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Glucosamine Ė a Fishy Story?

Loretta Marron BSc
From a Skeptics Perspective

Issue 79: February 2009
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People have put spuds in their pockets and under their pillows, have worn magnets and copper bracelets and have tried all sorts of other weird and wonderful gizmos and remedies to try to combat their arthritis, a painful and debilitating condition that has been affecting joints since the first vertebrate evolved.
The many anecdotes and the continual bombardment of advertising by high profile people, and the claims by Sponsors that their products are scientifically based, lead us to assume that Glucosamine improves mobility and reduces pain.
However, in the UK, clinical guidelines for osteoarthritis (1) do not recommend it.
So, do ground-up prawn shell pills help with arthritis?
This month I’m going to talk about Glucosamine.

Costing the country around $24 billion per year, about 1.3 million Australians live with persistent pain from osteoarthritis.
With our ageing population this number is expected to rise to about 7 million by 2050.
Osteoarthritis is one of our most chronic diseases and it continues to be the major source of disability among the elderly.

There are basically three types of Glucosamine sold (with and without shark cartilage).
One is Glucosamine Hydrochloride and the other two are versions of Glucosamine Sulphate; Rottapharm’s DONA and the rest, which is every other Glucosamine Sulphates such as those we buy in Australia.
There are two conditions that Glucosamine is meant to treat; pain management and for slowing the narrowing of joint width.

Look up any evidence-based medicine website and they all agree that Glucosamine Hydrochloride is "not effective" (2) for either condition.

The Glucosamine Sulphate story is a bit more complicated.

In 2005, a Cochrane Review (4), investigating 20 studies involving 2570 patients, “failed to show benefit of glucosamine for pain and WOMAC (Western Ontario & McMasters University Osteoarthritis Arthritis Index) function”.
It also noted that “further long-term trials and trials evaluating different forms of glucosamine are warranted before its usefulness and safety can be clearly established”.
The Review concluded “WOMAC outcomes of pain, stiffness and function did not show a superiority of glucosamine over placebo for both Rotta and non-Rotta preparations of glucosamine”.

Two studies included in the Cochrane Review were sponsored by Rottapharm, used their own product DONA and showed positive results.
Antonino Santora, the Director of Rottapharm, is clearly ticked off with the claims made by the Sponsors of non-DONA products.
In a 2008 letter to the MJA (3) he stated that DONA Glucosamine has “shown consistent efficacy across all trials” because their product is “a patented formulation of crystalline glucosamine sulfate, which is not comparable with glucosamine hydrochloride or other glucosamine sulfate formulations.”
He also said that DONA is the “only glucosamine product available with proven human bioavailability and pharmocokinetics”.

However, trials using non-DONA Glucosamine Sulphate have failed to live up to the Santora claims made for Rottapharm’s product.
In 2006, 570 patients with osteoarthritis of the knee were followed for two years (5). The findings were that the narrowing of the joint space did not slow down in the treatment group.
In 2008, a 2 year randomised control trial following 222 patients with hip osteoarthritis concluded that Glucosamine Sulphate was no better than placebo in reducing symptoms and progression of hip osteoarthritis (6).
These results seem to support Santora’s statements.

CHOICE took on Glucosamine (7) and concluded, “New research makes the evidence look shaky”.
Researching 26 Australian products they found “the scientific evidence that Glucosamine or Glucosamine/Chondroitin makes it seem doubtful that it’s effective at relieving the pain of arthritis”.

When Sponsors want to sell a new product, they can go on-line to the Therapeutic Goods Administration (TGA) website and provided that the TGA considers that the active ingredients mentioned in their product are safe, they will easily obtain an AUST L number.
The TGA also does not check individual preparations nor do they require that the products work.
Last time I counted there were 320 Glucosamine products with approval numbers – none of which are DONA - so it seems you can make any old Glucosamine product in your garage, apply for a listing number, claim that your product is scientifically proven to work and start selling.

People who experience arthritic pain have confided in me that they would “tango with a witchdoctor if it would fix it”, and will (and do) try anything that claims to help.
My local pharmacy doesn’t stock DONA. However, they have built a metre high pyramid of bottles of Glucosamine Hydrochloride positioning it next to their prescription counter.
They also have quite a number of Glucosamine products from different Sponsors on their shelves and have a large display case out front.

After all, with our ageing population, any products stocked in pharmacies that claim to help with arthritis will always be easy to sell, won’t they?

1. National Institute for Health and Clinical Excellence, 2008. Osteoarthritis: The care and management of osteoarthritis in Adults. http:/www.nice.org.uk/nicemedia/pdf/CG59NICEguidelines.pdf
2. Sawitzke AD and others. [The effect of glucosamine and/or chondroitin sulfate on the progression of knee osteoarthritis: A report from the Glucosamine/chondroitin Arthritis Intervention Trial. Arthritis & Rheumatism 58:3183-3191, 2008 http://www.ncbi.nlm.nih.gov/pubmed/18821708.
3. MJA report Pollard NA || Santoro A || Kotsirilos V || Masters CS || Harvey KJ, Korczak VS, Marron LJ and Newgreen DB. Commercialism, choice and consumer protection: regulation of complementary medicines in Australia [letters]. Med J Aust 2008; 189 (1): 50-53.
4. Healthy Skepticism Library number: 14482 Glucosamine therapy for treating osteoarthritis
5. Clegg DO and others. Glucosamine, chondroitin sulfate, and the two in combination for painful knee osteoarthritis. New England Journal of Medicine
354:795-808, 2006
6. Rozendaal RM, Koes BW, van Osch GJVM, et al. Effect of Glucosamine Sulfate on Hip Osteoarthritis: A
Randomized Trial. Ann Intern Med. 2008;148:268-277.
7. Choice > Home > Health > Medicines > Glucosamine (05/08):

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