Glucosamine + Chondroitin

Glucosamine and chondroitin are cartilage components long sold as joint supplements, and more recently marketed for slowing aging and extending lifespan. The benefit for this use has not been shown: there is no evidence base supporting an anti-aging effect or any impact on longevity. What actually helps with healthy aging is different – movement, sleep, nutrition, and managing risk factors like blood pressure and blood sugar. The substance itself is harmless in this role, but there is no reason to expect a rejuvenating effect.

Glucosamine and chondroitin are widely sold and prescribed for knee osteoarthritis. AEMPS registered Xicil (glucosamine sulfate 1500 mg) and Condrosulf/Condrosan (chondroitin sulfate 400 mg × 3 times) for symptomatic treatment of mild-to-moderate knee OA. In Russia, Dona and Structum are also registered as medicines. Evidence base is contradictory and weak in large independent trials. The largest independent RCT GAIT (Clegg 2006, NEJM, 1583 patients) showed no significant effect of glucosamine, chondroitin or combination monotherapy vs placebo. Wandel 2010 network meta-analysis (BMJ, 10 RCTs, 3803 patients, including GAIT) confirmed no clinically significant effect. Cochrane Towheed 2005 found an effect only in Rotta-sponsored glucosamine sulfate RCTs; not in independent ones. OARSI 2019 does not recommend glucosamine and chondroitin for routine use. NICE NG226 2022 does not recommend either option. ESCEO 2014 recommends only prescription crystalline glucosamine sulfate (pCGS) Rottapharm in mild disease as first-line – a position criticised for conflict of interest. First-line for knee OA is non-pharmacological (weight loss at BMI>25, quadriceps-strengthening exercise), topical NSAIDs (diclofenac gel), paracetamol as option, intra-articular steroid if insufficient effect. If glucosamine-chondroitin was offered as a substitute for exercise therapy and weight loss, consider seeking a second opinion from a rheumatologist.

The distinction between pharmaceutical glucosamine sulphate (Dona, Structum) and over-the-counter glucosamine hydrochloride is important: positive RCTs mainly used the sulphate form at 1,500 mg daily.

ICD-10: M17 · ICD-11: FA01

Glucosamine-chondroitin is used in hip, hand and generalised osteoarthritis. Evidence base is weaker in hip and hand OA than in knee OA. Wandel 2010 (BMJ, 10 RCTs, 3803 patients) in hip and knee OA showed no clinically significant effect of any option. EULAR 2018 in hand OA and NICE NG226 2022 in any-site OA do not recommend glucosamine and chondroitin. First-line for OA is non-pharmacological (weight loss in hip and knee OA, base-of-thumb splinting in rhizarthrosis, exercise), topical NSAIDs, paracetamol as option, short courses of systemic NSAIDs, intra-articular steroid for knee and hip when insufficient effect. For severe OA – referral to orthopaedics for arthroplasty discussion. If glucosamine-chondroitin was offered as a substitute for exercise therapy and topical NSAIDs, consider seeking a second opinion from a rheumatologist.

ICD-10: M19 · ICD-11: FA0Z