A look at the evidence for vitamins D, K, and B; trace minerals; and glucosamine and chondroitin.
References1. Mabey T, Honsawek S. Role of vitamin D in osteoarthritis: molecular, cellular, and clinical perspectives. Int J Endocrinol. 2015;2015:383918.2. Christodoulou S, Goula T, Ververidis A, Drosos G. Vitamin D and bone disease. Biomed Res Int. 2013;2013:396541.3. Cianferotti L, Bertoldo F, Bischoff-Ferrari HA, et al. Vitamin D supplementation in the prevention and management of major chronic diseases not related to mineral homeostasis in adults: research for evidence and a scientific statement from the European society for clinical and economic aspects of osteoporosis. Endocrine. 2017;56:245-261.4. Misra D, Booth SL, Tolstykh I, et al. Vitamin K deficiency is associated with incident knee osteoarthritis. Am J Med. 2013;126:243-248.5. Neogi T, Booth SL, Zhang YQ, et al. Low vitamin K status is associated with osteoarthritis in the hand and knee. Arthritis Rheum. 2006;54:1255-1261.6. Shea MK, Kritchevsky SB, Hsu FC, et al. The association between vitamin K status and knee osteoarthritis features in older adults: the Health, Aging and Body Composition Study. Osteoarthritis Cartilage. 2015;23:370-378.7. Henrotin Y, Hunter DJ, Uebelhart D. What is the current status of chondroitin sulfate and glucosamine for the treatment of knee osteoarthritis? Maturitas. 2014;78:184-187.8. Grover AK, Samson SE. Benefits of antioxidant supplements for knee osteoarthritis: rationale and reality. Nutr J. 2016;15:1.9. MagaÃ±a-Villa MC, Rocha-GonzÃ¡lez HI, FernÃ¡ndez del Valle-Laisequilla C, et al. B-vitamin mixture improves the analgesic effect of diclofenac in patients with osteoarthritis: a double blind study. Drug Res (Stuttg). 2013;63:289-292.
Patients with osteoarthritis often ask about the benefits of supplements. What will you tell them?
Here’s a look at the evidence behind vitamins D, K, and B; antioxidants; trace minerals; and glucosamine and chondroitin.
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In some regions, up to 75% of the population may have vitamin D deficiency. The best natural source is sunlight (ultraviolet B rays); however, dermatologists recommend limited sun exposure, and many people do not receive sufficient exposure anyway.1,2 Supplementation is recommended for those at risk for bone disease, but there are no clear guidelines on optimal dosage.3
Vitamin K contributes to regulation of skeletal mineralization. Deficiency has been found in several studies to be associated with OA of the knee and hand and also contributes to progressive bone and joint damage.4-6 Vitamin K is considered a possible preventive option for OA.
The combination of glucosamine 500 mg and chondroitin 400 mg 3 times daily was shown to relieve pain and improve function in moderate to severe OA of the knee.7 In limited studies, glucosamine and chondroitin have demonstrated a small but significant reduction in the rate of joint space narrowing in OA.7 Pharmaceutical grade supplements are preferred because commercial grade products are often of poor quality.
As in many inflammatory disorders, free radicals are believed to contribute to the underlying causes of OA. Antioxidant vitamins C, E, and beta-carotene are the most potent combatants of free radicals. While antioxidants are readily available in foods, particularly orange and yellow vegetables and citrus fruits, these sources may not be sufficient and supplements are widely used.8
Some evidence indicates that the addition of B vitamins to a regimen of diclofenac for OA improves pain relief.9