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Efficacy of glucosamine, chondroitin, and methylsulfonylmethane for spinal degenerative joint disease and degenerative disc disease: A systematic review

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Nutritional supplements are commonly used for a variety of musculoskeletal conditions, including knee and hip degenerative joint disease. Although these supplements are occasionally recommended for patients with degenerative disc disease and spinal degenerative joint disease, the evidence supporting this use is unknown. To systematically search and assess the quality of the literature on the use of glucosamine, chondroitin sulfate, and methylsulfonylmethane for the treatment of spinal osteoarthritis / degenerative joint disease, and degenerative disc disease. The Index of Chiropractic Literature, AMED, Medline, and CINAHL were searched for randomized controlled trials in English from 1984 to July 2009. Data from studies meeting the inclusion criteria was extracted and reviewed by three reviewers. The Jadad scale was used to assess study quality. No attempts were made at meta-analysis due to variation in study design. Two articles met the inclusion criteria. One study was found to have good quality but reported negative results for the supplemented group compared with placebo, the other study had low quality but reported significant positive results for the supplemented group when compared with a no intervention control group. There was little literature found to support the use of common nutritional supplements for spinal degeneration, making it difficult to determine whether clinicians should recommend them.
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0008-3194/2011/47–55/$2.00/©JCCA 2011
J Can Chiropr Assoc 2011; 55(1) 47
Effi cacy of glucosamine, chondroitin, and
methylsulfonylmethane for spinal degenerative
joint disease and degenerative disc disease:
a systematic review
Kent Stuber, BSc, DC, MSc*
Sandy Sajko, BPHE, DC, MSc, RCCSS(C)†
Kevyn Kristmanson, BSc, DC§
* Canadian Memorial Chiropractic College; Private Practice, Calgary Alberta
† Private practice, Oakville, Ontario.
§ Private practice, Swift Current, Saskatchewan.
Primary contact: Kent Stuber DC, MSc, 19–8 Weston Drive SW, Calgary, Alberta, 403.685.5252.
E-mail: kstuber@cmcc.ca
The authors attest that there are no disclaimers or confl icts of interest.
No funding or support was received in conducting this study or preparing the manuscript.
© JCCA 2011
Contexte : Les suppléments alimentaires sont
couramment utilisés dans une variété de troubles
musculosquelettiques, y compris les maladies
dégénératives des articulations des genoux et
des hanches. Bien que ces suppléments soient
occasionnellement recommandés pour les patients
atteints de discarthrose et d’arthrose cervicale, aucune
preuve ne vient à l’appui de cette utilisation.
Objectif : Rechercher systématiquement et évaluer
la qualité de la littérature concernant l’utilisation
de la glucosamine, du sulfate de chondroïtine et du
méthylsulfonylméthane pour le traitement de l’ostéo-
arthrite et l’ostéoarthrose cervicale ainsi que de la
discarthrose.
Sources : Des essais cliniques aléatoires en anglais
menés entre 1984 et juillet 2009 ont été recherchés dans
l’Index of Chiropractic Literature, AMED, Medline, et
CINAHL.
Extraction et synthèse des données : Les données des
études respectant les critères d’inclusion ont été extraites
et examinées par trois réviseurs. L’échelle de Jadad a
été utilisée pour évaluer la qualité des études. Il n’a pas
été tenté de procéder à une méta-analyse en raison de la
diversité des modèles d’étude.
Résultats : Deux articles ont respecté les critères
d’inclusion. Une étude était de bonne qualité, mais
indiquait des résultats négatifs du groupe supplémenté
par rapport au groupe placebo. L’autre étude était de
moindre qualité mais indiquait des résultats positifs
Background: Nutritional supplements are commonly
used for a variety of musculoskeletal conditions,
including knee and hip degenerative joint disease.
Although these supplements are occasionally
recommended for patients with degenerative disc disease
and spinal degenerative joint disease, the evidence
supporting this use is unknown.
Objective: To systematically search and assess the
quality of the literature on the use of glucosamine,
chondroitin sulfate, and methylsulfonylmethane for the
treatment of spinal osteoarthritis / degenerative joint
disease, and degenerative disc disease.
Data Sources: The Index of Chiropractic Literature,
AMED, Medline, and CINAHL were searched for
randomized controlled trials in English from 1984 to
July 2009.
Data Extraction and Synthesis: Data from studies
meeting the inclusion criteria was extracted and
reviewed by three reviewers. The Jadad scale was used
to assess study quality. No attempts were made at meta-
analysis due to variation in study design.
Results: Two articles met the inclusion criteria. One
study was found to have good quality but reported
negative results for the supplemented group compared
with placebo, the other study had low quality but
reported signifi cant positive results for the supplemented
group when compared with a no intervention control
group.
Conclusion: There was little literature found to
48 J Can Chiropr Assoc 2011; 55(1)
Effi cacy of glucosamine, chondroitin, and methylsulfonylmethane
Introduction
Osteoarthritis is a pathology that affects approximately
15% of the world’s population.1 It is a chronic condition
that is most prevalent in the elderly and three times more
common in women than in men.2 Its characterizing fea-
ture is the progressive destruction of the articular cartilage
of joint surfaces which can result in impaired joint bio-
mechanics, swelling, pain, and disability.
Typically, the literature surrounding osteoarthritis is
categorized according to the affected body region. Spinal
osteoarthritis is one area that has garnered attention due
to its relatively high prevalence and the impact that it
can have on those affected. As individuals age, spinal os-
seous degeneration and age-related changes occur in the
macroscopic, histologic and biochemical composition
and structure of the nucleus pulposus and the annulus
brosus. It has been suggested that these changes occur
more frequently in the lumbar spine than the thoracic re-
gion due to the “splinting” by the costovertebral joints,
and again less frequently in the cervical spine due to the
relatively low need for weight-bearing.3
A common medicinal treatment for individuals
suffering from spinal osteoarthritis is nonsteroidal anti-
infl ammatory drugs (NSAIDs), but with the associated
serious gastrointestinal side effects many patients look
towards complementary and alternative medicine to gain
symptomatic relief and avoid iatrogenic illness.4
Glucosamine and chondroitin sulfate have been util-
ized medicinally in Europe for over 40 years and have
gained in popularity in North America since the late
1990’s.5 Glucosamine and chondroitin sulfate, studied
alone or in combination, appear to be somewhat effective
for osteoarthritis of the knee6–8 or hip7,8 but there is no
consensus with respect to a specifi c biochemical rationale
or reasoning behind the results. It has been suggested that
osteoarthritis is associated with a local defi ciency in some
key natural substances and that glucosamine acts as a
substrate for cartilage repair by stimulating proteoglycan
synthesis by chondrocytes.9 In the case of chondroitin, it
has been contended that since it constitutes the majority
of the glycosaminoglycans (GAGs) in articular cartilage,
it helps to maintain the viscosity in joints, stimulates car-
tilage repair and inhibits enzymes that lead to degenera-
tion of cartilage.10
More recently, methylsulfonylmethane or MSM has
been promoted as a possible supplement for osteoarth-
ritis due to its suggested anti-infl ammatory and anal-
gesic effects.11 Similar to glucosamine and chondroitin
sulfate, most MSM research has evaluated the effects of
MSM supplementation on knee osteoarthritis, as Usha
and Naidu12 and Kim et al13 both looked at the effects
of 12-weeks of supplementation with methylsulfonyl-
methane on knee osteoarthritis. In both studies, there was
a signifi cant difference between the supplementation and
placebo group with the supplementation group showing
decreased pain levels. In the study by Usha and Naidu12
specifi cally, when methylsulfonylmethane and glucosa-
mine were combined there was a signifi cant difference in
swelling index, joint function, walking time, joint mobil-
ity index, and overall function ability when compared to
the placebo and the supplements when taken individually.
The objective of this paper was to systematically
search and assess the quality of the literature on the use
of glucosamine, chondroitin sulfate, and methylsulfonyl-
support the use of common nutritional supplements for
spinal degeneration, making it diffi cult to determine
whether clinicians should recommend them.
(JCCA 2011; 55(1):47–55)
key words: systematic review, glucosamine,
chondroitin, methylsulfonylmethane, osteoarthritis,
degenerative joint disease, spine
du groupe supplémenté par rapport à un groupe de
contrôle.
Conclusion : Peu de littérature était disponible à
l’appui de l’utilisation de suppléments alimentaires
communs dans le traitement de la dégénérescence
cervicale. Il est par conséquent diffi cile de déterminer si
les cliniciens doivent les recommander.
(JCCA 2011; 55(1):47–55)
mots clés : examen systématique, glucosamine,
chondroïtine, méthylsulfonylméthane, ostéo-arthrite,
ostéoarthrose cervicale, discarthrose, colonne vertébrale
J Can Chiropr Assoc 2011; 55(1) 49
K Stuber, S Sajko, K Kristmanson
methane, alone or in combination, for the treatment of
spinal osteoarthritis / degenerative joint disease, and de-
generative disc disease.
Methods
An electronic search for relevant literature was conducted
on the Index of Chiropractic Literature, AMED, Med-
line, and CINAHL up to and including July 2009. Search
terms consisted of combinations of glucosamine sulfate
(GS), chondrotin sulfate (CS), or methylsulfonylmethane
(MSM) with terms for spinal arthritis or osteoarthritis,
spinal degenerative joint disease, or degenerative disc dis-
ease (the exact search terms and strategies employed are
available from the authors). Relevant MeSH terms were
employed whenever possible. The Cochrane Library was
also searched for relevant reviews or articles using similar
search terms. The authors also hand searched their per-
sonal libraries. Two of the authors (KS and SS) scrutin-
ized the electronic search results, titles and abstracts in
particular, to determine which full manuscripts should be
obtained and evaluated. Each of these authors composed
a list of studies from the electronic search results that they
felt may be clinical studies using GS, CS, or MSM, these
lists were compared and any differences were resolved by
discussion to obtain a fi nal list of manuscripts to obtain.
The full manuscripts that were obtained were for any clin-
ical studies on spinal arthritis, osteoarthritis, degenerative
joint disease, or degenerative disc disease using GS, CS
or MSM.
The inclusion criteria used for this review are indicated
in Table 1, but consisted of studies that were randomized
controlled trials conducted on patients with spinal degen-
erative joint disease, spinal osteoarthritis/osteoarthrosis,
and/or degenerative disc disease. Interventions could in-
clude glucosamine (sulfate or HCl), chondroitin sulfate,
and methylsulfonylmethane (MSM) in any combination
or dosage with co-interventions being allowed; these
could be compared to a do nothing control group, pla-
cebo, or another active intervention. Outcome measures
of interest had to include at least one validated and reli-
able assessment of pain (such as a visual analog scale or
numerical pain rating scale) or disability due to pain (such
as the Oswestry Low Back Disability Index). Only articles
published in a peer-reviewed journal in English within the
past 25 years (1984–2009) were considered. These cri-
teria were applied to all of the obtained full manuscripts.
Reference searching was conducted from the reference
lists of all retrieved studies.
One of the authors (KS) initially extracted data (such as
sample details, interventions, outcome measures, results,
adverse events, withdrawals/dropouts) from the studies
meeting the inclusion criteria into a data extraction sheet
that was checked and edited by the other authors (SS, KK).
The Jadad scale (or Oxford quality scoring system) was
used to assess study quality.14 The Jadad scale is among
the most referenced and widely used of all quality scoring
systems and considered valid and reliable.14,15 The Jadad
scale asks questions about three different aspects of study
design: double blinding, randomization, and the handling
of withdrawals and dropouts.14 There are seven questions
which lead to a score that out of fi ve, with zero being the
lowest score and fi ve being the highest.14 We applied the
classifi cation developed by Abraham et al to determine
whether included trials were of good or poor quality,
where they defi ned a good quality trial as receiving four
or higher on the Jadad scale and a poor quality trial as one
Table 1 Review Inclusion Criteria
Published in English
Published in a peer-reviewed journal
Published in the past 25 years (1984–2009)
Randomized controlled trial
Patients must have spinal osteoarthritis / osteoarthrosis / degenerative joint disease and/or degenerative disc disease proven
via diagnostic imaging
Use glucosamine sulfate (or glucosamine HCl) and/or chondroitin sulfate and/or methylsulfonylmethane (MSM)
Use of other medications, supplements, or interventions tolerable
Comparison group could consist of a do nothing control, placebo, or a different active treatment
Outcome measures include an assessment of pain and/or disability due to pain
50 J Can Chiropr Assoc 2011; 55(1)
Effi cacy of glucosamine, chondroitin, and methylsulfonylmethane
earning three or less.16 All three authors independently re-
viewed the included studies and resolved any differences
by discussion. No attempts were made at meta-analysis
as it was felt there would be too much variation in study
parameters to allow for suitable synthesis.
Results
Figure 1 depicts the fl ow of trials through the review.
The electronic database search initially yielded 17 arti-
cles from Medline, 2 from CINAHL, 2 from the Index
to Chiropractic Literature, 1 from AMED, and none from
the Cochrane Library, for a total or 21 articles excluding
overlap. These search results were scrutinized and only
three articles were obtained for full manuscript review.
Upon review of these three manuscripts, two were found
to be RCTs17,18 and one was a case report19 and thus ex-
cluded. One article was identifi ed by reference searching
from a previous systematic review of glucosamine for
osteoarthritis8 but was excluded as it was not published
in the peer-reviewed literature.20 Thus only two articles
were accepted for analysis.17,18 Table 2 depicts the qual-
ity rating of the two articles included in the review using
the Jadad scale. There was complete (100%) agreement
between the authors on the rating of these articles.
The paper by Leffl er et al17 received a score of 4/5 which
corresponds with a good quality article16, with the only
point missing being for the description of randomization
method. Leffl er et al compared the use of a combination
of glucosamine, chondroitin, and manganese ascorbate
with placebo for patients with degenerative joint disease
of the knee or low back. The subjects were 34 males in
the United States Navy with x-ray proven degenerative
changes in the knees or low back. The 23 subjects with
low back DJD were 43.6 years old on average. The sub-
jects received either oral Cosamin (at a dosage of 1500
mg/day of glucosamine HCl, 1200 mg/day of chondroitin
sulphate, and 228 mg/day of manganese ascorbate) or
a matching placebo, each taken three times daily. Sub-
Figure 1 Literature Search Flow
21 articles identified through the electronic search,
1 article identified through reference searching(20)
3 articles retrieved for more detailed evaluation
2 studies included in the review(17,18)
2 articles excluded that were not published in English,
16 were not clinical studies, 1 article excluded because
it was not published in the peer-reviewed literature(20)
1 article excluded because it was not an RCT(19)
J Can Chiropr Assoc 2011; 55(1) 51
K Stuber, S Sajko, K Kristmanson
jects spent three weeks in a baseline period, then received
either 8 weeks of Cosamin or placebo, then crossed over
to the other group for a fi nal 8 weeks. Subjects were not
permitted to take NSAIDs during the trial but they could
take acetaminophen as necessary.
Outcome measure assessment occurred after weeks 2
and 3 of the baseline period and after weeks 7 and 8 of
each treatment period (thus 6 times in total); there was
no long term follow-up. Outcome measures for the low
back degenerative joint disease subjects included the
Roland-Morris questionnaire for back disability, patient
subjective assessment of handicap (from 0 to 5), phys-
ician assessment of severity (from 0 to 3), an 11 point
visual analog scale, tenderness with movement of the low
back (from 0 to 3), a sprint and stair run, Pavelka physical
examination maneuvers, the Modifi ed Schober technique
for assessing lumbar fl exion, and patient’s subjective as-
sessment of results of treatment (from –3 to +3) (Leffl er).
All of these assessments were totalled to provide an over-
all summary score.
By the end of the trial, four patients withdrew from the
low back degenerative joint disease group. There were
no statistically signifi cant changes in the low back group
when considering the overall summary score or individ-
ual outcome measures. However, the summary score and
patient assessment of treatment effect did show wide 95%
Confi dence Interval’s indicating that clinically meaning-
ful results may have been obtained. No statistically sig-
nifi cant differences were identifi ed between groups with
respect to reported adverse effects.
Fujita et al’s paper18 scored 1/5 which corresponds
with a low quality article,16 with the only point allocated
for the study being described as randomized. This study
compared the use of a combination of glucosamine (1800
mg/day), active absorbable algal calcium (900 mg/day),
porcine skin collagen (10,500 mg/day), composite muco-
polysaccharide (600 mg/day), and vitamin C (600 mg/
day) with control for 80 patients with knee or low back
pain. The number of subjects in this trial with low back
degenerative joint disease was not indicated. The subjects
were randomly divided into two groups: one that would
receive three daily doses of the glucosamine combination
treatment over a four month time period (after a suitable
washout period) and a second group that did not receive
supplements. Subjects were not permitted analgesics dur-
ing the trial. The average age of the subjects was approxi-
mately 65 years old and 75 out of 80 were female. The
supplement group had an average of 1.47/3 in terms of
radiographic degree of spondylosis deformans, compared
with 1.65 in the control group (not a signifi cant differ-
ence).
Outcome measures were assessed at baseline and after
Table 2 Jadad Scale Scoring Results
Jadad Scale Item
Leffl er CT, et al. Military
Med 1999; 164(2): 85–91.
Fujita T, et al. J Bone
Miner Metab 2002; 20:
298–302.
Study described as randomized? 11
Randomization method described and appropriate? 00
Study described as double blind? 10
Double blinding method described and appropriate? 10
Description of withdrawals and dropouts? 10
Subtract 1 point if the randomization method was
described but was inappropriate.
00
Subtract 1 point if the double blinding method was described
but was inappropriate.
00
Total Score (/5) 4 1
52 J Can Chiropr Assoc 2011; 55(1)
Effi cacy of glucosamine, chondroitin, and methylsulfonylmethane
the 4 month trial period and included a subjective pain
rating (from 0–3). Pain levels were also measured by skin
impedance when quietly sitting (the basal value), when
standing up, walking, squatting, climbing up and down
stairs (which were all expressed in terms of percentage
change from the basal value). Lumbar spinal radiographs
and bone mineral densities were performed prior to and
following the trial. The supplement group had a signifi cant
decrease in skin impedance from the beginning to conclu-
sion of the trial; this change was not seen in the control
group. Signifi cant decreases in skin impedance during
various tasks (standing up, walking, squatting, climbing
up and down stairs) when compared with rest were again
noted in the supplement group. Subjective pain values de-
creased signifi cantly in the supplement group, but not the
control group. The lumbar bone mineral density increased
signifi cantly in the supplement group; however the degree
of vertebral deformity did not change in either group.
Discussion
Only two papers met the inclusion criteria for this review
and these articles by Leffl er et al17 and Fujita et al18 are
contradictory in their fi ndings. Leffl er et al17 examined
the effects of glucosamine, chrondroitin sulfate, and man-
ganese ascorbate on degenerative joint disease of the
low back or knee. These authors found no discernable
improvements or change in the supplemented group when
compared to the control group. The article was rated as
having good quality.16 Fujita et al18 looked at the effect
of glucosamine, active absorbable algal calcium, porcine
skin collage, composite mucopolysaccharide, and vita-
min C on back or knee pain. The results indicated that the
group assigned to supplements had signifi cant decreases
in skin impedance and pain over the duration of the study
when compared to the control group. This article was rat-
ed as having poor quality.16
The supplements used by the active treatment (i.e. non-
control) groups in both Leffl er et al’s17 and Fujita et al’s18
studies each had several components, thus it cannot be
ascertained which component(s) of the supplements pro-
duced the improvements (if any) in those subjects. For the
purposes of this review, it cannot be discerned whether the
glucosamine or chondroitin sulfate produced any benefi -
cial effects in the study by Leffl er et al17 or if glucosamine
was responsible for any improvements noted in the study
by Fujita et al.18 The methods of randomization used
in both of the included studies were not revealed. Both
studies indicated that randomization of subjects did take
place, but the exact methods were not disclosed and thus
we cannot discern if the methods were appropriate. The
follow-up periods of 7 to 8 weeks employed by Leffl er et
al17 and 4 months by Fujita et al18 were likely inadequate,
given that spinal osteoarthritis is a long-term condition. It
would seem more suitable for researchers to utilize longer
follow-up periods of at least one year and preferably to
ve years or more. Both of the involved studies had mixed
populations with Leffl er et al including patients with low
back and/or knee degenerative joint disease17 and Fujita
et al including patients with back or knee pain.18 In the
case of Fujita et al18 the average degree of spondylosis
deformans on a scale of zero to three was noted at base-
line indicating that there was some amount of radiograph-
proven spinal osteoarthritis present on average, however
the number of subjects diagnosed with spinal degenera-
tion was not indicated.18
Thus, for the clinician there is contradictory evidence
to support the use of glucosamine in the treatment of spin-
al osteoarthritis or disc degeneration based on the results
of one positive study with low quality and one negative
study with good quality. We identifi ed no articles to sup-
port the use of chondroitin sulfate based on one negative
study with good quality, or MSM based on no identifi ed
studies. Regardless, use of these supplements and their
recommendation in practice is widespread.
In a recent randomized clinical trial analyzing the use
of alternative therapies by individuals with osteoarthritis,
the authors found that 47% of their participants reported
utilizing at least one type of alternative care with the most
common types being massage therapy (57% of alterna-
tive care users), chiropractic (20.7%) and non-prescribed
alternative medications (17.2%).21 A survey of over 2,500
full-time chiropractors in the United States revealed that
on average they treat patients with osteoarthritis/degen-
erative joint disease “often” which was equivalent to one
to two times per week.22 The specifi c anatomic locations
of the osteoarthritis/degenerative joint disease were not
indicated in that survey. The specifi c methods of treat-
ment for a patient with osteoarthritis/degenerative joint
disease was not assessed, however 89% of the chiroprac-
tors surveyed utilized nutritional counselling, therapy,
or supplementation in their practices over the previous
year and on average they indicated that 34.6% of their
J Can Chiropr Assoc 2011; 55(1) 53
K Stuber, S Sajko, K Kristmanson
patients would receive this type of passive adjunctive
procedure.22
A prospective cohort study of a random sample of 9423
Canadians found that 11.5% of their participants were
taking glucosamine fi ve years into the trial compared with
1.6% at baseline.23 This increased usage was associated
with several factors including age, presence of arthritis
and or back pain, calcium intake, regular physical activ-
ity, and use of glucosamine previously.23 The authors felt
that some participants use glucosamine to manage the
symptoms of arthritis and/or back pain, while others use
it on a preventive basis.23 In 2007 glucosamine was the
second most commonly used natural health product, used
by 19.9% of participants over the previous thirty days in
a survey of adults in the general population of the United
States who used nonvitamin, nonmineral health prod-
ucts.24 In the same survey chondroitin was used by 11.9%
of the participants, ranking eighth, while MSM was used
by 4.1% of the participants, ranking eighteenth.24
For clinicians who do choose to recommend these
supplements, it is important to bear in mind that there are
some potential side-effects or contraindications to their
use. It has been proposed that glucosamine sulfate could
potentially alter glucose control, specifi cally interfering
with the hexosamine biosynthesis pathway,25 and as such
down-regulating cellular glucose uptake and leading to
hypergylcemia and insulin resistance. To date, no effects on
glucose concentrations were documented in studies evalu-
ating the use of long-term oral glucosamine for osteoarth-
ritis.9,26 Although no specifi c glucosamine sulfate induced
changes in glycemic control are found in the literature, it
should be noted that the subjects in these studies had well-
controlled type II diabetes and it is unclear how glucosa-
mine sulfate would affect individuals with type I diabetes
who are unable to secrete additional endogenous insulin
to compensate for the potential glucosamine-induced in-
sulin resistance.27 Recently, a case report by Knudsen and
Sokol addressed the effects of glucosamine sulfate on an
individual utilizing warfarin.28 The authors suggested that
the supplementation of glucosamine or glucosamine com-
bined with chondroitin sulfate in individuals consuming
warfarin could potentiate the anticoagulant effects of war-
farin and thereby increase the risk of bleeding.28 Although
this was only a case report, chiropractors should be cogni-
zant of this potential glucosamine-warfarin interaction as
some of the patients for whom they may consider a recom-
mendation for glucosamine may be currently taking war-
farin as an anti-coagulant.
The literature regarding possible contraindications for
MSM is limited, as no formal safety data or long-term
assessment was available. Animal toxicity studies have
shown only minor adverse effects in levels that are 5 to 7
times the proposed maximum recommended human dose
of 6 grams per day.29 The only proposed adverse effects
regarding human supplementation with MSM include al-
lergic gastrointestinal disruptions and skin rashes.30
This review has some possible limitations including
the limitations of the literature itself as there were only
two articles that met our inclusion criteria. This calls into
question whether there may be some publication bias in
this area. It is striking that there have only been two RCTs
published on these supplements for spinal osteoarthritis
when compared with the number of available studies for
these supplements on hip and knee osteoarthritis. Ref-
erence searching of the Cochrane systematic review by
Towheed et al8 yielded an additional short term pilot RCT
article pertaining to the use of glucosamine for osteoarth-
ritis of the spine.20 However, this article was excluded
from the review by Towheed et al8 and did not meet the
inclusion criteria for this review as it was not published in
the peer-reviewed literature; it was an unpublished tech-
nical report by a pharmaceutical company.20
From this limited evidence base fi rm conclusions can-
not be drawn with respect to the effectiveness of glu-
cosamine, chondroitin, or MSM for spinal osteoarthritis,
because their effectiveness is still largely untested. It is
diffi cult to generalize the fi ndings from systematic re-
views pertaining to topics that are as poorly studied as this
one and if more studies had been eligible for this review
it would have led to a stronger conclusion. However it is
still important to present the results of such systematic
reviews so that clinicians can make evidence-based deci-
sions; there have even been systematic reviews published
that had zero articles meet their inclusion criteria.31 From
this overt lack of studies it can be easily stated that there
is a defi nite need for more research in this area.
Another possible limitation of this review is by way of
a language bias as we only permitted articles published in
English. Furthermore we did not search the “grey” litera-
ture or additional electronic databases such as EMBASE.
However, we conducted a multi-modal search strategy
using several electronic databases with hand reference
54 J Can Chiropr Assoc 2011; 55(1)
Effi cacy of glucosamine, chondroitin, and methylsulfonylmethane
searching of obtained articles, thus numerous steps were
taken to thoroughly evaluate the literature.
It could also be argued that a weakness in the meth-
ods of this systematic review was only including RCTs
according to the inclusion criteria employed. However,
in looking at the results of the literature search as seen
in Figure 1, the only other clinical study identifi ed in the
electronic literature search, which was not limited by
study type, was a case report by van Blitterswijkk et al19
that would have been excluded from the review regardless
as it did not employ suitable outcome measures of pain
and/or disability due to pain, along with the single study
found through reference searching, the aforementioned
pilot RCT20 which was excluded as it was not published
in a peer-reviewed journal. As such, use of this particular
inclusion criterion did not affect the outcome of the re-
view.” The use of the Jadad scale may be questioned as it
is a relatively simple tool for rating the quality of RCTs.14
The Jadad scale only evaluates randomization, blinding,
and withdrawals and dropouts, and does not look at other
areas to assess study quality.15 However the Jadad scale is
the most frequently used health care literature quality as-
sessment tool and it has been tested extensively and found
to be valid and reliable.15
Future research in this area should take place to de-
termine the rates at which health care professionals rec-
ommend or prescribe nutritional supplements such as
glucosamine sulfate, chondroitin sulfate, and MSM to pa-
tients with spinal arthritis and disc degeneration, as well
as the consumer usage rates of these supplements. Further
clinical research by way of randomized controlled trials
on the effects of these supplements is also suggested as
there have been only two RCTs in this area using vastly
different supplements and without solely examining pa-
tients with spinal osteoarthritis and/or disc degeneration.
Conclusions
Given the paucity of evidence surrounding the use of glu-
cosamine, chondroitin, and MSM for spinal arthritis and
disc degeneration and the confl icting results in the two
studies that were identifi ed, it would be diffi cult for evi-
dence-based practitioners to justify the recommendation
of these supplements for the pain and resultant disabil-
ity from spinal degenerative conditions. There is an in-
adequate amount of literature examining the use of these
supplements for lumbar spinal degenerative conditions in
comparison with the volume available pertaining to their
use for knee or hip osteoarthritis. Further research is ne-
cessary to clarify if these supplements are of any potential
benefi t for patients with spinal degenerative conditions.
Acknowledgments
The authors would like to thank and acknowledge Ms.
Anne Taylor-Vaisey, reference librarian at the Canadian
Memorial Chiropractic College for her assistance with the
literature search.
References
1 Huskisson EC. Glucosamine and chondroitin for
osteoarthritis. J Int Med Res. 2008; 36(2):1161–1179.
2 Hopman WM, Harrison MB, Friedberg E, Buchanan
M, VanDenKerkhof EG. Associations between chronic
disease, age and physical and mental health status. Chronic
Dis Can. 2009; 29(3): 08–116.
3 Sarzi-Puttini P, Atzeni F, Fumagalli M, Capsoni F,
Carrabba M. Osteoarthritis of the spine. Semin Arthritis
Rheum. 2004; 6(Suppl 2):38–43.
4 Lichtenstein DR, Syngal S, Wolfe MM. Nonsteroidal
anti-infl ammatory drugs and the gastrointestinal tract. The
double-edged sword. Arthritis Rheum. 1995; 38:5–18.
5 Vangsness CT, Spiker W, Erickson J. A review of
evidence-based medicine for glucosamine and chondroitin
sulfate use in knee osteoarthritis. Arthroscopy. 2009; 25(1):
86–94.
6 Richy F, Bruyere O, Ethgen O, Cucherat M, Henrotin
Y, Reginster JY. Structural and symptomatic effi cacy of
glucosamine and chondroitin: a comprehensive meta-
analysis. Arch Intern Med. 2003; 163(13):1514–1522.
7 McAlindon TE, LaValley MP, Gullin JP, Felson
DT. Glucosamine and chondroitin for treatment of
osteoarthritis: a systematic quality assessment and meta-
analysis. JAMA. 2000; 283(11):1469–1475.
8 Towheed T, Maxwell L, Anastassiades TP, Shea B, Houpt
JB, Welch V, Hochberg MC, Wells GA. Glucosamine
therapy for treating osteoarthritis. Cochrane Database of
Systematic Reviews 2005, Issue 2. Art. No.: CD002946.
DOI:10.1002/14651858.CD002946.pub2.
9 Pavelka K, Gatterova J, Olejarova M, Machacek S,
Giacovelli G, Rovati LC.. Glucosamine sulfate use and
delay of progression of knee osteoarthritis: a 3-year,
randomized, placebo-controlled, double-blind study. Arch
Intern Med. 2002; 162(18):2113–2123.
10 Lippiello L, Woodward J, Karpman R, Hammad TA.
In vivo chondroprotection and metabolic synergy of
glucosamine and chondroitin sulfate. Clin Orthop Relat
Res. 2000; Dec(381):229–240.
11 Ameye LG, Chee WS. Osteoarthrithis and nutrition. From
nutriceuticals to functional foods: A systematic review
J Can Chiropr Assoc 2011; 55(1) 55
K Stuber, S Sajko, K Kristmanson
of the scientifi c evidence. Arthritis Res Ther. 2006; 8(4):
R127.
12 Usha PR, Naidu, MUR. Randomized double blind,
parallel, placebo controlled study of oral glucosamine,
methylsulfonylmethane and their combination in
osteoarthritis. Clin Drug Investig. 2004; 24(6):353–363.
13 Kim LS, Axelrod LJ, Howard P, Buratovich N, Waters
RF. Effi cacy of methylsulfonylmethane (MSM) in
osteoarthritis pain of the knee: A pilot clinical trial.
Osteoarthritis Cartilage. 2006; 14(3):286–294.
14 Jadad, AR, Moore RA, Carroll D, Jenkinson C, Reynolds
DJM, Gavaghan DJ, McQuay HJ. Assessing the quality of
reports of randomized clinical trials: Is blinding necessary?
Controlled Clinical Trials. 17(1):1–12.
15 Olivo SA, Macedo LG, Gadotti IC, Fuentes J, Stanton
T, Magee DJ. Scales to assess the quality of randomized
controlled trials: a systematic review. Phys Ther. 2008;
88(2):156–75.
16 Abraham NS, Moayyedi P, Daniels B, Veldhuyzen
Van Zanten SJ. Systematic review: the methodological
quality of trials affects estimates of treatment effi cacy in
functional (non-ulcer) dyspepsia. Aliment Pharmacol Ther.
2004 Mar 15; 19(6):631–41.
17 Leffl er CT, Philippi AF, Leffl er SG, Mosure JC, Kim
PD. Glucosamine, chondroitin, and manganese ascorbate
for degenerative joint disease of the knee or low back: a
randomized, double-blind, placebo-controlled pilot study.
Military Med. 1999; 164(2):85–91.
18 Fujita T, Ohue M, Fujii Y, Miyauchi A, Takagi Y. The
effect of active absorbable algal calcium (AAA Ca) with
collagen and other matrix components on back and joint
pain and skin impedance. J Bone Miner Metab. 2002; 20:
298–302.
19 van Blitterswijkk WJ, van de Nes JCM, Wuisman PIJM.
Glucosamine and chondroitin sulphate supplementation
to treat symptomatic disc degeneration: biochemical
rational and case report. BMC Comp Alt Med. 2003;
3(2):doi:10.1186/1472-6882-3-2
20 Rovati LC, Poma A, Biavati G, et al. A multicenter,
randomized, double-blind, parallel-group study to
investigate effi cacy and safety of oral glucosamine sulfate
in osteoarthritis of the spine. Milan, Italy: Rotthapharm;
1993. Unpublished technical report prepared by
Rottapharm.
21 Ramsey SD, Spencer AC, Topolski TD, Belza B, Patrick
DL. Use of alternative therapies by older adults with
osteoarthritis. Arthritis Rheum. 2001; 45(3):222–227.
22 National Board of Chiropractic Examiners: Job analysis of
chiropractic 2005. Edited by: Christensen MG, Kollasch
MW, Ward R, Webb KR, Day AA, zumBrunnen J. 2005;
1–205.
23 Hopman WM, Towheed TE, Gao Y, Berger C, Joseph L,
Vik SA, Hanley D, Carran J, Anastassiades T. Prevalence
of and factors associated with glucosamine use in Canada.
OsteoArthritis Cartilage. 2006; 14(12):1288–1293.
24 Barnes PM, Bloom B, Nahim RL. Complementary and
alternative medicine use among adults and children:
United States, 2007. National Health Statistics Reports
2008; 12. Hyattsville, MD: National Center for Health
Statistics.
25 McClain DA, Crook ED. Hexosamines and insulin
resistance. Diabetes. 1996; 45(8):1003–1009.
26 Reginster JY, Deroisy R, Rovati LC, Lee Rl, Lejeune
E, Bruyere O, Giacovelli G, Henrotin Y, Dacre JE,
Gossett C. Long-term effects of glucosamine sulphate
on osteoarthritis progression: a randomized, placebo-
controlled clinical trial. Lancet. 2001; 357(9252):251–256.
27 Stumpf JL, Lin S-W. Effect of glucosamine on glucose
control. Ann Pharmacother. 2006; 40(4):694–698.
28 Knudsen JF, Sokol GH. Potential glucosamine-warfarin
interaction resulting in increased international normalized
ratio: case report and review of literature and medwatch
database. Pharmocotherapy. 2008; 28(4):540–548.
29 Horvath K, Noker PE, Somfai-Relle S, Glavits R, Financsek
I, Schauss AG. Toxicity of methylsulfonylmethane in rats.
Food Chem Toxicol. 2002; 40(10): 1459–1462.
30 Brien S, Prescott P, Bashir N, Lewith H, Lewith G.
Systematic review of the nutritional supplements dimethyl
sulfoxide (DMSO) and methysulfonlmethane (MSM) in
the treatment of osteoarthritis. Osteoarthritis and Cartilage.
2008; 16(11):1277–1288.
31 Richards CE, Magin PJ, Callister R. Is your prescription of
distance running shoes evidence-based? Br J Sports Med.
2009; 43(3):159–162.
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