An estimated 50 million Americans suffer from osteoarthritis, with direct and indirect costs associated with arthritis and other rheumatic conditions pegged at about $128 billion, according to 2003 data from the US Centers for Disease Control and Prevention (CDC).
The joint health segment is dominated by combination products containing glucosamine and chondroitin sulfate, driven by positive data from big studies like GAIT and demand from aging consumers to naturally support their joints. (Pharmaceutical solutions include non-steroidal anti-inflammatory drugs (NSAIDs), but these have been linked with gastrointestinal toxicity, increased blood pressure, and increased risk of cardiovascular disease.)
“For quite a while glucosamine, chondroitin sulfate and MSM were really the only scientifically supported ingredients available for joint care,” explained Cal Bewicke, CEO of Ethical Naturals Inc. “And there was a huge wave of popularity and interest, but it was unlikely to keep those levels.”
Indeed, the global retail value of glucosamine products was valued at $1.895 billion in 2009, which then grew to $2.041 billion in 2011, according to data from Euromonitor International*. But then the market began to flag, with 2013’s value at $1.823 billion, and the 2015 forecast predicting a market worth $1.770 billion.
Chris Schmidt, Consumer Health Analyst for Euromonitor told us: "Two big contributors to our declining estimates come to mind: The first is definitional, in that a growing number of glucosamine-containing products are actually being tracked under combination dietary supplements. This has increased recently, as there is a trend among producers to include more ingredients in their products (as opposed to stand-alone formulations) in an effort to broaden their appeal. A good example is the Schiff (Reckitt Benckiser Plc RB) brand Move Free. Move Free has done quite a few line extensions in the recent past incorporating ingredients like vitamin D, cartilage, omega fatty acids and hyaluronic acid.
"The second contributor is that other categories are increasingly targeting consumers looking for joint health benefits and may be pulling dollars from the glucosamine category. Fish oils/Omega fatty acids having been doing this for a good while, collagen is starting to show up in a lot of joint products, and there’s been a big upsurge in herbal/traditional ingredients like turmeric and amla."
Bewicke added: “Over the last few years there have been a lot of other joint care ingredients come onto the market, and they have taken market share from glucosamine and chondroitin sulfate to some extent."
The combination with chondroitin has also played against glucosamine, he said, with concerns about sourcing leading to a decline in popularity for chondroitin sulfate (efforts by supplier Synutra International to clean up the chondroitin supply chain appear to be reversing this. The company has moved from fifth biggest chondroitin player to the number spot in less than two years).
The rise of vegetarian sourced material
While there may be a decline in the overall glucosamine market, one sector that is growing is in vegetable-sourced glucosamine, said Bewicke, whose company supplies a vegetable-derived non-GMO glucosamine called GreenGrown.
“We’re seeing sales of our vegetable-sourced glucosamine going up every year. This is partly because more people are interested in vegetarian and vegan products. There is also more concern about where materials are sourced from and concerns over Asian shellfish.
“And you also have some brands like NOW Foods actually marketing that they use GreenGrown Glucosamine.”
ENI is by no means alone in this segment of the market, with Regenasure by Cargill perhaps the most prominent vegetarian, while TSI USA also offers a vegetarian version called GlucosaGreen.
The potential benefits of glucosamine and chondroitin sulfate have been supported by numerous clinical trials, including the $14 million Glucosamine/chondroitin Arthritis Intervention Trial (GAIT), sponsored by the National Institute of Health, which studied the effects of the supplements in 1,583 people with osteoarthritis
The results, published in the prestigious New England Journal of Medicine (2006, Vol. 354, pp. 795-808), indicated that the combination of glucosamine and chondroitin sulfate “significantly decreased” knee pain for people suffering from moderate-to-severe osteoarthritis.
Others studies have not reported the same level of benefits, and a ‘critical and evidenced-based review’ published in the International Journal of Rheumatic Diseases in 2011 (Vol. 14, pp. 152-158) concluded that the evidence for glucosamine and chondroitin was “inconclusive”.
Two reviews published this year on glucosamine in relation to osteoarthritis paint a different picture, however. The first, published in Arthritis (doi: 10.1155/2014/432463), concluded: “Glucosamine supplements have been more than sufficiently proven to display overtly beneficial risk-to-reward profiles, and they should remain fundamental components of [osteoarthritis] therapy.”
The second, published in Maturitas (Vol. 78, pp. 184-187), discussed the importance of dual consumption of glucosamine and chondroitin sulfate. Authors led by Yves Henrotin from the Bone and Cartilage Research Unit at the University of Liège in Belgium concluded: “Most of the authors of the literature cited recommend the use of pharmaceutical grade products rather than food supplements. They insist on the importance of the formulation and quality of [glucosamine] and [chondroitin sulfate].
“In the same way of thinking, one may consider the use of [glucosamine] and [chondroitin sulfate] as a combination therapy. Moreover, much evidence has been gathered here that document the potential that both compounds could exert on joint tissues during [osteoarthritis]. One may therefore foresee additional benefits if not merely a synergistic potency.”
The focus on osteoarthritis is problematic from a regulatory stand-point, however. Cargill has talked about shifting the thinking about glucosamine from something to treat pain to something that could support joint health by enhancing the cellular homeostasis mechanisms to maintain the integrity of cartilage.
In vitro and in vivo studies funded by the ag-tech giant and published in the Arthritis & Rheumatism (2013, Vol. 65, pp. 1843-1852) indicated that glucosamine could modulate autophagy, reported to be a critical mechanism in maintaining cellular health in joints and other tissues throughout the body. By exploring the realm of ‘healthy cartilage aging’ product marketers will move towards a ‘helps maintain cartilage health’ type claim.
“We are now focusing our research on pre-disease states with a focus on the role glucosamine can play in preserving the health of the superficial zone of cartilage,” Jennifer van de Ligt, PhD, senior manager, Cargill Nutrition, Scientific and Regulatory Affairs told us previously. “We’re in the emerging field of healthy cartilage aging. This would be moving towards a ‘helps maintain cartilage health’ type claim.”
* Euromonitor International’s criteria: Positioned for ‘joint health’. Includes supplements with glucosamine as primary ingredient, may be in combination with others where glucosamine is promoted as a key ingredient (glucosamine/chondroitin/ MSM). Excludes multiple-ingredient supplements (included under Other dietary supplements).