Effects of Oral Chondroitin Sulfate on Osteoarthritis-Related Pain and Joint Structural Changes: Systematic Review and Meta-Analysis

Joseph Knapik, Rodney R Pope, Sally Hoedebecke, Ben Schram, Rob Marc Orr

Research output: Contribution to journalArticleResearchpeer-review

7 Citations (Scopus)


Osteoarthritis (OA) is a disorder involving the deterioration of
articular cartilage and underlying bone and is associated with
symptoms of pain and disability. In military personnel, the incidence
of OA has increased between 2000 and 2012 and was
the first or second leading cause of medical separations in this
period. It has been suggested that consumption of chondroitin
sulfate (CS) may reduce the pain and joint deterioration
associated with OA. This article reports on a systematic review
and meta-analysis of the effectiveness of CS on reducing
pain and joint deterioration. PubMed and Ovid
Embase databases and other sources were searched to find
randomized, double-blind, placebo-controlled trials on the
effects of orally consumed CS on pain and/or joint structure.
The outcome measure was the standardized mean difference
(SMD) which was the improvement in the placebo groups minus
the improvement in the CS groups divided by the pooled
standard deviation. There were 18 trials meeting the review
criteria for pain with SMD –0.41, 95% confidence interval
(95% CI) –0.57 to –0.25 (negative SMD favors CS). Six studies
met the review criteria for joint space narrowing with SMD
–0.30, 95% CI –0.61 to +0.00. Two studies meet the review
criteria for cartilage volume with SMD –0.11, 95% CI –0.48
to +0.26. Larger dosages (1200mg/d) had greater pain reduction
efficacy than lower dosages (≤1000mg/d). These data suggest
that CS has small to moderate effectiveness in reducing
OA-related pain but minimal effects on joint space narrowing
and no effect on cartilage volume. It is important that clinicians
recommend pharmaceutical-grade CS to their patients
due to the variability in the amount of CS in dietary supplements
purporting to contain CS.
Original languageEnglish
Pages (from-to)113-124
Number of pages12
JournalJournal of special operations medicine : a peer reviewed journal for SOF medical professionals
Issue number1
Publication statusPublished - 19 Mar 2019


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