What is the evidence for high-dose glucosamine and chondroitin in the treatment of spinal degenerative bone disease, also known as osteoarthritis (OA)?

From the Guidelines

The use of high-dose glucosamine and chondroitin for spinal degenerative bone disease is not recommended due to a lack of strong evidence supporting their effectiveness. The most recent and highest quality study, published in 2020 by the American College of Rheumatology, strongly recommends against the use of glucosamine in patients with osteoarthritis of the hand, hip, and knee 1. This recommendation is based on the lack of clear biologic understanding of how efficacy would vary with the type of salt studied and the discrepancies in efficacy reported in studies that were industry sponsored as opposed to publicly funded.

While some patients may report subjective improvement in pain and function, clinical research has not consistently demonstrated significant benefits for spinal conditions specifically. If considering these supplements, patients should be aware of the potential risks and limitations, including the lack of regulation and standardization of these supplements. The potential toxicity of glucosamine is low, though some patients exposed to glucosamine may show elevations in serum glucose levels 1.

Other approaches like physical therapy, appropriate exercise, weight management, and conventional pain management may offer more reliable benefits for spinal degenerative disease. Patients should discuss these supplements with their healthcare provider before starting them, especially if taking other medications, as interactions are possible. The use of glucosamine and chondroitin products is not recommended, as stated in the 2008 guidance from the National Institute for Health and Care Excellence (NICE) 1 and the 2014 clinical practice guideline from the American Academy of Orthopaedic Surgeons (AAOS) 1.

In terms of alternative treatments, the evidence suggests that adjunct non-pharmacological treatments, such as exercise, weight loss, and the use of suitable footwear, may be beneficial for patients with osteoarthritis 1. Additionally, other therapies, such as local heat or cold applications, manipulation and stretching, and transcutaneous electrical nerve stimulation (TENS), may be considered 1. However, electroacupuncture is not recommended due to insufficient evidence 1.

In conclusion is not allowed, so:

• The key points to consider when evaluating the use of high-dose glucosamine and chondroitin for spinal degenerative bone disease include the lack of strong evidence supporting their effectiveness, the potential risks and limitations, and the availability of alternative treatments.
• Patients should discuss these supplements with their healthcare provider before starting them, especially if taking other medications, as interactions are possible.
• Other approaches like physical therapy, appropriate exercise, weight management, and conventional pain management may offer more reliable benefits for spinal degenerative disease.

From the Research

Evidence for High Dose Glucosamine and Chondroitin

• There is limited evidence to support the use of high dose glucosamine and chondroitin for spinal degenerative bone disease, as most studies have focused on their use in osteoarthritis of the knee 2, 3.
• A systematic review found that there was little literature to support the use of common nutritional supplements, including glucosamine and chondroitin, for spinal degeneration 3.
• However, some studies suggest that glucosamine sulfate may be effective in the management of osteoarthritis, with evidence from real-life setting trials and surveys showing that it can delay joint structural changes and reduce the need for additional pain analgesia and non-steroidal anti-inflammatory drugs (NSAIDs) 4.

Safety and Efficacy

• Glucosamine is generally considered safe, with reported adverse effects being relatively uncommon and minor 2.
• However, glucosamine should be used with caution in patients who have shellfish allergies or asthma, and in those taking diabetes medications or warfarin 2.
• There is no clear evidence to suggest that glucosamine affects glucose metabolism or insulin sensitivity in healthy individuals or those with diabetes 5.

Dosage and Formulation

• The European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO) recommends a dose of 1500mg of prescription patented crystalline glucosamine sulfate (pCGS) once-daily for the management of osteoarthritis 4.
• The ESCEO task force advocates differentiation of prescription pCGS over other glucosamine preparations, with evidence showing that it may delay joint structural changes and reduce the need for additional pain analgesia and NSAIDs 4.