Chondroitin sulfate is a popular supplement for managing osteoarthritis and other joint-related conditions. But how safe is it? In this blog post, we will explore the safety profile of chondroitin sulfate, shedding light on its potential side effects and considerations for use.
Clinical evidence and meta-analysis
Extensive research has been conducted to assess the safety of chondroitin sulfate, a supplement that is generally considered safe. A recently published meta-analysis, which evaluated the efficacy and safety of chondroitin sulfate (and glucosamine sulfate), found that the most common adverse events reported in randomized clinical trials are diarrhea, headache, urinary tract infections, skin allergies, and upper respiratory tract infections (1). However, there is no significant difference between the placebo groups and those groups receiving chondroitin sulfate.
Comparative safety analysis
Another study, published in 2018, provides a comprehensive analysis of the safety of various treatment options for hip and knee osteoarthritis (2). This systematic review assessed the risks associated with both medical and surgical treatments for these conditions, highlighting mortality and serious complications. Some of the conclusions are that chondroitin sulfate is generally considered safe with a favorable risk profile. Compared to non-steroidal anti-inflammatory drugs (NSAIDs), it does not significantly increase the risk of gastrointestinal, cardiovascular, or renal complications.
In an attempt to quantify the total risk associated with different treatment modalities used for treating OA, the authors computed a combined risk score (the combined risk of mortality, gastrointestinal complications, serious cardiovascular complications, serious kidney complications, and infections), which can be seen in the figure below. Chondroitin sulfate and glucosamine were clearly the safest.
Choosing a quality supplement
When selecting a chondroitin sulfate supplement, consider the following tips to ensure safety and efficacy:
Considerations for use
Given its safety profile, good quality chondroitin sulfate is a viable option for patients with osteoarthritis, particularly for those with comorbidities that might preclude the use of NSAIDs or other medications with higher risk profiles.
Figure from Aweid et al, J Ortop Surg, 2018. Combined risk score for each treatment modality.
TKR: total knee replacement; THR: total hip replacement; COX: cyclooxygenase.
References:
1. Rabade A, Viswanatha GL, Nandakumar K, Kishore A. Evaluation of efficacy and safety of glucosamine sulfate, chondroitin sulfate, and their combination regimen in managing knee osteoarthritis: a systematic review and meta-analysis. Inflammopharmacology. 2024 Jun;32(3):1759-1775. doi: 10.1007/s10787-024-01460-9. Epub 2024 Apr 6. PMID: 38581640.
2. Aweid O, Haider Z, Saed A, Kalairajah Y. Treatment modalities for hip and knee osteoarthritis: A systematic review of safety. J Orthop Surg (Hong Kong). 2018 May-Aug;26(3):2309499018808669. doi: 10.1177/2309499018808669. PMID: 30415598.