• Lloydine Jacobs, Nam Vo, Joao Paulo Coelho, Qing Dong, Bernard Bechara, Barrett Woods, Eric Hempen, Robert Hartman, Harry Preuss, Judith Balk, James Kang, and Gwendolyn Sowa.
• *The Ferguson Laboratory for Orthopaedic and Spine Research †Department of Physical Medicine and Rehabilitation, Pittsburgh, PA ‡Department of Internal Medicine, Georgetown University School of Medicine, Washington, DC; and §Department of Obstetrics and Gynecology, University of Pittsburgh School of Medicine, Pittsburgh, PA.
• Spine. 2013 May 20;38(12):984-90.

Study DesignLaboratory based controlled in vivo study.ObjectiveTo determine the in vivo effects of oral glucosamine sulfate on intervertebral disc degeneration.Summary Of Background DataAlthough glucosamine has demonstrated beneficial effect in articular cartilage, clinical benefit is uncertain. A Centers for Disease Control report from 2009 reported that many patients are using glucosamine supplementation for low back pain, without significant evidence to support its use. Because disc degeneration is a major contributor of low back pain, we explored the effects of glucosamine on disc matrix homeostasis in an animal model of disc degeneration.MethodsEighteen skeletally mature New Zealand White rabbits were divided into 4 groups: control, annular puncture, glucosamine, and annular puncture + glucosamine. Glucosamine treated rabbits received daily oral supplementation with 107 mg/d (weight based equivalent to human 1500 mg/d). Annular puncture surgery involved puncturing the annulus fibrosus of 3 lumbar discs with a 16-gauge needle to induce degeneration. Serial magnetic resonance images were obtained at 0, 4, 8, 12, and 20 weeks. Discs were harvested at 20 weeks for determination of glycosaminoglycan content, relative gene expression measured by real time polymerase chain reaction, and histological analyses.ResultsThe magnetic resonance imaging index and nucleus pulposus area of injured discs of glucosamine treated animals with annular puncture was found to be lower than that of degenerated discs from rabbits not supplemented with glucosamine. Consistent with this, decreased glycosaminoglycan was demonstrated in glucosamine fed animals, as determined by both histological and glycosaminoglycan content. Gene expression was consistent with a detrimental effect on matrix.ConclusionThese data demonstrate that the net effect on matrix in an animal model in vivo, as measured by gene expression, magnetic resonance imaging, histology, and total proteoglycan is antianabolic. This raises concern about this commonly used supplement, and future research is needed to establish the clinical relevance of these findings.

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