Are there any effective supplements for osteoarthritis?

Do Supplements Work for Osteoarthritis?

No, the vast majority of supplements do not work for osteoarthritis and are strongly recommended against by major medical societies based on high-quality evidence showing no benefit over placebo.

Supplements That Do NOT Work (Strong Recommendations Against)

Glucosamine

• The American College of Rheumatology strongly recommends against glucosamine for knee, hip, and hand OA 1
• When industry-sponsored trials are excluded and only low-risk-of-bias studies are analyzed, glucosamine shows no meaningful benefit over placebo 1
• The apparent benefits seen in earlier studies were due to publication bias from industry-funded research 1
• May cause elevations in serum glucose levels in some patients 1
• Despite lack of efficacy, it remains one of the most commonly used supplements, so counsel patients accordingly 1

Chondroitin Sulfate

• The American College of Rheumatology strongly recommends against chondroitin for knee and hip OA 1
• Exception: Conditionally recommended for hand OA only, based on a single trial showing analgesic benefit without harm 1
• Combination products with glucosamine and chondroitin are also strongly recommended against 1

Vitamin D

• Conditionally recommended against for all OA sites (knee, hip, hand) 1
• Multiple trials showed either small effect sizes or no benefit, and pooled data yielded null results 1

Fish Oil

• Conditionally recommended against for all OA sites 1
• Only one published trial exists, which failed to show efficacy of higher versus lower doses 1
• Despite being the most commonly used dietary supplement in the US, evidence does not support its use 1

Bisphosphonates

• Strongly recommended against for all OA sites 1
• The preponderance of data shows no improvement in pain or functional outcomes 1

Supplements With Inconsistent Evidence

Turmeric and Ginger Extract

• The American Academy of Orthopaedic Surgeons evaluated these supplements but found evidence that "demonstrated either some improvement or no change in patient outcomes" 1
• The lack of reproducibility and variability between manufacturers with limited FDA oversight prevents strong recommendations 1
• While risks are minimal, the primary barrier is out-of-pocket expense without proven benefit 1

Critical Clinical Pitfalls

The Placebo Effect Problem

• Patients often perceive glucosamine as efficacious and believe different formulations have varying effectiveness 1
• The weight of evidence indicates large placebo effects but no true efficacy 1
• Counsel patients that their perceived benefit is likely placebo, not pharmacologic action 1

Quality and Regulation Issues

• Dietary supplements have limited FDA oversight, leading to variability between manufacturers 1
• Many products lack pharmaceutical-grade purity and may contain contaminants 1
• Labels may wrongly claim high levels of purity 2

What to Recommend Instead

First-Line Pharmacologic Options

• Oral NSAIDs: Consistently demonstrate improved pain and function 1
• Acetaminophen: Effective for pain relief, though carries FDA black box warning 1
• Topical NSAIDs: Particularly for patients ≥75 years old 1
• Intra-articular corticosteroid injections: Supported by 19 high-quality and 6 moderate-quality studies 1

Non-Pharmacologic Interventions

• Sustained weight loss: Benefits pain and function in overweight/obese patients, with obvious other health benefits 1
• Exercise programs: Preferably combined with diet for weight loss 1

The Bottom Line

The 2019-2020 American College of Rheumatology guidelines represent a significant shift from earlier recommendations, now strongly recommending against most supplements based on rigorous analysis that excluded biased studies 1. The American Academy of Orthopaedic Surgeons 2022 guidelines similarly found insufficient evidence to support supplement use 1. Save your patients' money and direct them toward evidence-based treatments like NSAIDs, weight loss, and exercise rather than expensive supplements with no proven benefit.