Chondroitin for arthritis same as placebo - meta-analysis

By Stephen Daniells

- Last updated on GMT

Related tags: Chondroitin sulfate

Chondroitin, one of the most popular supplements for joint health,
has the same effect as placebo for osteoarthritis in the hip and
knee, says a new meta-analysis.

The meta-analysis, published in the Annals of Internal Medicine​, reviewed 20 studies using the compound, but ultimately based its conclusion on only three studies, methodology that has drawn criticism from the dietary supplements industry. "Large-scale, methodologically sound trials indicate that the symptomatic benefit of chondroitin is minimal or non-existent. Use of chondroitin in routine clinical practice should therefore be discouraged,"​ said the reviewers, led by Stephan Reichenbach from the University of Bern. However, Dr. Andrew Shao from US trade association Council for Responsible Nutrition (CRN) said that while meta-analyses can be valuable tools they do have recognised limitations. "Although meta-analysis can be a useful tool to examine results from multiple trials, it is still just​ one tool, and in this case focused on only a narrow view of the entire body of evidence on the effect of chondroitin supplementation,"​ he said. Chondroitin sulphate is extracted from animal cartilage like shark cartilage. The supplement is usually sold in combination with glucosamine and, according to the Nutrition Business Journal, US sales for these combined supplements were $810 million (€132 million) in 2005. Reichenbach and collaborators from the University of Bristol and the University of Gottingen, searched four scientific databases and selected studies if they were randomised or quasi-randomised. Twenty trials, consisting of 3846 participants, were included. However, the results were heterogeneous, said the researchers, so they restricted their analysis to only three. While earlier trials reported large benefits for chondroitin the three recent trials did not report a significant effect, a result put down to "not only… lower methodological quality but also to a higher proportion of patients with low-grade osteoarthritis [in the earlier trials]."​ The reviewers state that they could not conclude that chondroitin may offer a clinical relevant effect in people with low-grade osteoarthritis, and called for a large-scale, rigorously designed trial to address this question. "No robust evidence supports the use of chondroitin in osteoarthritis,"​ concluded Reichenbach. "For patients with advanced osteoarthritis, a clinically relevant benefit is unlikely and the use of chondroitin should be discouraged."​ In an accompanying editorial, David Felson from the Boston University and Boston Medical Center asked: "Was is reasonable to select three recent large-scale trials and not summarise all of the evidence?" ​ He answers: "I believe that, by identifying a subgroup of trials with high-quality consistent evidence, they have provided a compelling estimate of the likely efficacy of chondroitin." ​ However, Felson points out that, in the US at least, chondroitin is almost sold in combination with glucosamine, and that the meta-analysis of Reichenbach only focused on chondroitin-only trials. "Therefore, the results of their meta-analysis might not apply to the combined product,"​ he said. Felson, who notes receiving grants from pharma giant Merck, quotes results from the recent Glucosamine/chondroitin Arthritis Intervention Trial (GAIT) that reported null result, and concludes that the combination most likely does not alleviate joint pain. However, the GAIT actually reported that the combination supplement did significantly decrease knee pain associated with moderate-to-sever osteoarthritis. Responding to the meta-analysis, Dr. Shao, vice president, scientific and regulatory affairs for the CRN, said: "One can include and exclude studies in various combination, but the bottom line is consumers use glucosamine and chondroitin supplements because they work."​ CRN stated that the reviewers could have included about 300 studies but, by focusing on only three they excluded the majority of data for this supplement. "With over 21 million osteoarthritis sufferers in the US alone, a conclusion based on only three studies hardly seems representative of the population in question,"​ said the CRN. Approximately seven million people in the UK alone are reported to have long-term health problems associated with arthritis. Around 206 million working days were lost in the UK in 1999-2000, equal to £18 billion (€26 billion) of lost productivity. Source: Annals of Internal Medicine​ Volume 146, Pages 580-590 "Meta-analysis: Chondroitin for osteoarthritis of the knee or hip" ​Authors: S. Reichenbach, R. Sterchi, M. Scherer, S. Trelle, E. Burgi, U. Burgi, P.A. Dieppe, P. Juni Editorial: Annals of Internal Medicine​ Volume 146, Pages 611-612 "Chondroitin for pain in osteoarthritis" ​Author: D.T. Felson

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