Supplements for Hip Osteoarthritis Pain: Evidence-Based Recommendations
Based on the most recent and highest quality evidence, I strongly recommend AGAINST using supplements for hip osteoarthritis pain, as major clinical guidelines demonstrate they lack meaningful efficacy.
Primary Recommendation
The 2019 American College of Rheumatology/Arthritis Foundation guidelines provide the most authoritative current evidence and strongly recommend against glucosamine and chondroitin sulfate for hip OA 1. The data with the lowest risk of bias fail to show any important benefits over placebo, and concerns about publication bias in industry-sponsored trials further undermine their credibility 1.
Specific Supplements Evaluated
Glucosamine
- Strongly recommended AGAINST for hip OA 1
- Multiple high-quality trials show no benefit over placebo when industry bias is removed 1, 2
- Effect sizes in mixed hip/knee trials were small (0.44 for pain relief) but not hip-specific 1
- May cause elevations in serum glucose levels in some patients 1
Chondroitin Sulfate
- Strongly recommended AGAINST for hip OA 1
- While older EULAR guidelines from 2005 showed effect sizes of 0.78 for pain in mixed trials, these were not hip-specific 1
- One hip-specific trial showed statistical benefit, but effect sizes could not be calculated due to missing data 1
- The 2019 ACR guidelines supersede older recommendations and show no meaningful benefit 1
Combination Products (Glucosamine + Chondroitin)
- Strongly recommended AGAINST for hip OA 1
- Network meta-analysis showed the combination produced only -0.5 cm improvement on a 10 cm pain scale, well below the clinically meaningful threshold of -0.9 cm 3
- No impact on joint space narrowing 3
Vitamin D
- Conditionally recommended AGAINST for hip OA 1
- Pooled data across studies yielded null results 1
- Small effect sizes in some trials do not translate to clinically meaningful benefit 1
Fish Oil
- Conditionally recommended AGAINST for hip OA 1
- Only one published trial exists, which failed to show efficacy of higher versus lower doses 1
Avocado Soybean Unsaponifiables (ASU)
- Initial small trial (n=50) showed promise with effect size of 0.76 1
- However, larger trial (n=163) over 2 years showed no significant benefit and no structural benefits 1
- Pooled effect sizes were not statistically significant 1
Bisphosphonates
- Strongly recommended AGAINST for hip OA 1
- Preponderance of data shows no improvement in pain or functional outcomes 1
Clinical Pitfalls to Avoid
Do not be swayed by patient perception or popularity. Glucosamine remains one of the most commonly used dietary supplements in the US despite lack of efficacy 1. Patients often believe different formulations have varying effectiveness and seek brand recommendations 1.
Recognize the industry bias problem. Industry-sponsored trials showed larger effects than publicly funded trials (P=0.02 for interaction) 3. When limited to trials with low risk of bias, benefits approach zero 1.
Understand the divergence between older and newer guidelines. The 2005 EULAR guidelines suggested small symptomatic effects with low toxicity for glucosamine and chondroitin 1, but the 2019 ACR guidelines represent a significant shift based on better quality evidence, now strongly recommending against these agents 1.
What to Recommend Instead
Rather than supplements, direct patients toward evidence-based treatments:
- Acetaminophen as first-line pharmacologic treatment for mild to moderate pain 2
- Topical NSAIDs for localized joint pain 2
- Physical activity and exercise programs 2
- Weight loss interventions for overweight or obese patients 2
When discussing supplements with patients, explain that the highest quality evidence shows no benefit over placebo for pain relief or disease modification 2. The small effect sizes reported in some older studies do not meet the threshold for clinically meaningful improvement and are likely explained by publication bias and placebo effects 1, 3.