Chondroitin Overview

Chondroitin sulfate is a naturally occurring substance in the body. It is a major constituent of cartilage—the tough, elastic connective tissue found in the joints.

Based on the evidence of preliminary double-blind studies , chondroitin is widely used as a treatment for osteoarthritis, the typical arthritis that many people suffer as they get older. However, the supporting evidence for this use is weak.

There is some evidence that chondroitin might go beyond treating symptoms and actually protect joints from damage. Current medical treatments for osteoarthritis, such as nonsteroidal anti-inflammatory drugs (NSAIDs), treat the symptoms but don't actually slow the disease's progression, and they may actually make it get worse faster. ^4,5,6,7 Chondroitin (along with glucosamine) may take the treatment of osteoarthritis to a new level. However, more research needs to be performed to prove definitively that this exciting possibility is real.

Chondroitin is not an essential nutrient. Animal cartilage is the only dietary source of chondroitin. (When it's on your plate, animal cartilage is called gristle.) Unless you enjoy chewing gristle, you'd do best to obtain chondroitin in pill form from a health food store or pharmacy.

The usual dosage of chondroitin is 400 mg taken 3 times daily, indefinitely. Two studies (mentioned below) used an "on and off" schedule of chondroitin (taking it for 3 months, going off of it for 3 months, and then taking it again). Other studies involved taking chondroitin daily. Regardless of which way you use it, be patient! The results are thought to take weeks to develop.

In commercial products, chondroitin is often combined with glucosamine . Preliminary information from one animal study suggests that this combination may be superior to either treatment alone. ¹ There are large differences between chondroitin products based on their chemical structure. ² This can be expected to lead to significant differences in absorption and hence effectiveness. Most likely, chondroitin products with physically smaller molecules (fewer than 16,900 daltons) are better absorbed. In addition, a review conducted in 2003 by the respected testing organization, Consumerlab.com, found that some products sold as providing chondroitin actually contained far less chondroitin (or even none at all) than stated on the label. ³ It may be advisable to use the exact products that were tested in double-blind trials.

For years, experts stated that oral chondroitin couldn't possibly work because its molecules are so big that it seemed doubtful that they could be absorbed through the digestive tract. However, in 1995, researchers laid this objection to rest when they found evidence that up to 15% of chondroitin is absorbed intact. ⁴

Reducing Symptoms of Osteoarthritis

Many but not all double-blind, placebo-controlled studies indicate that chondroitin can relieve symptoms of osteoarthritis.

For example, one study enrolled 85 people with osteoarthritis of the knee and followed them for 6 months. ⁵ Participants received either 400 mg of chondroitin sulfate twice daily or placebo. At the end of the trial, doctors rated the improvement as good or very good in 69% of those taking chondroitin sulfate, but in only 32% of those taking placebo.

Another way of comparing the results is to look at maximum walking speed among participants. Whereas individuals in the chondroitin group were able to improve their walking speed gradually over the course of the trial, walking speed did not improve at all in the placebo group. Additionally, there were improvements in other measures of osteoarthritis, such as pain level, with benefits seen as early as 1 month. This suggests that chondroitin was able to stop the arthritis from gradually getting worse. (See also Slowing the Progression of Osteoarthritis .)

Good results were seen in a 12-month, double-blind trial that compared chondroitin against placebo in 104 people, a 12-month trial of 42 people, ⁶ and a 12-month study of 120 people. ⁷ In two of these studies, chondroitin was taken for two separate 3-month periods separated by 3 months of no treatment; ⁸ in the others, it was taken continuously. No comparison of these two ways of using chondroitin has been published.

Benefits were also seen in two other double-blind, placebo-controlled trials involving a total of more than 350 individuals. ⁹ Another double-blind study compared chondroitin to the anti-inflammatory drug diclofenac and found equivalent benefits. ¹⁰ Additional studies combined glucosamine with chondroitin. A 6-month, double-blind, placebo-controlled study of 93 people with knee arthritis found that a combination of glucosamine and chondroitin (along with manganese) was more effective than placebo. ¹¹ Another double-blind, placebo-controlled study evaluated chondroitin/glucosamine for temporomandibular joint disease (TMJ) but found equivocal results. ¹² However, a very large (1,583 participants) and well-designed study failed to find either chondroitin or glucosamine plus chondroitin more effective than placebo. ¹³ When this study is pooled together with the two other best designed trials, no overall benefit is seen. ¹⁴ Yet another study also failed to find benefit with glucosamine plus chondroitin. ¹⁵ It has been suggested that chondroitin, like glucosamine, may primarily appear effective in studies funded by manufacturers of chondroitin products.

Slowing the Progression of Osteoarthritis

Osteoarthritis tends to worsen with time. As mentioned earlier, no conventional treatment for osteoarthritis protects joints from progressive damage. Some evidence hints that chondroitin can do this, but it is too early to consider the matter settled. ¹⁶ One study examined the progression of osteoarthritis in 119 people for 3 years. ¹⁷ In this double-blind, placebo-controlled trial, those who took 1,200 mg of chondroitin daily showed lower rates of severe joint damage. Only 8.8% of the chondroitin group developed severely damaged joints during the 3 years of the study, compared with almost 30% of the placebo group. This suggests that chondroitin was slowing the progression of osteoarthritis.

Protective effects were also seen in three 1-year studies enrolling a total of more than 200 people. ¹⁸ Animal studies provide some additional evidence for a joint-protecting benefit. ¹⁹ However, as with studies of chondroitin for treating osteoarthritis, too high a proportion of the research record involving prevention of osteoarthritis has involved industry-funded research.

How Does Chondroitin Work for Osteoarthritis?

Scientists are unsure how chondroitin sulfate works (if indeed it does).

At its most basic level, chondroitin may help cartilage by providing it with the building blocks it needs to repair itself. Chondroitin is also believed to block enzymes that break down cartilage in the joints. ²⁰ Another theory holds that chondroitin increases the amount of hyaluronic acid in the joints. ²¹ Hyaluronic acid is a protective fluid that keeps the joints lubricated. Finally, chondroitin may have a mild anti-inflammatory effect. ²²

1. Lippiello L, Woodward J, Karpman R, Hammad TA. In vivo chondroprotection and metabolic synergy of glucosamine and chondroitin sulfate. Clin Orthop Relat Res. (381):229-40.
2. Adebowale AO, Cox DS, Liang Z, et al. Analysis of glucosamine and chondroitin sulfate content in marketed products and the Caco-2 permeability of chondroitin sulfate raw materials. J Am Nutraceutical Assoc. 2000;3:37-44.
3. Product review: joint supplements (glucosamine, chondroitin, and MSM). Consumerlab website. Available at: http://www.consumerlabs.com/results/gluco.asp. Accessed May 8, 2006.
4. Conte A, Volpi N, Palmieri L, Bahous I, Ronca G. Biochemical and pharmacokinetic aspects of oral treatment with chondroitin sulfate. Arzneimittelforschung. 45(8):918-25.
5. Bucsi L, Poór G. Efficacy and tolerability of oral chondroitin sulfate as a symptomatic slow-acting drug for osteoarthritis (SYSADOA) in the treatment of knee osteoarthritis. Osteoarthritis Cartilage. 6 Suppl A():31-6.
6. Uebelhart D, Thonar EJ, Delmas PD, Chantraine A, Vignon E. Effects of oral chondroitin sulfate on the progression of knee osteoarthritis: a pilot study. Osteoarthritis Cartilage. 6 Suppl A():39-46.
7. Uebelhart D, Malaise M, Marcolongo R, de Vathaire F, Piperno M, Mailleux E, Fioravanti A, Matoso L, Vignon E. Intermittent treatment of knee osteoarthritis with oral chondroitin sulfate: a one-year, randomized, double-blind, multicenter study versus placebo. Osteoarthritis Cartilage. 12(4):269-76.
8. Conrozier T. Anti-arthrosis treatments: efficacy and tolerance of chondroitin sulfates (CS 4&6) [translated from French]. Presse Med. 1998;27:1862-1865.
9. Bourgeois P, Chales G, Dehais J, Delcambre B, Kuntz JL, Rozenberg S. Efficacy and tolerability of chondroitin sulfate 1200 mg/day vs chondroitin sulfate 3 x 400 mg/day vs placebo. Osteoarthritis Cartilage. 6 Suppl A():25-30.
10. Morreale P, Manopulo R, Galati M, Boccanera L, Saponati G, Bocchi L. Comparison of the antiinflammatory efficacy of chondroitin sulfate and diclofenac sodium in patients with knee osteoarthritis. J Rheumatol. 23(8):1385-91.
11. Das A Jr, Hammad TA. Efficacy of a combination of FCHG49 glucosamine hydrochloride, TRH122 low molecular weight sodium chondroitin sulfate and manganese ascorbate in the management of knee osteoarthritis. Osteoarthritis Cartilage. 8(5):343-50.
12. Nguyen P, Mohamed SE, Gardiner D, Salinas T. A randomized double-blind clinical trial of the effect of chondroitin sulfate and glucosamine hydrochloride on temporomandibular joint disorders: a pilot study. Cranio. 19(2):130-9.
13. Clegg DO, Reda DJ, Harris CL, Klein MA, O'Dell JR, Hooper MM, Bradley JD, Bingham CO 3rd, Weisman MH, Jackson CG, Lane NE, Cush JJ, Moreland LW, Schumacher HR Jr, Oddis CV, Wolfe F, Molitor JA, Yocum DE, Schnitzer TJ, Furst DE, Sawitzke AD, Shi H, Brandt KD, Moskowitz RW, Williams HJ. Glucosamine, chondroitin sulfate, and the two in combination for painful knee osteoarthritis. N Engl J Med. 354(8):795-808.
14. Reichenbach S, Sterchi R, Scherer M, et al. Meta-analysis: chondroitin for osteoarthritis of the knee or hip. Ann Intern Med. 2007;146:580-590.
15. Messier SP, Mihalko S, Loeser RF, Legault C, Jolla J, Pfruender J, Prosser B, Adrian A, Williamson JD. Glucosamine/chondroitin combined with exercise for the treatment of knee osteoarthritis: a preliminary study. Osteoarthritis Cartilage. 15(11):1256-66.
16. Richy F, Bruyere O, Ethgen O, Cucherat M, Henrotin Y, Reginster JY. Structural and symptomatic efficacy of glucosamine and chondroitin in knee osteoarthritis: a comprehensive meta-analysis. Arch Intern Med. 163(13):1514-22.
17. Verbruggen G, Goemaere S, Veys EM. Chondroitin sulfate: S/DMOAD (structure/disease modifying anti-osteoarthritis drug) in the treatment of finger joint OA. Osteoarthritis Cartilage. 6 Suppl A():37-8.
18. Conrozier T. Anti-arthrosis treatments: efficacy and tolerance of chondroitin sulfates (CS 4&6) [translated from French]. Presse Med. 1998;27:1862-1865.
19. Uebelhart D, Thonar EJ, Zhang J, Williams JM. Protective effect of exogenous chondroitin 4,6-sulfate in the acute degradation of articular cartilage in the rabbit. Osteoarthritis Cartilage. 6 Suppl A():6-13.
20. Uebelhart D, Thonar EJ, Zhang J, Williams JM. Protective effect of exogenous chondroitin 4,6-sulfate in the acute degradation of articular cartilage in the rabbit. Osteoarthritis Cartilage. 6 Suppl A():6-13.
21. Hungerford DS. Treating osteoarthritis with chondroprotective agents. Orthopedic Special Edition. 1998;4:39-42.
22. Ronca F, Palmieri L, Panicucci P, Ronca G. Anti-inflammatory activity of chondroitin sulfate. Osteoarthritis Cartilage. 6 Suppl A():14-21.