Effect of Glucosamine Sulfate on Hip Osteoarthritis

A Randomized Trial

19 February 2008 | Volume 148 Issue 4 | Pages 268-277

Background: The effectiveness of glucosamine sulfate as a symptom and disease modifier for osteoarthritis is still under debate.

Objective: To assess whether glucosamine sulfate has an effect on the symptoms and structural progression of hip osteoarthritis during 2 years of treatment.

Design: Randomized, controlled trial.

Setting: Primary care in the Netherlands.

Patients: 222 patients with hip osteoarthritis who were recruited by their general practitioner. Patients were eligible if they met the American College of Rheumatology clinical criteria for hip osteoarthritis.

Intervention: 2 years of treatment with 1500 mg of oral glucosamine sulfate or placebo once daily.

Measurements: Primary outcome measures were Western Ontario and McMaster Universities (WOMAC) pain and function subscales over 24 months and joint space narrowing after 24 months. The main secondary outcome measures were WOMAC pain, function, and stiffness after 3, 12, and 24 months.

Results: At baseline, both groups were similar in demographic and clinical variables. Overall, WOMAC pain did not differ (mean difference [glucosamine sulfate minus placebo], –1.54 [95% CI, –5.43 to 2.36]), nor did WOMAC function (mean difference, –2.01 [CI, –5.38 to 1.36]). Joint space narrowing also did not differ after 24 months (mean difference, –0.029 [CI, –0.122 to 0.064]). Only 1 of the sensitivity analyses, based on extreme assumptions regarding missing assessments due to total hip replacement, provided results consistent with a glucosamine effect.

Limitations: Twenty patients had total hip replacement during the trial. Half of the patients had a Kellgren and Lawrence score of 1.

Conclusion: Glucosamine sulfate was no better than placebo in reducing symptoms and progression of hip osteoarthritis.

International Standard Randomised Controlled Trial Number: ISRCTN54513166.

Editors' Notes Context Although many patients use glucosamine to treat osteoarthritis, available studies have reported inconsistent effects of glucosamine on symptoms and joint changes. In addition, previous studies have more often included patients with knee than with hip osteoarthritis. Contribution The investigators randomly assigned 222 patients with hip osteoarthritis to glucosamine, 1500 mg/d, or placebo. After 2 years of treatment, no clinically significant effect on pain, function, or joint space narrowing was found. Caution Twenty of the patients in the trial had joint replacement during the study. —The Editors

 

Author and Article Information

From Erasmus Medical Center, Rotterdam, the Netherlands, and Leiden University Medical Center, Leiden, the Netherlands.

Acknowledgment: The authors thank all the patients who participated in the trial and the general practitioners responsible for their recruitment. They also thank Diana van Emmerik for her contribution to the success of the trial.

Grant Support: By the Erasmus Medical Center–Breedtestrategie program.

Potential Financial Conflicts of Interest: None disclosed.

Requests for Single Reprints: Rianne M. Rozendaal, MSc, Department of General Practice, Erasmus Medical Center, Room Fg 351, PO Box 2040, 3000 CA Rotterdam, the Netherlands; e-mail, r.rozendaal{at}erasmusmc.nl.

Current Author Addresses: Ms. Rozendaal; Drs. Koes and Bierma-Zeinstra; and Mr. Willemson: Department of General Practice, Erasmus Medical Center, PO Box 2040, 3000 CA Rotterdam, the Netherlands.

Drs. van Osch, Uitterlinden, Verhaar, and Weinans: Department of Orthopaedics, Erasmus Medical Center, PO Box 2040, 3000 CA Rotterdam, the Netherlands.

Dr. Garling: Department of Orthopaedics, Biomechanics and Imaging Group, Leiden University Medical Center, PO Box 9600, J11-S, 2300 RC Leiden, the Netherlands.

Dr. Ginai: Department of Radiology, Erasmus Medical Center, PO Box 2040, 3000 CA Rotterdam, the Netherlands.

Author Contributions: Conception and design: B.W. Koes, G.J.V.M. van Osch, E.J. Uitterlinden, H. Weinans, S.M.A. Bierma-Zeinstra.

Analysis and interpretation of the data: R.M. Rozendaal, S.M.A. Bierma-Zeinstra.

Drafting of the article: R.M. Rozendaal, S.M.A. Bierma-Zeinstra.

Critical revision of the article for important intellectual content: B.W. Koes, G.J.V.M. van Osch, E.J. Uitterlinden, A.Z. Ginai, J.A.N. Verhaar, H. Weinans, S.M.A. Bierma-Zeinstra.

Final approval of the article: B.W. Koes, G.J.V.M. van Osch, E.H. Garling, A.Z. Ginai, J.A.N. Verhaar, S.M.A. Bierma-Zeinstra.

Statistical expertise: S.P. Willemsen.

Obtaining of funding: H. Weinans, S.M.A. Bierma-Zeinstra.

Administrative, technical, or logistic support: E.J. Uitterlinden.

Collection and assembly of data: R.M. Rozendaal, E.H. Garling.