Your joints endure repetitive forces that would quickly wear out most machines. Still, time takes its toll on joint cartilage, and can eventually result in osteoarthritis, or OA. Glucosamine combination products are supposed to treat OA by reducing cartilage loss and improving repair. Before taking glucosamine, discuss it with your doctor, as you would any new treatment regimen.
OA, Cartilage and Glucosamine
Cartilage is made by chondrocytes, cells that produce a complex matrix of collagen and proteoglycans, proteins covered with chains of sugar molecules. One of the most important of these sugars is glucosamine. The idea behind glucosamine supplements is to provide chondrocytes with glucosamine for the manufacture of new cartilage matrix.
Glucosamine Combination Products
If replacing one component of cartilage matrix is good, you might suppose that replacing two in a combination product would be better. The most widely sold and frequently studied combination is glucosamine with chondroitin, another sugar component of cartilage proteoglycans.
Safety of Glucosasmine Combination Products
A large body of research, including the systematic review studies discussed below, indicates that glucosamine combination products are well-tolerated and safe. Side effects are mild and infrequent, and include rash and gastrointestinal upset. A risk assessment of both glucosamine and chondroitin published by Hathcock and Shao in 2007 supports the long-term safety of these drugs. However, you should remember that such products are not tightly regulated in the U.S., and variability in their manufacture is to be expected.
Efficacy of Glucosamine Combination Products
If you take glucosamine products, they should reduce your pain, or reduce joint damage, or both. Unfortunately, as of 2010, the evidence from individual studies varies so widely that we must turn to large "meta-analyses," or systematic reviews of the research, for a clearer picture. A 2009 review by Black et al found some evidence for reduction in pain and damage, although the effect was not large. A 2009 analysis by the Cochrane Collaboration found that if only the best studies were analyzed there was no difference between glucosamine preparations and placebos. A meta-analysis published by Wandel et al in the British Medical Journal in 2010, which examined 10 large-scale randomized trials, found that glucosamine products did not reduce joint space narrowing, an indicator of joint damage, nor did they have an effect on pain.
Summary: If Glucosamine Helps, It Doesn't Help Much
As of 2010, data supporting the efficacy of glucosamine compounds in OA is mixed at best. This suggests that even if glucosamine has a beneficial effect, it's not dramatic. If you're an OA sufferer, you might conclude that every little bit helps, and that the cost of a glucosamine preparation is worth the small and uncertain potential benefit. This is not unreasonable, but given the evidence it is not realistic to expect glucosamine products to have a major impact on OA.
References
- "Health Technology Assessments"; The clinical effectiveness of glucosamine and chondroitin supplements in slowing or arresting progression of osteoarthritis of the knee: a systematic review and economic evaluation; Black, C et al; 2009
- "British Medical Journal"; Effects of glucosamine, chondroitin, or placebo in patients with osteoarthritis of hip or knee: network meta-analysis; Wandel et al, 2010
- "The Cochrane Collaboration"; Glucosamine therapy for osteoarthritis; Towheed T et al; 2008
- "Regulatory Toxicology Pharmacology"; Risk assessment for glucosamine and chondroitin sulfate; Hathcock and Shao; 2007
- "Internationsl Journal of Experimental Pathology"; Proteoglycans and more -- from molecules to biology; Heinegard D, 2009
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