April 17, 2007 -- At least 7 million Americans take chondroitin, alone or combined with other supplements, for joint pain, current industry figures suggest.
Now, a new study suggests that the supplement may be doing little, if any good.
The study, called a meta-analysis, combines data from 20 prior studies examining the benefits of chondroitin on knee or hip arthritis.
What the analysis found was that chondroitin was only minimally beneficial, if at all, in treating joint pain from arthritis and should not be recommended as treatment.
Good Today, Bad Tomorrow
Many experts say it is little surprise that so many patients are interested in dietary supplements such as chondroitin because current treatments for arthritis are limited and poor.
However, reliable research on chondroitin has thus far been scant -- leading many in the field to question its true effectiveness.
"[This study] accomplished something that is very challenging because the studies of chondroitin are not consistent," said Dr. David Felson, professor of medicine and public health at the Boston University School of Medicine.
"Some of the largest studies have shown no efficacy of chondroitin. Other studies have shown very impressive efficacy. So the question is, what do you believe?"
Eating Cartilage Not the Answer
Arthritis is a degenerative joint disease that affects more than 20 million people in the United States.
It is the most common type of joint disease and a major cause of joint pain because of deterioration of cartilage, which serves as a cushion at the ends of bones that allows for smooth joint movement.
"Originally, the premise behind the use of chondroitin and glucosamine was that they provided the basic elements of healthy cartilage," said Dr. Dennis Boulware, professor of medicine at the University of Alabama at Birmingham.
But Dr. Eric Matteson, chair of the division of rheumatology at the Mayo Clinic in Rochester, Minn., stated, "There is no biologically plausible way that [chondroitin] can work to repair joints damaged by arthritis."
The reason for this, he says, is that even if one were to consume a large amount of the substances that make up cartilage, it seems unlikely that these building blocks would be able to reach the joint where they would be useful, as the cartilage in many joints has no blood supply.
"The substance has to be made and used by cartilage cells to work," Matteson added. "Cells damaged by arthritis cannot do this."
Moreover, Boulware said, "If they really believed that premise, then bald men should eat more healthy hair."
Other research suggests that many patients may not even be getting what they bargained for from their supplement pills. Some chondroitin supplements do not even contain any of the advertised product, as recently discovered by Consumerlabs.com, a leading provider of independent test results and information on health products.
Some Still Believe
Despite the findings of the new study, some continue to tout the benefits of chondroitin.
The National Products Association is a nonprofit organization that represents nearly 10,000 retailers, manufacturers, wholesalers and distributors of natural products.
Daniel Fabricant, vice president of scientific and regulatory affairs for the association, said, "I don't agree with the statement that there is no benefit from chondroitin. Other studies have shown that chondroitin is beneficial, especially when taken with glucosamine."
One of the studies that Fabricant refers to is the Glucosamine/Chondroitin Arthritis Intervention Trial (GAIT) funded by the National Institutes of Health. This trial, one of the largest of its kind in the United States, seemed to suggest that chondroitin, taken along with the supplement glucosamine, reduced pain for a small group of patients.
However, while these dietary supplements showed hints of possible benefits, experts emphasize that rigorous statistical analysis found none of these hints to be real.
Furthermore, Felson added that this new study, which included GAIT, "used very sophisticated strategies to determine what was most trustworthy of finding."
"They took the largest and best done studies and showed no efficacy. I think that's very believable." he said.
A Tough Pill to Swallow?
Most experts remain unconvinced that chondroitin has any beneficial effects for joints. But they also agree that it has not been found to be harmful.
Considering this, some doctors such as Dr. David Campen, medical director of drug information, utilization and technology for Kaiser's California pharmacy operations, "would encourage [patients] to try [chondroitin] for four to six weeks to see if it helps their particular case of arthritis."
Nortin Hadler, attending rheumatologist at the University of North Carolina Hospitals, however, has a different take.
"Ingesting chondroitin is a waste of money," he said. "I've long said that, and told my patients."
"Some have money to waste. So be it."
After informing patients that data supporting the use of chondroitin in treating arthritis are lacking, most doctors ultimately leave the decision up to them.
It's not uncommon for patients to experience improvement simply from taking a pill, so Felson said, "If patients come to me and tell me it's helping, I don't dissuade them from taking it. When people come to me who aren't on it and ask if they should take it, I don't recommend it."
Dr. Peter Juni, head of the division of clinical epidemiology and biostatistics at the University of Berne in Switzerland and senior author of the new study, added that they made the best of studies they had to work with and cannot rule out a possible benefit of chondroitin in a select group of patients, but that more studies need to be performed.