Osteo Bi-Flex Triple Strength is Osteo Bi-Flex’s extra strength formula, designed to provide over-all joint protection and possibly reduce symptoms of osteoarthritis…[Skip to the Bottom Line]
Glucosamine is a member of the group known as ‘amino sugars’, and has been studied primarily in regards to joint health. Glucosamine is commonly found in two forms: glucosamine sulfate and glucosamine hydrochloride. Glucosamine sulfate appears to be the most readily absorbed when consumed orally.
While originally thought to directly induce collagen synthesis, more recent research indicates that glucosamine may actually work by inhibiting Interleukin-1, a protein which regulates inflammatory response and ultimately breaks down collagen. By inhibiting IL-1, glucosamine may reduce inflammation and slow down the degradation of collagen, thereby preserving the joint and possibly reducing joint pain.
This was evidenced in a recent 2013 study, as well as a 2009 study which noted lower levels of CX-II (a bio-marker of collagen breakdown) in athletes (bicyclists and soccer players) following glucosamine supplementation (most effective at 3 grams daily).
While glucosamine appears to be at least somewhat effective at preserving joints, there is no evidence to suggest that supplementation can reverse osteoarthritis (degradation of joints). However, preserving joints is still of much importance to athletes (particularly high impact sports) who may be at increased risk of developing osteoarthritis.
Overall, glucosamine may certainly benefit those suffering from osteoarthritis (or perhaps less severe joint degradation), but the miracle claims made by some supplement companies are a bit exaggerated. Osteo Bi Flex contains 1500mg of glucosamine sulfate which in in-line with what research has shown to be effective.
Chondroitin, a major component of cartilage, is generally seen along-side glucosamine in joint supplements based on the belief that the two work synergistically together to reduce inflammation and repair joints. In vitro, chondroitin and glucosamine have been demonstrated to synergistically induce collagen synthesis. However, in vivo studies comparing and contrasting the effects of chondroitin relative to glucosamine fail to find such synergy between the two. In fact, most of the benefit obtained from supplementation with glucosamine and chondroitin is thought to be from glucosamine alone, as chondroitin has shown little promise when studied in isolation.
Methylsulfonylmethane (MSM) is similar in efficacy to glucosamine, but a significant synergistic effect has never been recorded. It is hypothesized that the real benefit of MSM lies in the fact that it contains sulfur, which is a component of collagen, and thus necessary for functional, healthy joints. According to this hypothesis, only people with sulfur deficiencies would derive benefit, and would be able to derive the same benefit from other sulfur containing compounds such as the amino acids methionine and cysteine. However, this is just a hypothesis and an exact mechanism of action is not currently known. Overall, it appears MSM offers the same benefits as glucosamine in regards to joint health, but there is no evidence that the same benefit cannot be derived from glucosamine supplementation alone.
Hydrolyzed Gelatin, also commonly referred to as Collagen Hydrolysate is produced from actual collagen (though doesn’t state exactly what type of collagen). A 24-week study published in 2008 found that non-professional athletes who consumed 10 grams of collagen hydrolysate daily experienced an overall reduction in joint pain throughout the course of the study. A 2009 study published in the “International Journal of Food Sciences and Nutrition” reported similar findings: Subjects who consumed 10 grams of collagen hydrolysate daily experienced an overall increase in knee joint comfort. However, in patients diagnosed with rheumatoid arthritis, collagen supplementation has been largely ineffective, according to several studies. So, it appears as though collagen may be more beneficial in individuals with osteoarthritis or as joint protection for athletes who are may be at risk for developing osteoarthritis. Efficacy has been demonstrated at doses of 10 grams daily, but Osteo Bi Flex contains far less. Based on a 1250mg blend, the amount of Collagen present in the formula is nowhere near 10 grams, or even more than 1 gram for that matter.
5-LOXIN (BOSWELLIA SERRATA):
5-Loxin refers to a patented standardized form of Boswellia Serrata extract that is marketed on its own for joint health as well as in combination with such compounds as glucosamine and hyaluronic acid. Boswellia has been the subject of several human studies, and has shown promise as a treatment for osteoarthritis in all. A 2008 study published in “Arthritis Research and Therapy”, as well as two (2010 and 2011) studies published in the “International Journal of Medical Sciences” noted significant improvement in measures of mobility and pain in subjects given two different patented forms of Boswellia extract (Aflapin and 5-Loxin) in doses ranging from 100mg to 250mg. Furthermore, A 2011 study involving 56 patients, each showing ‘signs and symptoms’ of osteoarthritis, found that supplementation with 6 grams Boswellia extract daily effectively relieved many of the symptoms the subjects had previously reported, and increased mobility. However, this study was un-blinded and therefore cause for potential bias exists in the design. Fortunately, even if we disregard this last study, we are left with three seemingly sound studies which indicate that Boswellia (more specifically 5-Loxin) is an effective treatment for osteoarthritis. The Osteo Bi Flex formula contains 100mg of 5-Loxin which is at the lower end of what has been demonstrated to be effective.
Manganese is a trace mineral present in the bones, liver, kidneys and certain other parts of the body. It is necessary for proper nerve function, absorption of other minerals, and formation of connective tissue. So, while a manganese deficiency may have a negative impact on the formation of connective tissue, there is little evidence to suggest that excess intake of manganese will further strengthen connective tissue. A 2001 study showed that a combination of glucosamine, chondroitin, and manganese, and vitamin c (manganese ascorbate) effectively decreased the severity of arthritis in rats. However, since the glucosamine alone has already been demonstrated to do that, manganese may have had nothing to do with it. Ultimately, only individuals who are deficient in manganese are likely to benefit from its inclusion in the Osteo Bi Flex formula. While we wouldn’t consider manganese a “main ingredient”, it may simply serve to ensure adequate levels of manganese in individuals with questionable diets.
Like glucosamine, hyaluronic Acid is a major constituent of synovial fluid, the body’s natural joint lubricant. It has been studied primarily as a potential treatment for joint pain, and while a significant analgesic (painkiller) effect has been noted in rats following injections with hyaluronic acid, similar treatment has only been mildly effective in humans suffering from osteoarthritis of the knee. While most studies have used injection, a 2012 study published in “The Scientific World Journal” found that oral supplementation with 200mg hyaluronic acid daily over a 12 month period improved symptoms in subjects suffering from osteoarthritis of the knee. However, these results were far from miraculous and it should be noted this particular study combined the treatment with a quadriceps strengthening exercise regimen. Ultimately, hyaluronic acid injections appear to be more effective at reducing joint pain than oral supplements. While some efficacy has been noted with oral HA supplements, it’s tough to say whether this same pain relief could be achieved with a simple OTC pain medication. As far as a synergistic effect between HA and glucosamine, more studies are needed.
Boron is yet another trace mineral with potential for the treatment of osteoarthritis. The hypothesis stems from findings that individuals with arthritis have lower concentrations of boron in the synovial fluid (joint lubricant) and bones. Furthermore, it has been noted that areas of the world in which boron intake is higher on average tend to have much lower rates of osteoarthritis as well. A 1990 study published in the “Journal of Nutrition and Environmental Medicine” found that out of 10 patients treated with 6mg Boron daily, 50% (5 people) showed improvement while only 10% (1 person) showed improvement in the control group. While these findings are far from conclusive, they certainly warrant further investigation into Boron’s potential for osteoarthritis. Osteo Bi Flex contains 3mg of Boron, half the dose used in the above mentioned study.
THE BOTTOM LINE:
Osteo Bi Flex contains the standard array of joint-health ingredients: glucosamine, MSM, chondroitin, hyaluronic acid, as well as 5-Loxin and Boron. The formula also contains collagen, but the dose is likely insignificant. While we doubt the efficacy of certain ingredients, the formula as a whole may certainly be effective at reducing certain symptoms of osteoarthritis and/or protecting joints to some degree from wear and tear. Osteo Bi Flex is sold pretty much everywhere that sells supplements so the price tends to be different depending on where it is purchased. At the lowest price point, it retails for 40 cents per serving which is extremely competitive when taking into account the average individual cost of each ingredient.
- Biggee, Beth Anne, et al. “Low levels of human serum glucosamine after ingestion of glucosamine sulphate relative to capability for peripheral effectiveness.” Annals of the rheumatic diseases 65.2 (2006): 222-226.
- Noyszewski, Elizabeth A., et al. “Preferential incorporation of glucosamine into the galactosamine moieties of chondroitin sulfates in articular cartilage explants.” Arthritis & Rheumatism 44.5 (2001): 1089-1095.
- Momomura, Rei, et al. “Evaluation of the effect of glucosamine administration on biomarkers of cartilage and bone metabolism in bicycle racers.” Molecular medicine reports 7.3 (2013): 742-746.
- Henrotin, Yves, et al. “Physiological effects of oral glucosamine on joint health: current status and consensus on future research priorities.” BMC research notes 6.1 (2013): 115.
- Yoshimura, Masafumi, et al. “Evaluation of the effect of glucosamine administration on biomarkers for cartilage and bone metabolism in soccer players.” International journal of molecular medicine 24.4 (2009): 487.
- Sawitzke, Allen D., et al. “Clinical efficacy and safety of glucosamine, chondroitin sulphate, their combination, celecoxib or placebo taken to treat osteoarthritis of the knee: 2-year results from GAIT.” Annals of the rheumatic diseases 69.8 (2010): 1459-1464.
- Deal, Chad L., and Roland W. Moskowitz. “Nutraceuticals as therapeutic agents in osteoarthritis: the role of glucosamine, chondroitin sulfate, and collagen hydrolysate.” Rheumatic Disease Clinics of North America 25.2 (1999): 379-395.
- Bruyere, Olivier, and Jean-Yves Reginster. “Glucosamine and chondroitin sulfate as therapeutic agents for knee and hip osteoarthritis.” Drugs & aging24.7 (2007): 573-5Black, Corrinda, et al. “The clinical effectiveness of glucosamine and chondroitin supplements in slowing or arresting progression of osteoarthritis of the knee: a systematic review and economic evaluation.” (2009).80.
- Ezaki, Junko, et al. “Assessment of safety and efficacy of methylsulfonylmethane on bone and knee joints in osteoarthritis animal model.”Journal of bone and mineral metabolism 31.1 (2013): 16-25.
- Kim, L. S., et al. “Efficacy of methylsulfonylmethane (MSM) in osteoarthritis pain of the knee: a pilot clinical trial.” Osteoarthritis and Cartilage 14.3 (2006): 286-294.
- Moskowitz, Roland W. “Role of collagen hydrolysate in bone and joint disease.”Seminars in arthritis and rheumatism. Vol. 30. No. 2. WB Saunders, 2000.
- Benito-Ruiz, P., et al. “A randomized controlled trial on the efficacy and safety of a food ingredient, collagen hydrolysate, for improving joint comfort.”International journal of food sciences and nutrition 60.S2 (2009): 99-113.
- Clark, Kristine L., et al. “24-Week study on the use of collagen hydrolysate as a dietary supplement in athletes with activity-related joint pain.” Current Medical Research and Opinion® 24.5 (2008): 1485-1496.
- Oesser, Steffen, et al. “Oral administration of 14C labeled gelatin hydrolysate leads to an accumulation of radioactivity in cartilage of mice (C57/BL).” The Journal of nutrition 129.10 (1999): 1891-1895.
- Barnett, Martha L., et al. “Treatment of rheumatoid arthritis with oral type II collagen.” Arthritis Rheum 41.2 (1998): 290-297.
- Trentham, David E., et al. “Effects of oral administration of type II collagen on rheumatoid arthritis.” Science 261.5129 (1993): 1727-1730.
- Gotoh, Sachiko, et al. “Effects of the molecular weight of hyaluronic acid and its action mechanisms on experimental joint pain in rats.” Annals of the rheumatic diseases 52.11 (1993): 817-822.
- Lo, Grace H., et al. “Intra-articular hyaluronic acid in treatment of knee osteoarthritis.” JAMA: the journal of the American Medical Association 290.23 (2003): 3115-3121.
- Neo, Hisashi, et al. “The effect of hyaluronic acid on experimental temporomandibular joint osteoarthrosis in the sheep.” Journal of oral and maxillofacial surgery 55.10 (1997): 1114-1119.
- Aggarwal, Anita, and Ian P. Sempowski. “Hyaluronic acid injections for knee osteoarthritis. Systematic review of the literature.” Canadian family physician50.2 (2004): 249-256.
- Tashiro, Toshiyuki, et al. “Oral administration of polymer hyaluronic acid alleviates symptoms of knee osteoarthritis: a double-blind, placebo-controlled study over a 12-month period.” The Scientific World Journal 2012 (2012).
- Sengupta, Krishanu, et al. “A double blind, randomized, placebo controlled study of the efficacy and safety of 5-Loxin (R) for treatment of osteoarthritis of the knee.” Arthritis Research and Therapy 10.4 (2008): R85.
- Beren, Joel, et al. “Effect of pre-loading oral glucosamine HCl/chondroitin sulfate/manganese ascorbate combination on experimental arthritis in rats.”Experimental Biology and Medicine 226.2 (2001): 144-151.
- Newnham, Rex E. “Essentiality of boron for healthy bones and joints.”Environmental Health Perspectives 102.Suppl 7 (1994): 83.
- Travers, Richard L., George C. Rennie, and Rex E. Newnham. “Boron and arthritis: the results of a double-blind pilot study.” Journal of Nutritional and Environmental Medicine 1.2 (1990): 127-132.