Glucosamine Sulfate Monograph

This section is compiled by Frank M. Painter, D.C.
Send all comments or additions to:    Frankp@chiro.org

FROM:   Alternative Medicine Review 1999 (Jun);   4 (3):   193–195 ~ FULL TEXT

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Glucosamine sulfate's role in halting or reversing joint degeneration appears to be directly due to its ability to act as an essential substrate for, and to stimulate the biosynthesis of, the glycosaminoglycans and the hyaluronic acid backbone needed for the formation of the proteoglycans found in the structural matrix of joints. Successful treatment of osteoarthritis must effectively control pain and should slow down or reverse the progression of the degeneration. Biochemical and pharmacological data combined with animal and human studies demonstrate that glucosamine sulfate is capable of satisfying both of these criteria.

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Introduction

Glucosamine is the most fundamental building block required for biosynthesis of the classes of compounds including glycolipids, glycoproteins, glycosaminoglycans (formerly called mucopolysaccharides), hyaluronate, and proteoglycans. As a component of these macromolecules, glucosamine has a role in the synthesis of cell membrane lining, collagen, osteoid, and bone matrix. Glucosamine is also required for the formation of lubricants and protective agents such as mucin and mucous secretions.

      Pharmacokinetics

In humans, about 90 percent of glucosamine, administered as an oral dose of glucosamine sulfate, is absorbed from the digestive tract. [1] After an oral dose, glucosamine concentrates in the liver, where it is either incorporated into plasma proteins, degraded into smaller molecules, or utilized for other biosynthetic processes. [1] Elimination of glucosamine is primarily through the urine, with a small amount of glucosamine or its derivatives eliminated in the feces. [2, 3]

      Mechanism of Action

Glucosamine sulfate is capable of stimulating proteoglycan synthesis, inhibiting the degradation of proteoglycans, and stimulating the regeneration of experimentally-induced cartilage damage. [4, 5] Some experts also believe glucosamine sulfate might promote the incorporation of sulfur into cartilage. [6]

      Clinical Research on Osteoarthritis

The primary therapeutic use of glucosamine sulfate has been in the treatment of degenerative diseases of the joints. Although many of the available studies have compared glucosamine sulfate to placebo, in the trials where glucosamine sulfate has been compared to NSAIDs, long-term reductions in pain are greater in patients receiving glucosamine sulfate. [7–11]

Symptoms such as articular pain, joint tenderness, and swelling often improve following a 6-8 week period of oral administration of glucosamine sulfate. [7–13] For most individuals, an expectation of a reduction in symptoms of from 50-70 percent is reasonable. [7] Improvements secondary to glucosamine sulfate therapy generally are sustained six to 12 weeks following cessation of the treatment regimen. [12]

For arthritis of the knee, evidence suggests that about 60 percent of patients will have a good to excellent response to this intervention, while an additional 35 percent will have a more moderate benefit. Preliminary evidence suggests patients with arthritis of the shoulder or elbow respond the best to glucosamine sulfate (about 75 percent judged as good and only one percent judged as insufficient), while polyarticular arthritis and arthritis of the hip had the poorest response rate (only 43 percent and 49 percent, respectively). [12]

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