Page 141 - JSOM Winter 2018

An Ongoing Series

Effects of Oral Glucosamine Sulfate on
Osteoarthritis-Related Pain and Joint-Space Changes

Systematic Review and Meta-Analysis

Joseph J. Knapik, ScD *; Rodney Pope, PhD ; Sally S. Hoedebecke, MS, RD ;
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Ben Schram, PhD ; Robin Orr, PhD ; Harris R. Lieberman, PhD 6
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ABSTRACT
Background: Osteoarthritis (OA) is a disorder involving dete- dose (1500 mg). Conclusion: These data indicate that GS may
rioration of articular cartilage and underlying bone and is as- have a small to moderate effect in reducing OA-related pain
sociated with symptoms of pain and disability. Glucosamine is but little effect on joint-space narrowing. Until there is more
a component of articular cartilage naturally synthesized in the definitive evidence, healthcare providers should be cautious in
body from glucose and incorporated into substances contained recommending use of GS to their patients. Because GS dosages
in the cartilage. It has been suggested that consumption of glu- used in studies to date resulted in mild and transient adverse
cosamine may reduce the pain of OA and may have favorable effects, and these were similar to that experienced by patients
effects on structural changes in the cartilage. This article pres- receiving placebos, larger GS doses possibly could be investi-
ents a systematic review and meta-analysis of the effectiveness gated in future studies.
of orally consumed glucosamine sulfate (GS) on OA-related
pain and joint structural changes. Methods: PubMed and Keywords: glucosamine sulfate; meta-analysis; osteoarthritis;
Ovid Embase were searched using specific search terms to dietary supplement
find randomized, double-blinded, placebo-controlled trials
on the effects of GS on pain and/or joint-space narrowing.
The outcome measure was the standardized mean difference Introduction
(SMD), which was the improvement in the placebo groups mi-
nus the improvement in the GS groups divided by the pooled In a previous article in Journal of Special Operations Med-
standard deviation. Results: There were 17 studies meeting the icine, we examined the pathophysiology of osteoarthritis
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review criteria for pain, and the summary SMD was –0.35, (OA), prevalence and trends in the military, and the advantages
with a 95% confidence interval (95% CI) = –0.54 to –0.16 of exercise for those with OA. To summarize, OA is a disorder
(negative SMD is in favor of GS). Of the 17 studies, 7 showed involving deterioration of articular cartilage and underlying
a statistically significant reduction in pain from GS use. Four bone, and is associated with symptoms of pain and disability.
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studies met the review criteria for joint space narrowing with The incidence of OA in the military increased over the years
a summary SMD = –0.10 (95% CI = –0.23 to +0.04). Studies 2000 to 2012, and OA was the first or second leading cause
3,4
without involvement of the commercial glucosamine industry of medical separations in this period. Risk factors for OA in-
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had a lower (but still significant) pain reduction efficacy (sum- clude older age, black race, genetics, higher body mass index,
mary SMD = –0.19, 95% CI = –0.39 to –0.02) than those with prior knee injury, and excessive joint loading. 3,6–9 Results of
industry involvement. Several smaller dosages throughout the animal studies indicate that moderate exercise can assist in
day had larger pain reduction effects than a single daily large maintaining normal cartilage ; supporting this, recreational
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*Correspondence to joseph.knapik@JSOMonline.org
1 MAJ (Ret) Knapik served in the US military as a wheel vehicle mechanic, medic, Medical Service Corps officer, and Department of Defense civil-
ian. He is currently a senior epidemiologist/research physiologist with the Henry M. Jackson Foundation and an adjunct professor at Uniformed
Services University and Bond University, Robina, Australia. Dr Pope is professor of Physiotherapy at Charles Sturt University, Australia. He
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has spent much of his 30-year career researching, practicing, and advising on injury risk management in military and other tactical populations.
3 COL (Ret) Hoedebecke served 30 years as a dietitian in the US Army. She had a variety of assignments, including deployment during Desert
Storm. She completed a fellowship in Health Care Policy at George Washington University and has specialized in fitness, nutrition, and policy.
4 Dr Schram served as an officer in the Australian Army Reserve involved in injury minimization, strength and conditioning, and validating fitness
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standards. He is an assistant professor at Bond University and is the research and data coordinator for the Tactical Research Unit. Dr Orr served
in the Australian Regular Army for over 20 years as an infantry soldier, physical training instructor, physiotherapist, and human performance
officer. He currently serves in the Army Reserves and is an associate professor and leader of the Tactical Research Unit at Bond University, Rob-
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ina, Australia. Dr Lieberman is a senior civilian member of the Military Nutrition Division of the US Army Research Institute of Environmental
Medicine. He is an internationally recognized expert on dietary supplements and military nutrition.
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