one another5
o  OA symptoms improved, but types and magnitude of
improvements are not given5
 Conclusion
•  Effectiveness of glucosamine for OA
management remains unclear
o  Research differs by treatment design, brand and dosage of
supplements, timing of follow-ups, and sample sizes7

•  Few side effects noted

o  GI upset
o  Increased blood glucose in people with diabetes

•  The following organizations do not support

the use of glucosamine for OA
management:
o  American College of Rheumatology
o  American Academy of Orthopedic Surgeons
o  Osteoarthritis Research Society International (OARSI)
 Resources
1. Cross M, Smith E, Hoy D, et al. The global burden of hip and knee osteoarthritis:
estimates from the global burden of disease 2010 study. Annals of the rheumatic
diseases. 2014;73(7):1323-1330.
2. Grygielska J, Klak A, Raciborski F, Manczak M. Nutrition and quality of life
referring to physical abilities - a comparative analysis of a questionnaire study of
patients with rheumatoid arthritis and osteoarthritis. Reumatologia. 2017;55(5):
222-229.
3. Kasper DL, Fauci, Anthony S., Hauser, Stephen L., Longo, Dan L., Jameson, J.
Larry, Loscalzo, Joseph. Osteoarthritis. Harrison’s Manual of Medicine, 19e2016.
4. The NIH Glucosamine/Chondroitin Arthritis Intervention Trial (GAIT). Journal of
pain & palliative care pharmacotherapy. 2008;22(1):39-43.
5. Kongtharvonskul J, Woratanarat P, McEvoy M, et al. Efficacy of glucosamine
plus diacerein versus monotherapy of glucosamine: a double-blind, parallel
randomized clinical trial. Arthritis research & therapy. 2016;18(1):233.
6. Glucosamine Sulfate. 2017; https://medlineplus.gov/druginfo/natural/807.html.
Accessed March 1, 2018.
7. Zeng C, Wei J, Li H, et al. Effectiveness and safety of Glucosamine, chondroitin,
the two in combination, or celecoxib in the treatment of osteoarthritis of the knee.
Scientific reports. 2015;5:16827.
8. Runhaar J, Rozendaal RM, van Middelkoop M, et al. Subgroup analyses of the
effectiveness of oral glucosamine for knee and hip osteoarthritis: a systematic
review and individual patient data meta-analysis from the OA trial bank. Annals
of the rheumatic diseases. 2017;76(11):1862-1869.