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Nutritional Supplements for Musculoskeletal Health

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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.

Updated Jul 2026
A supplement capsule beside a leaf.
Some supplements support bone and joint health while many are over-sold — it helps to know which have evidence. Kieran Hirpara 4.0

What you're feeling

You may notice stiffness and pain in your joints, especially after resting or first thing in the morning. This wear-and-tear arthritis often makes daily tasks difficult. You might struggle with simple movements like reaching behind your back to fasten a bra or tucking in your shirt. Pain can flare up after activity or when you sleep on your side, disrupting your rest.

Your surgeon may discuss nutritional supplements to help manage these symptoms. Glucosamine and chondroitin sulfate are common options. They have an excellent safety profile and may serve as an initial treatment for many patients with osteoarthritis. Evidence supports glucosamine sulfate in reducing pain and improving function. It may also help regulate joint damage in the knee. However, unanswered questions regarding long-term effects and dosage prevent a definitive endorsement. There is also a lack of substantial evidence to fully endorse these agents for everyone.

If cost is not prohibitive, these supplements may be reasonable options as part of a broader plan for symptomatic primary osteoarthritis of the hand. Additionally, n-3 polyunsaturated fatty acids are effective in relieving pain and improving joint function in osteoarthritis patients. For geriatric patients who are unable to exercise, specific nutritional supplementation alone may provide benefits.

After surgery, such as anterior cruciate ligament reconstruction, adjuvant oral supplementation containing collagen, hyaluronic acid, chondroitin sulfate, and plasma proteins may increase the efficacy of physical therapy. This approach can shorten the time needed to return to pre-injury activity and reduce the need for pain medication. Intravenous protein or amino acid supplementation also offers benefits for patients undergoing total joint replacement, though effects on muscle strength and function are mixed.

Nutritional optimization is associated with improved outcomes for spine surgery patients. It markedly reduces hospital costs by lowering rates of intensive care unit admissions, hospital-associated complications, and hospital-acquired infections. Conditionally essential amino acid supplementation has a protective effect against common complications and early skeletal muscle wasting after operative fixation of extremity and pelvic fractures.

Despite these benefits, substantial barriers to nutritional optimization in spine surgery include inconsistent protocols and patient nonadherence. Standardization of multidisciplinary nutritional protocols is needed. Additional investigation is required to determine effective perioperative nutritional protocols for spine surgery. Your surgeon will help you navigate these options based on your specific needs and evidence-based guidelines.

What's actually happening

Your joints are designed to move smoothly. Cartilage acts like a shock absorber between your bones. It is the smooth coating on the bone ends that prevents friction. When this coating wears down, you feel pain and stiffness. This wear-and-tear is common in osteoarthritis. Your body tries to repair the damage, but it often cannot keep up.

Nutritional supplements aim to support this repair process. For example, glucosamine and chondroitin sulfate may help maintain cartilage health. They have an excellent safety profile and low side effects. Some patients find they reduce pain and improve function. However, the evidence is not strong enough to guarantee results for everyone. We do not yet know the best long-term dosage for these supplements. Therefore, we cannot definitively endorse them as a cure.

Other supplements target inflammation and muscle health. N-3 polyunsaturated fatty acids may relieve pain and improve joint function. Collagen and hyaluronic acid might help your body heal faster after surgery. They can shorten the time needed to return to your pre-injury activities. This is especially helpful if you are recovering from an anterior cruciate ligament reconstruction.

For older adults or those who cannot exercise, specific supplements may provide direct benefit. Intravenous protein or amino acids can support recovery after total joint replacement. This helps counteract muscle wasting, which is the loss of muscle mass after surgery. Proper nutrition also reduces hospital costs by lowering the risk of complications and infections.

In spine surgery, nutritional optimization improves outcomes. Yet, inconsistent protocols and patient nonadherence remain significant barriers. We are still investigating the best protocols for spine patients. For now, supplements are one part of a broader plan. They work best alongside physical therapy and other treatments. Your surgeon will help you decide if they are right for your specific situation.

What to expect

Nutritional supplements can play a helpful role in your musculoskeletal health, though results vary. For older adults who cannot exercise, specific supplements may offer clear benefits. If you are having joint replacement surgery, intravenous protein or amino acids might help your recovery, even if muscle strength gains are not guaranteed. For general joint pain, supplements like glucosamine and chondroitin sulfate have an excellent safety profile. They may serve as a first step in managing wear-and-tear arthritis. You might find that they reduce pain and improve function with few side effects. However, we do not yet fully understand their long-term effects or the best dosages. This lack of certainty means we cannot give them a definitive endorsement for everyone.

If you have osteoarthritis in your hand, these supplements may be a reasonable part of your treatment plan if cost is not a barrier. For knee osteoarthritis, glucosamine sulfate may help regulate joint damage and relieve pain. Omega-3 fatty acids (n-3 polyunsaturated fatty acids) are also effective for relieving pain and improving joint function. After knee ligament reconstruction, supplements containing collagen, hyaluronic acid, and other proteins may help you return to your pre-injury activities faster. You may also need fewer pain medications during this time.

For spine surgery patients, preparing your body with proper nutrition before the operation is linked to better outcomes. This is known as perioperative nutritional optimization. It helps reduce hospital costs by lowering the risk of intensive care admissions and infections. However, sticking to these nutritional plans can be difficult due to inconsistent guidelines or personal adherence issues. We are still investigating the best protocols for spine surgery. Ultimately, while supplements can support your healing and reduce pain, they work best as part of a broader care plan that includes physical therapy and professional medical guidance.

Reviewed by Kieran Hirpara · 12 June 2026.

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Evidence & references

Overview

  • Specific nutritional supplementation alone may benefit geriatric patients, particularly those unable to exercise [1].
  • Intravenous protein or amino acid supplementation offers benefits for patients undergoing total joint arthroplasty, although effects on muscle strength and function are mixed [2].
  • 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].
  • 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 needed to return to pre-injury activity and reducing analgesic consumption [4].
  • Evidence supports the efficacy of glucosamine sulfate in reducing pain, improving function, and possibly regulating 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].
  • Nutritional supplementation markedly reduces hospital costs by reducing rates of ICU admissions, hospital-associated complications, and hospital-acquired infections in orthopaedic surgery [7].
  • If cost is not prohibitive, glucosamine and chondroitin sulfate products may be considered reasonable treatment options as part of a multimodal approach for symptomatic primary osteoarthritis of the hand [8].
  • Supplementation of n-3 polyunsaturated fatty acids is effective to relieve pain and improve joint function in patients with osteoarthritis [9].
  • Conditionally essential amino acid supplementation has a protective effect against common complications and early skeletal muscle wasting after operative fixation of extremity and pelvic fractures [10].
  • Perioperative nutritional optimization is associated with improved outcomes for patients undergoing spine surgery [23].
  • Additional investigation is needed to determine effective perioperative nutritional protocols for spine surgery [23].
  • Substantial barriers to nutritional optimization in spine surgery include inconsistent protocols and patient nonadherence, highlighting the need for multifactorial assessment and standardization of multidisciplinary nutritional protocols [17].

How It Works

  • Specific nutritional supplementation alone may benefit geriatric patients, particularly those unable to exercise [1].
  • Intravenous protein or amino acid supplementation offers benefits for total joint arthroplasty, although effects on muscle strength and function are mixed [2].
  • Glucosamine and chondroitin sulfate have an excellent safety profile and may serve as an initial treatment modality for many osteoarthritis patients [3].
  • 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].
  • Glucosamine sulfate may have a synergic action with non-steroidal anti-inflammatory drugs for the treatment of knee osteoarthritis [5].
  • Evidence supports glucosamine sulfate efficacy in reducing pain, improving function, and possibly regulating 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].
  • Nutritional supplementation markedly reduces hospital costs by reducing rates of ICU admissions, hospital-associated complications, and hospital-acquired infections [7].
  • Glucosamine and chondroitin sulfate products may be considered reasonable treatment options as part of a multimodal approach for symptomatic primary osteoarthritis if the cost is not prohibitive [8].
  • Supplementation of n-3 polyunsaturated fatty acids is effective to relieve pain and improve joint function in patients with osteoarthritis [9].
  • Conditionally essential amino acid supplementation has a protective effect against common complications and early skeletal muscle wasting after operative fixation of extremity and pelvic fractures [10].
  • Protein supplementation is a low-cost intervention that is easy to incorporate into perioperative management for total knee arthroplasty [11].
  • Protein supplementation has beneficial effects on muscle strength that could potentially reduce the risk of longer-term complications, such as falls and periprosthetic fracture, after total knee arthroplasty [11].
  • Integrating targeted nutrition into prehabilitation pathways may help reduce complications and support faster functional gains in total joint arthroplasty [12].
  • Omega-3 fatty acids protect cartilage from acute injuries by reducing the mechanical sensitivity of chondrocytes [13].
  • EPA supplementation could offer a promising strategy for preventing post-traumatic osteoarthritis progression following acute cartilage injuries [13].
  • Protein supplementation appears to have beneficial effects on mitigating muscle atrophy in the postoperative period following anterior cruciate ligament reconstruction, total hip arthroplasty, total knee arthroplasty, and surgical treatment of hip fracture [14].
  • An eight-week collagen-based supplement containing type I and type III collagen peptide and type II hydrolyzed collagen had a positive effect on pain and quality of life levels and some functional test results in patients with meniscopathy [16].

What the Evidence Shows

Osteoarthritis Management

  • 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 has the potential to relieve pain and improve function with low side effects [6].
  • Unanswered questions regarding long-term effects and dosage of glucosamine sulfate preclude a definitive endorsement [6].
  • A lack of substantial evidence currently prevents a ringing endorsement of glucosamine and chondroitin agents [6].
  • If cost is not prohibitive, glucosamine and chondroitin products may be considered reasonable treatment options as part of a multimodal approach for symptomatic primary osteoarthritis [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 [19].
  • Glucosamine showed an effect on stiffness outcomes in osteoarthritis [19].
  • Supplementation of n-3 polyunsaturated fatty acids (omega-3 PUFAs) is effective to relieve pain and improve joint function in patients with osteoarthritis [9].

Perioperative and Postoperative Supplementation

  • Specific nutritional supplementation alone might benefit geriatric patients, especially those unable to exercise [1].
  • While effects on muscle strength and function are mixed, intravenous protein or amino acid supplementation offers benefits in total joint arthroplasty [2].
  • 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].
  • Nutritional supplementation markedly reduces hospital costs by reducing rates of ICU admissions, hospital-associated complications, and hospital-acquired infections [7].
  • 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].
  • Protein supplementation is a low-cost intervention that is easy to incorporate into perioperative management for total knee arthroplasty [11].
  • Beneficial effects of protein supplementation on muscle strength could potentially reduce the risk of longer-term complications, such as falls and periprosthetic fracture, after total knee arthroplasty [11].
  • Integrating targeted nutrition into prehabilitation pathways may help reduce complications and support faster functional gains in total joint arthroplasty [12].
  • Protein supplementation appears to have 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].
  • Oral nutritional supplementation and dietetic assistance represent low-risk interventions that may improve morbidity and mortality in hip fracture aftercare for older people [15].
  • A comprehensive balanced nutrition supplement resulted in lower complication rates and mortality at 120 days postoperatively for hip fracture patients [20].

Specific Supplement Efficacy and Limitations

  • An 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 [16].
  • Patients do not benefit from creatine supplementation during the first 12 weeks of rehabilitation after anterior cruciate ligament reconstruction [21].

Practical Considerations

  • Specific nutritional supplementation alone may benefit geriatric patients, particularly those unable to exercise [1].
  • Intravenous protein or amino acid supplementation offers benefits for total joint arthroplasty, although effects on muscle strength and function are mixed [2].
  • 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].
  • 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 [4].
  • Adjuvant oral supplementation containing collagen, hyaluronic acid, chondroitin sulfate, and plasma proteins may reduce analgesic consumption after anterior cruciate ligament reconstruction [4].
  • Evidence supports the efficacy of glucosamine sulfate in reducing pain and improving function in knee osteoarthritis [5].
  • Glucosamine sulfate may possibly regulate joint damage in knee osteoarthritis [5].
  • Glucosamine sulfate has potential to relieve pain and improve function with low side effects in osteoarthritis [6].
  • Unanswered questions regarding long-term effects and dosage of glucosamine sulfate preclude a definitive endorsement [6].
  • Lack of substantial evidence currently prevents a ringing endorsement of glucosamine and chondroitin sulfate agents [6].
  • Nutritional supplementation markedly reduces hospital costs by reducing rates of ICU admissions, hospital-associated complications, and hospital-acquired infections [7].
  • If cost is not prohibitive, glucosamine and chondroitin sulfate may be considered reasonable treatment options as part of a multimodal approach for symptomatic primary osteoarthritis of the hand [8].
  • Protein supplementation is a low-cost intervention that is easy to incorporate into perioperative management for total knee arthroplasty [11].
  • Protein supplementation after total knee arthroplasty has beneficial effects on muscle strength [11].
  • Beneficial effects of protein supplementation on muscle strength after total knee arthroplasty 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].
  • EPA supplementation could offer a promising strategy for preventing post-traumatic osteoarthritis progression following acute cartilage injuries [13].
  • Oral nutritional supplementation and dietetic assistance represent low-risk interventions that may improve morbidity and mortality in older people after hip fracture [15].
  • Substantial barriers to nutritional optimization in spine surgery include inconsistent protocols and patient nonadherence [17].
  • Standardization of multidisciplinary nutritional protocols is needed in spine surgery [17].
  • Use of low-cost commercially available amino acid supplementation resulted in fewer overall complications postoperatively [18].
  • Amino acid supplementation is a low-risk intervention for the patient population studied [18].

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. [1] (10.1016/j.jamda.2015.05.021)
  • [L1] While effects on muscle strength and function are mixed, intravenous supplementation offers benefits. [2] (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. [3] (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. [4] (10.1177/2325967118s00040)
  • [L4] The evidence supports efficacy in reducing pain, improving function, and possibly regulating joint damage. [5] (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. [6] (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. [7] (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. [8] (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. [9] (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] (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. [11] (10.2106/jbjs.22.01357)
  • [L4] Integrating targeted nutrition into prehabilitation pathways may help reduce complications and support faster functional gains. [12] (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. [13] (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. [14] (10.1177/2325967123s00326)
  • [L1] However, oral nutritional supplementation and dietetic assistance represent low-risk interventions that may improve morbidity and mortality. [15] (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. [16] (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. [17] (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. [18] (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. [19] (10.1186/s13018-018-0871-5)
  • [L1] The comprehensive balanced nutrition supplement resulted in lower complication rates and mortality at 120 days postoperatively. [20] (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. [21] (10.1177/0363546503261731)
  • [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. [23] (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 [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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6. No endorsement. Nothing in this Public License constitutes or may be construed as permission to assert or imply that You are, or that Your use of the Licensed Material is, connected with, or sponsored, endorsed, or granted official status by, the Licensor or others designated to receive attribution as provided in Section 3(a)(1)(A)(i).

b. Other rights.

1. Moral rights, such as the right of integrity, are not licensed under this Public License, nor are publicity, privacy, and/or other similar personality rights; however, to the extent possible, the Licensor waives and/or agrees not to assert any such rights held by the Licensor to the limited extent necessary to allow You to exercise the Licensed Rights, but not otherwise.

2. Patent and trademark rights are not licensed under this Public License.

3. To the extent possible, the Licensor waives any right to collect royalties from You for the exercise of the Licensed Rights, whether directly or through a collecting society under any voluntary or waivable statutory or compulsory licensing scheme. In all other cases the Licensor expressly reserves any right to collect such royalties, including when the Licensed Material is used other than for NonCommercial purposes.

Section 3 -- License Conditions.

Your exercise of the Licensed Rights is expressly made subject to the following conditions.

a. Attribution.

1. If You Share the Licensed Material (including in modified form), You must:

a. retain the following if it is supplied by the Licensor with the Licensed Material:

i. identification of the creator(s) of the Licensed Material and any others designated to receive attribution, in any reasonable manner requested by the Licensor (including by pseudonym if designated);

ii. a copyright notice;

iii. a notice that refers to this Public License;

iv. a notice that refers to the disclaimer of warranties;

v. a URI or hyperlink to the Licensed Material to the extent reasonably practicable;

b. indicate if You modified the Licensed Material and retain an indication of any previous modifications; and

c. indicate the Licensed Material is licensed under this Public License, and include the text of, or the URI or hyperlink to, this Public License.

2. You may satisfy the conditions in Section 3(a)(1) in any reasonable manner based on the medium, means, and context in which You Share the Licensed Material. For example, it may be reasonable to satisfy the conditions by providing a URI or hyperlink to a resource that includes the required information.

3. If requested by the Licensor, You must remove any of the information required by Section 3(a)(1)(A) to the extent reasonably practicable.

4. If You Share Adapted Material You produce, the Adapter's License You apply must not prevent recipients of the Adapted Material from complying with this Public License.

Section 4 -- Sui Generis Database Rights.

Where the Licensed Rights include Sui Generis Database Rights that apply to Your use of the Licensed Material:

a. for the avoidance of doubt, Section 2(a)(1) grants You the right to extract, reuse, reproduce, and Share all or a substantial portion of the contents of the database for NonCommercial purposes only;

b. if You include all or a substantial portion of the database contents in a database in which You have Sui Generis Database Rights, then the database in which You have Sui Generis Database Rights (but not its individual contents) is Adapted Material; and

c. You must comply with the conditions in Section 3(a) if You Share all or a substantial portion of the contents of the database.

For the avoidance of doubt, this Section 4 supplements and does not replace Your obligations under this Public License where the Licensed Rights include other Copyright and Similar Rights.

Section 5 -- Disclaimer of Warranties and Limitation of Liability.

a. UNLESS OTHERWISE SEPARATELY UNDERTAKEN BY THE LICENSOR, TO THE EXTENT POSSIBLE, THE LICENSOR OFFERS THE LICENSED MATERIAL AS-IS AND AS-AVAILABLE, AND MAKES NO REPRESENTATIONS OR WARRANTIES OF ANY KIND CONCERNING THE LICENSED MATERIAL, WHETHER EXPRESS, IMPLIED, STATUTORY, OR OTHER. THIS INCLUDES, WITHOUT LIMITATION, WARRANTIES OF TITLE, MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE, NON-INFRINGEMENT, ABSENCE OF LATENT OR OTHER DEFECTS, ACCURACY, OR THE PRESENCE OR ABSENCE OF ERRORS, WHETHER OR NOT KNOWN OR DISCOVERABLE. WHERE DISCLAIMERS OF WARRANTIES ARE NOT ALLOWED IN FULL OR IN PART, THIS DISCLAIMER MAY NOT APPLY TO YOU.

b. TO THE EXTENT POSSIBLE, IN NO EVENT WILL THE LICENSOR BE LIABLE TO YOU ON ANY LEGAL THEORY (INCLUDING, WITHOUT LIMITATION, NEGLIGENCE) OR OTHERWISE FOR ANY DIRECT, SPECIAL, INDIRECT, INCIDENTAL, CONSEQUENTIAL, PUNITIVE, EXEMPLARY, OR OTHER LOSSES, COSTS, EXPENSES, OR DAMAGES ARISING OUT OF THIS PUBLIC LICENSE OR USE OF THE LICENSED MATERIAL, EVEN IF THE LICENSOR HAS BEEN ADVISED OF THE POSSIBILITY OF SUCH LOSSES, COSTS, EXPENSES, OR DAMAGES. WHERE A LIMITATION OF LIABILITY IS NOT ALLOWED IN FULL OR IN PART, THIS LIMITATION MAY NOT APPLY TO YOU.

c. The disclaimer of warranties and limitation of liability provided above shall be interpreted in a manner that, to the extent possible, most closely approximates an absolute disclaimer and waiver of all liability.

Section 6 -- Term and Termination.

a. This Public License applies for the term of the Copyright and Similar Rights licensed here. However, if You fail to comply with this Public License, then Your rights under this Public License terminate automatically.

b. Where Your right to use the Licensed Material has terminated under Section 6(a), it reinstates:

1. automatically as of the date the violation is cured, provided it is cured within 30 days of Your discovery of the violation; or

2. upon express reinstatement by the Licensor.

For the avoidance of doubt, this Section 6(b) does not affect any right the Licensor may have to seek remedies for Your violations of this Public License.

c. For the avoidance of doubt, the Licensor may also offer the Licensed Material under separate terms or conditions or stop distributing the Licensed Material at any time; however, doing so will not terminate this Public License.

d. Sections 1, 5, 6, 7, and 8 survive termination of this Public License.

Section 7 -- Other Terms and Conditions.

a. The Licensor shall not be bound by any additional or different terms or conditions communicated by You unless expressly agreed.

b. Any arrangements, understandings, or agreements regarding the Licensed Material not stated herein are separate from and independent of the terms and conditions of this Public License.

Section 8 -- Interpretation.

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.

Creative Commons may be contacted at creativecommons.org.