Does Glucosamine/Chondroitin Help Joint Health? - Member Case Study

author : AMSSM

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Supplementing with glucosamine and chondroitin for joint health improvement for a member with a diagnosed chondromalacia patellar problem.

Question from jkbostic:

Several years ago, I was diagnosed with chondromalacia patella. After several series of static strengthing exercises I began to feel some relief, but it wasn't until I started training for triathlons that I was able to eliminate much of my pain. Prior to and during my training, I've been using glucosamine/chondroitin supplements to "maintain" joint health. The G/C was never prescribed by a doc or anything, I just started taking it after doing some research on the net.

While I've had no real knee issues over the last 6 months, I'm not sure if the G/C or the cross training is the reason why my knees are feeling as good as they have been. Does taking maintenance doses of G/C provide me with any additional protection or healing? Am I wasting my money on needless supplements? What is the optimum dose for your average active person with knee issues like mine to be taking on a daily basis if any?

Answer:

My understanding of your post is that you have been diagnosed with chondromalacia involving only the patella. Chondromalacia is a form of early degenerative arthritis on the back of your kneecap, and is very common. It appears that though you started glucosamine/chondroitin when your pain was present, you now continue it for joint health as you noted the pain resolved when starting triathlons.

There have been several types of research articles in the area of supplementing with glucosamine and chondroitin. When we look at the research, we consider the athlete to whom we are applying the recommendations. Research is still lacking in the standardization of therapy in this area regarding the use of glucosamine and chondroitin as a product that provides benefit for the chondral(cartilage) environment of the joint. There is support for use of glucosamine as a product to help with the pain management of osteoarthritis. Twenty-50 percent may have decreased pain in some studies. There is also the suggestion that the rate of joint space narrowing, you did not mention any joint line narrowing in yourself, may slow with supplementation. The definition of osteoarthritis relates to the degree of joint involvement, which includes the cartilage wear you mentioned, and, joint space, and other x-ray findings of osteoarthritis. I cannot answer with any certainty if the supplement helped with your pain or not. Since several factors in the lower leg could have contributed to your cartilage wear, such as joint mechanics, and strength, flexibility and balance of your muscles, your training for triathalons may have made the most difference. There is a nice review in Curr Rheumatol Rep. 6(1): 41-5 of 2004 that notes the need for more information in order to have a proven and practical guideline to use in our patients.

The second aspect of using supplements is there is no current FDA regulation regarding the bioavailability testing for these products. Thus, it is difficult to tell you what is the correct amount to take on a daily basis to maintain the suggested effects of this supplement. Most products suggest 1500mg, but, you must look at the label. Still, the product may not be 100% absorbed when taken. Some of the studies suggest 2000mg/day of the product is needed; however, these studies used a prescription-type formula that has standardized ingredients—it is unclear if it is comparable to the over-the-counter or supplement products that can be obtained. Purity is also a concern with any supplement. I hope this answers your question.

A practical recommendation to answer your question may be to discontinue the glucosamine/chondroitin for a few months. If your pain returns then restart the supplement. If your pain lessens about 6 weeks after your restart it, it is probably helping control your pain. As noted above, there is not enough research to address the cartilage protective effects, and, no long-term research to address the safety of long-term use of these supplements.

Katherine L. Dec, MD Member AMSSM

www.amssm.org
 

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date: April 9, 2005