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

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

Research output: Contribution to journalArticleResearchpeer-review

9 Citations (Scopus)


Background: Osteoarthritis (OA) is a disorder involving deterioration
of articular cartilage and underlying bone and is associated
with symptoms of pain and disability. Glucosamine is
a component of articular cartilage naturally synthesized in the
body from glucose and incorporated into substances contained
in the cartilage. It has been suggested that consumption of glucosamine
may reduce the pain of OA and may have favorable
effects on structural changes in the cartilage. This article presents
a systematic review and meta-analysis of the effectiveness
of orally consumed glucosamine sulfate (GS) on OA-related
pain and joint structural changes. Methods: PubMed and
Ovid Embase were searched using specific search terms to
find randomized, double-blinded, placebo-controlled trials
on the effects of GS on pain and/or joint-space narrowing.
The outcome measure was the standardized mean difference
(SMD), which was the improvement in the placebo groups minus
the improvement in the GS groups divided by the pooled
standard deviation. Results: There were 17 studies meeting the
review criteria for pain, and the summary SMD was –0.35,
with a 95% confidence interval (95% CI) = –0.54 to –0.16
(negative SMD is in favor of GS). Of the 17 studies, 7 showed
a statistically significant reduction in pain from GS use. Four
studies met the review criteria for joint space narrowing with
a summary SMD = –0.10 (95% CI = –0.23 to +0.04). Studies
without involvement of the commercial glucosamine industry
had a lower (but still significant) pain reduction efficacy (summary
SMD = –0.19, 95% CI = –0.39 to –0.02) than those with
industry involvement. Several smaller dosages throughout the
day had larger pain reduction effects than a single daily large
dose (1500 mg). Conclusion: These data indicate that GS may
have a small to moderate effect in reducing OA-related pain
but little effect on joint-space narrowing. Until there is more
definitive evidence, healthcare providers should be cautious in
recommending use of GS to their patients. Because GS dosages
used in studies to date resulted in mild and transient adverse
effects, and these were similar to that experienced by patients
receiving placebos, larger GS doses possibly could be investigated
in future studies.
Original languageEnglish
Pages (from-to)139-147
Number of pages9
JournalJournal of special operations medicine : a peer reviewed journal for SOF medical professionals
Issue number4
Publication statusPublished - Dec 2018


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