Definition
- Amino sugar used as a precursor of glycosaminoglycans in articular cartilage
- Sold as glucosamine sulphate or hydrochloride, often with chondroitin
- Most positive European trials used crystalline glucosamine sulphate
- Product content varies, as supplements are listed rather than registered medicines
Evidence
- GAIT trial (NEJM 2006) found no benefit over placebo for knee osteoarthritis pain
- Network meta-analysis (Wandel, BMJ 2010) found no clinically relevant effect on pain or joint space
- RACGP and international guidelines advise against routine use
- Industry funded trials report larger effects than independent trials
- LEGS study (Fransen, Ann Rheum Dis 2015) found no symptom benefit at 2 years, with a small reduction in joint space narrowing from combined glucosamine and chondroitin
- No evidence of benefit in hip osteoarthritis
- Cochrane review (Towheed 2005) found benefit only in lower quality trials
Adverse Effects
- Well tolerated in trials
- Caution with shellfish allergy
- May raise INR with warfarin
- See Chondroprotective Supplements
- Mild gastrointestinal upset is the most common side effect
Clinical Practice
- Patients often ask about supplements, and a clear summary of the evidence supports shared decisions
- A 3 month trial is reasonable if the patient wishes, stopping if there is no benefit
- Weight loss and exercise have stronger evidence for knee osteoarthritis
Reviewed by Professor Phong Tran, Head of Orthopaedic Surgery, Western Health. Last updated 10 October 2026.