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Nutritional Supplements for Musculoskeletal Health

Evidence on dietary supplements for joint, muscle and bone health — protein and amino acids, creatine, collagen peptides, glucosamine and chondroitin, and omega-3 — including perioperative recovery and osteoarthritis.

Overview

Nutritional supplementation serves as a critical adjunct in orthopaedic care, particularly for geriatric patients unable to exercise [1]. Intravenous protein or amino acid supplementation benefits patients undergoing total joint arthroplasty, though effects on muscle strength and function remain mixed [2]. In spine surgery, perioperative nutritional optimization is associated with improved outcomes, yet substantial barriers such as inconsistent protocols and patient nonadherence persist, necessitating standardized multidisciplinary protocols [17, 23]. Further investigation is required to define effective perioperative nutritional protocols for this population [23].

Specific agents demonstrate targeted efficacy in musculoskeletal conditions. Glucosamine sulfate reduces pain, improves function, and may regulate joint damage in knee osteoarthritis with low side effects [5, 6]. However, unanswered questions regarding long-term effects and dosage preclude definitive endorsement, and a lack of substantial evidence prevents a ringing endorsement of glucosamine and chondroitin sulfate agents [6]. These agents possess an excellent safety profile and may serve as an initial treatment modality for many osteoarthritis patients [3]. For symptomatic primary osteoarthritis of the hand, glucosamine and chondroitin sulfate are reasonable treatment options within a multimodal approach if cost is not prohibitive [8].

Other supplements show promise in specific contexts. Adjuvant oral supplementation containing collagen, hyaluronic acid, chondroitin sulfate, and plasma proteins increases physical therapy efficacy after anterior cruciate ligament reconstruction by shortening return-to-activity time and reducing analgesic consumption [4]. Supplementation of n-3 polyunsaturated fatty acids effectively relieves pain and improves joint function in osteoarthritis [9]. Conditionally essential amino acid supplementation protects against complications and early skeletal muscle wasting after operative fixation of extremity and pelvic fractures [10]. Furthermore, nutritional supplementation markedly reduces hospital costs in orthopaedic surgery by lowering rates of ICU admissions, hospital-associated complications, and hospital-acquired infections [7].

How It Works

Geriatric and Fracture Management: Specific nutritional supplementation with Vitamin D and Leucine-Enriched Whey Protein benefits geriatric patients, particularly those unable to exercise [1]. Conditionally Essential Amino Acid (CEAA) supplementation protects against common complications and early skeletal muscle wasting after operative fixation of extremity and pelvic fractures [10].

Total Joint Arthroplasty and ACL Reconstruction: Intravenous protein or amino acid supplementation offers benefits for patients undergoing total joint arthroplasty, although effects on muscle strength and function are mixed [2]. Protein supplementation is a low-cost intervention easy to incorporate into perioperative management for total knee arthroplasty, with beneficial effects on muscle strength that could potentially reduce the risk of longer-term complications such as falls and periprosthetic fracture [11]. Integrating targeted nutrition into prehabilitation pathways may help reduce complications and support faster functional gains in total joint arthroplasty [12]. Protein supplementation has beneficial effects on mitigating muscle atrophy in the postoperative period following ACL reconstruction, total hip arthroplasty, total knee arthroplasty, and surgical treatment of hip fracture [14]. Adjuvant oral supplementation containing Collagen, Hyaluronic Acid, Chondroitin Sulfate, and Plasma Proteins may increase the efficacy of physical therapy by shortening the time needed to return to pre-injury activity and reducing analgesic consumption after Anterior Cruciate Ligament Reconstruction [4].

Osteoarthritis and Meniscopathy: Glucosamine and Chondroitin Sulfate have an excellent safety profile and may serve as an initial treatment modality for many osteoarthritis (OA) patients [3]. Glucosamine sulfate may have a synergic action with non-steroidal anti-inflammatory drugs for the treatment of knee osteoarthritis [5]. Glucosamine sulfate has potential to relieve pain and improve function with low side effects, but unanswered questions regarding long-term effects and dosage preclude a definitive endorsement [6]. Supplementation with n-3 polyunsaturated fatty acids (PUFAs) is effective to relieve pain and improve joint function in patients with OA [9]. Glucosamine and Chondroitin Sulfate may be considered reasonable treatment options as part of a multimodal approach for symptomatic primary osteoarthritis if the cost is not prohibitive [8]. An eight-week collagen-based supplement containing type I and type III collagen peptide and type II hydrolyzed collagen has a positive effect on pain, quality of life levels, and some functional test results in patients with meniscopathy [16].

Post-Traumatic Osteoarthritis: EPA supplementation may offer a strategy for preventing post-traumatic osteoarthritis (PTOA) progression following acute cartilage injuries by protecting cartilage from acute injury through reducing the mechanical sensitivity of chondrocytes [13].

Healthcare Economics: Nutritional supplementation markedly reduces hospital costs by reducing rates of ICU admissions, hospital-associated complications, and hospital-acquired infections [7].

What the Evidence Shows

Sarcopenia and Geriatric Populations

Geriatric Supplementation: Specific nutritional supplementation with vitamin D and leucine-enriched whey protein may benefit geriatric patients, particularly those unable to exercise [1]. Post-Hip Fracture Nutrition: Oral nutritional supplementation and dietetic assistance are low-risk interventions that may improve morbidity and mortality in older people after hip fracture [15]. Comprehensive balanced nutrition supplementation results in lower complication rates and mortality at 120 days postoperatively for hip fracture patients [20].

Perioperative Protein and Amino Acid Supplementation

Total Joint Arthroplasty: Intravenous protein or amino acid supplementation offers benefits for total joint arthroplasty, although effects on muscle strength and function are mixed [2]. Integrating targeted nutrition into prehabilitation pathways may help reduce complications and support faster functional gains in total joint arthroplasty [12]. Postoperative Muscle Preservation: Protein supplementation mitigates muscle atrophy in the postoperative period following anterior cruciate ligament reconstruction (ACLR), total hip arthroplasty (THA), total knee arthroplasty (TKA), and surgical treatment of hip fracture [14]. Fracture Fixation: Conditionally essential amino acid (CEAA) supplementation has a protective effect against common complications and early skeletal muscle wasting after operative fixation of extremity and pelvic fractures [10]. TKA Outcomes: Protein supplementation is a low-cost intervention that improves muscle strength after total knee arthroplasty, potentially reducing the risk of longer-term complications such as falls and periprosthetic fracture [11]. Cost Reduction: Nutritional supplementation with amino acids markedly reduces hospital costs by reducing rates of ICU admissions, hospital-associated complications, and hospital-acquired infections [7].

Osteoarthritis (OA) Management

Glucosamine and Chondroitin: Glucosamine and chondroitin sulfate have an excellent safety profile and may serve as an initial treatment modality for many osteoarthritis patients [3]. Glucosamine sulfate has the potential to relieve pain and improve function with low side effects, but unanswered questions regarding long-term effects and dosage preclude a definitive endorsement [6]. Glucosamine and chondroitin sulfate may be considered reasonable treatment options as part of a multimodal approach for symptomatic primary osteoarthritis if the cost is not prohibitive [8]. Evidence supports the efficacy of glucosamine sulfate in reducing pain, improving function, and possibly regulating joint damage in knee osteoarthritis [5]. Oral chondroitin is more effective than placebo on relieving pain and improving physical function in osteoarthritis, while glucosamine showed an effect on stiffness outcomes [19]. Omega-3 Fatty Acids: Omega-3 polyunsaturated fatty acid (n-3 PUFAs) supplementation is effective to relieve pain and improve joint function in patients with osteoarthritis [9].

Post-Surgical Recovery and Specific Injuries

ACLR Adjuncts: Adjuvant oral supplementation containing collagen, hyaluronic acid, chondroitin sulfate, and plasma proteins may increase the efficacy of physical therapy by shortening the time needed to return to pre-injury activity and reducing analgesic consumption after anterior cruciate ligament reconstruction [4]. Patients do not benefit from creatine supplementation during the first 12 weeks of rehabilitation after anterior cruciate ligament reconstruction [21]. Meniscopathy: An eight-week collagen-based supplement (type I and type III collagen peptide and type II hydrolyzed collagen) has a positive effect on pain, quality of life, and some functional test results in patients with meniscopathy [16].

Ongoing Research

Hip OA Trials: A long-term randomized clinical trial is designed to examine the symptom-modifying and disease-modifying effectiveness of glucosamine sulfate in patients with hip osteoarthritis [22].

Practical Considerations

Geriatric and Hip Fracture Management: Specific nutritional supplementation benefits geriatric patients, particularly those unable to exercise [1]. Oral nutritional supplementation and dietetic assistance represent low-risk interventions that may improve morbidity and mortality in older people after hip fracture [15].

Total Joint Arthroplasty: Integrating targeted nutrition into prehabilitation pathways may help reduce complications and support faster functional gains in total joint arthroplasty [12]. Intravenous protein or amino acid supplementation offers benefits for total joint arthroplasty, although effects on muscle strength and function are mixed [2]. Protein supplementation is a low-cost intervention that is easy to incorporate into perioperative management for total knee arthroplasty [11]. Protein supplementation may reduce the risk of longer-term complications, such as falls and periprosthetic fracture, through beneficial effects on muscle strength [11]. Low-cost commercially available amino acid supplementation resulted in fewer overall postoperative complications and was a low-risk intervention [18]. Nutritional supplementation markedly reduces hospital costs by reducing rates of ICU admissions, hospital-associated complications, and hospital-acquired infections [7].

Osteoarthritis: Glucosamine and chondroitin sulfate have an excellent safety profile [3]. Glucosamine and chondroitin sulfate may serve as an initial treatment modality for many osteoarthritis patients [3]. Glucosamine sulfate may reduce pain, improve function, and possibly regulate joint damage in knee osteoarthritis [5]. Glucosamine sulfate has potential to relieve pain and improve function with low side effects, but unanswered questions regarding long-term effects and dosage preclude a definitive endorsement [6]. The lack of substantial evidence currently prevents a ringing endorsement of glucosamine and chondroitin sulfate agents [6]. Glucosamine and chondroitin sulfate may be considered reasonable treatment options as part of a multimodal approach for symptomatic primary osteoarthritis if the cost is not prohibitive [8].

Anterior Cruciate Ligament Reconstruction: Adjuvant oral supplementation containing collagen, hyaluronic acid, chondroitin sulfate, and plasma proteins may increase the efficacy of physical therapy after anterior cruciate ligament reconstruction by shortening the time to return to pre-injury activity and reducing analgesic consumption [4].

Post-Traumatic Osteoarthritis: EPA supplementation could offer a promising strategy for preventing post-traumatic osteoarthritis progression following acute cartilage injuries by protecting cartilage from acute injury [13].

Spine Surgery: Substantial barriers to nutritional optimization in spine surgery include inconsistent protocols and patient nonadherence [17]. Standardization of multidisciplinary nutritional protocols is needed for spine surgery due to barriers like inconsistent protocols and patient nonadherence [17].

Key Evidence

  • [L1] This study shows proof-of-principle that specific nutritional supplementation alone might benefit geriatric patients, especially relevant for those who are unable to exercise. (10.1016/j.jamda.2015.05.021)
  • [L1] While effects on muscle strength and function are mixed, intravenous supplementation offers benefits. (10.1186/s13018-025-05847-4)
  • [L2] The excellent safety profile of these supplements should be discussed with patients, and they may serve a role as an initial treatment modality for many OA patients. (10.1016/j.arthro.2008.07.020)
  • [L1] Adjuvant oral supplementation may increase the efficacy of physical therapy by shortening the time needed to return to pre-injury activity and the analgesic consumption. (10.1177/2325967118s00040)
  • [L4] The evidence supports efficacy in reducing pain, improving function, and possibly regulating joint damage. (10.1186/s12891-022-06046-6)
  • [L5] The authors conclude that while glucosamine sulfate has potential to relieve pain and improve function with low side effects, unanswered questions regarding long-term effects and dosage preclude a definitive endorsement, and the lack of substantial evidence currently prevents a ringing endorsement of these agents. (10.5435/00124635-200109000-00009)
  • [L4] Nutritional supplementation has been shown to markedly reduce hospital costs by reducing rates of ICU admissions, hospital-associated complications, and hospital-acquired infections. (10.5435/jaaos-d-23-00300)
  • [L4] If the cost is not prohibitive, these products may be considered reasonable treatment options as part of a multimodal approach for symptomatic primary osteoarthritis. (10.1016/j.jhsa.2013.05.017)
  • [L1] Supplementation of n-3 PUFAs is effective to relieve pain and improve joint function in patients with OA. (10.1186/s13018-023-03855-w)
  • [L1] CEAA supplementation has a protective effect against common complications and early skeletal muscle wasting after operative fixation of extremity and pelvic fractures. (10.2106/jbjs.21.01014)
  • [L5] Protein supplementation is a low-cost intervention that is easy to incorporate into perioperative management, and the beneficial effects on muscle strength could potentially reduce the risk of longer-term complications, such as falls and periprosthetic fracture. (10.2106/jbjs.22.01357)
  • [L4] Integrating targeted nutrition into prehabilitation pathways may help reduce complications and support faster functional gains. (10.1016/j.arth.2026.03.088)
  • [L5] The findings suggest that EPA supplementation could offer a promising strategy for preventing PTOA progression following acute cartilage injuries. (10.1186/s13018-024-05081-4)
  • [L1] Protein supplementation appears to have beneficial effects on mitigating muscle atrophy in the postoperative period following ACLR, THA, TKA, and surgical treatment of hip fracture. (10.1177/2325967123s00326)
  • [L1] However, oral nutritional supplementation and dietetic assistance represent low-risk interventions that may improve morbidity and mortality. (10.1097/corr.0000000000000658)
  • [L1] The results of the study showed that the eight-week collagen-based supplement had a positive effect on pain and quality of life levels and some functional test results in patients with meniscopathy. (10.1186/s12891-024-08244-w)
  • [L4] Despite these benefits, substantial barriers like inconsistent protocols and patient nonadherence remain, highlighting the need for multifactorial assessment and standardization of multidisciplinary nutritional protocols. (10.5435/jaaos-d-25-00757)
  • [L5] The use of the low-cost commercially available amino acid supplement resulted in fewer overall complications postoperatively and was a low-risk intervention for their patient population. (10.2106/jbjs.22.00078)
  • [L1] Oral chondroitin is more effective than placebo on relieving pain and improving physical function, while glucosamine showed effect on stiffness outcome. (10.1186/s13018-018-0871-5)
  • [L1] The comprehensive balanced nutrition supplement resulted in lower complication rates and mortality at 120 days postoperatively. (10.1097/01.blo.0000224054.86625.06)
  • [L1] The results demonstrate that patients do not benefit from creatine supplementation during the first 12 weeks of rehabilitation after ACL reconstruction. (10.1177/0363546503261731)
  • [L2] This article presents the design of a long-term randomised clinical trial to examine the symptom-modifying and disease-modifying effectiveness of glucosamine sulphate in patients with hip osteoarthritis. (10.1186/1471-2474-6-20)
  • [L4] Perioperative nutritional optimization has been associated with improved outcomes for patients undergoing spine surgery, but additional investigation is needed to determine effective perioperative nutritional protocols. (10.5435/jaaos-d-24-01101)

References

[1] Effects of a Vitamin D and Leucine-Enriched Whey Protein Nutritional Supplement on Measures of Sarcopenia in Older Adults, the PROVIDE Study: A Randomized, Double-Blind, Placebo-Controlled Trial. Journal of the American Medical Directors Association. 2015. DOI: 10.1016/j.jamda.2015.05.021

[2] Peri-operative protein or amino acid supplementation for total joint arthroplasty: a systematic review and meta-analysis. Journal of Orthopaedic Surgery and Research. 2025. DOI: 10.1186/s13018-025-05847-4

[3] A Review of Evidence‐Based Medicine for Glucosamine and Chondroitin Sulfate Use in Knee Osteoarthritis. Arthroscopy. 2008. DOI: 10.1016/j.arthro.2008.07.020

[4] Efficacy and Tolerability of a Dietary Supplement Containing Collagen, Hyaluronic Acid, Chondroitin Sulfate and Plasma Proteins in the Recovery After Anterior Cruciate Ligament Reconstruction. Orthopaedic Journal of Sports Medicine. 2018. DOI: 10.1177/2325967118s00040

[5] Possible synergic action of non-steroidal anti-inflammatory drugs and glucosamine sulfate for the treatment of knee osteoarthritis: a scoping review. BMC Musculoskeletal Disorders. 2022. DOI: 10.1186/s12891-022-06046-6

[6] Use of Glucosamine and Chondroitin Sulfate in the Management of Osteoarthritis. Journal of the American Academy of Orthopaedic Surgeons. 2001. DOI: 10.5435/00124635-200109000-00009

[7] The Role of Amino Acid Supplementation in Orthopaedic Surgery. Journal of the American Academy of Orthopaedic Surgeons. 2023. DOI: 10.5435/jaaos-d-23-00300

[8] Glucosamine and Chondroitin Sulfate Treatment of Hand Osteoarthritis. The Journal of Hand Surgery. 2013. DOI: 10.1016/j.jhsa.2013.05.017

[9] Effect of omega-3 polyunsaturated fatty acids supplementation for patients with osteoarthritis: a meta-analysis. Journal of Orthopaedic Surgery and Research. 2023. DOI: 10.1186/s13018-023-03855-w

[10] Conditionally Essential Amino Acid Supplementation Reduces Postoperative Complications and Muscle Wasting After Fracture Fixation. Journal of Bone and Joint Surgery. 2022. DOI: 10.2106/jbjs.21.01014

[11] Nutritional Optimization with Amino Acid Supplementation Aids Recovery After Total Knee Arthroplasty. Journal of Bone and Joint Surgery. 2023. DOI: 10.2106/jbjs.22.01357

[12] Perioperative Nutritional Optimization in Total Joint Arthroplasty: From Screening to Supplementation. The Journal of Arthroplasty. 2026. DOI: 10.1016/j.arth.2026.03.088

[13] Omega-3 fatty acids protect cartilage from acute injurie by reducing the mechanical sensitivity of chondrocytes. Journal of Orthopaedic Surgery and Research. 2024. DOI: 10.1186/s13018-024-05081-4

[14] Poster 363: Post-Operative Protein Supplementation following Orthopaedic Surgery: A Systematic Review. Orthopaedic Journal of Sports Medicine. 2023. DOI: 10.1177/2325967123s00326

[15] Cochrane in CORR®: Nutritional Supplementation for Hip Fracture Aftercare in Older People. Clinical Orthopaedics & Related Research. 2019. DOI: 10.1097/corr.0000000000000658

[16] The effect of supplementation with type I and type III collagen peptide and type II hydrolyzed collagen on pain, quality of life and physical function in patients with meniscopathy: a randomized, double-blind, placebo-controlled study. BMC Musculoskeletal Disorders. 2025. DOI: 10.1186/s12891-024-08244-w

[17] Nutritional Optimization in Spine Surgery: A Review of Its Implications for Postoperative Recovery and Outcomes. Journal of the American Academy of Orthopaedic Surgeons. 2026. DOI: 10.5435/jaaos-d-25-00757

[18] Essential Amino Acid Supplementation: Feed the Injured Patient. Journal of Bone and Joint Surgery. 2022. DOI: 10.2106/jbjs.22.00078

[19] Effectiveness and safety of glucosamine and chondroitin for the treatment of osteoarthritis: a meta-analysis of randomized controlled trials. Journal of Orthopaedic Surgery and Research. 2018. DOI: 10.1186/s13018-018-0871-5

[20] Nutritional Supplementation Decreases Hip Fracture-related Complications. Clinical Orthopaedics and Related Research. 2006. DOI: 10.1097/01.blo.0000224054.86625.06

[21] The Effect of Creatine Supplementation on Strength Recovery after Anterior Cruciate Ligament (ACL) Reconstruction. The American Journal of Sports Medicine. 2004. DOI: 10.1177/0363546503261731

[22] The effect of glucosamine sulphate on osteoarthritis: design of a long-term randomised clinical trial [ISRCTN54513166]. BMC Musculoskeletal Disorders. 2005. DOI: 10.1186/1471-2474-6-20

[23] Perioperative Nutritional Optimization in Spine Surgery. Journal of the American Academy of Orthopaedic Surgeons. 2025. DOI: 10.5435/jaaos-d-24-01101

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a. For the avoidance of doubt, this Public License does not, and shall not be interpreted to, reduce, limit, restrict, or impose conditions on any use of the Licensed Material that could lawfully be made without permission under this Public License.

b. To the extent possible, if any provision of this Public License is deemed unenforceable, it shall be automatically reformed to the minimum extent necessary to make it enforceable. If the provision cannot be reformed, it shall be severed from this Public License without affecting the enforceability of the remaining terms and conditions.

c. No term or condition of this Public License will be waived and no failure to comply consented to unless expressly agreed to by the Licensor.

d. Nothing in this Public License constitutes or may be interpreted as a limitation upon, or waiver of, any privileges and immunities that apply to the Licensor or You, including from the legal processes of any jurisdiction or authority.

Creative Commons is not a party to its public licenses. Notwithstanding, Creative Commons may elect to apply one of its public licenses to material it publishes and in those instances will be considered the “Licensor.” The text of the Creative Commons public licenses is dedicated to the public domain under the CC0 Public Domain Dedication. Except for the limited purpose of indicating that material is shared under a Creative Commons public license or as otherwise permitted by the Creative Commons policies published at creativecommons.org/policies, Creative Commons does not authorize the use of the trademark "Creative Commons" or any other trademark or logo of Creative Commons without its prior written consent including, without limitation, in connection with any unauthorized modifications to any of its public licenses or any other arrangements, understandings, or agreements concerning use of licensed material. For the avoidance of doubt, this paragraph does not form part of the public licenses.

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