Suplementos nutricionais para a saúde musculoesquelética

This is the clinical evidence summary written for health professionals. It is technical, and it lists the research this page was built from. You do not need to read it to understand your treatment or to make a decision about it.

Overview¶

• Peptide supplements should not currently be recommended as a replacement or adjunct for existing orthopaedic standard of care due to the lack of robust efficacy and safety data [1].
• Specific nutritional supplementation alone might benefit geriatric patients, especially those who are unable to exercise [2].
• Intravenous peri-operative protein or amino acid supplementation offers benefits for total joint arthroplasty, while effects on muscle strength and function are mixed [3].
• Glucosamine and chondroitin sulfate have an excellent safety profile and may serve a role as an initial treatment modality for many osteoarthritis patients [4].
• 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 [5].
• The evidence supports the efficacy of non-steroidal anti-inflammatory drugs and glucosamine sulfate in reducing pain, improving function, and possibly regulating joint damage in knee osteoarthritis [7].
• Supplementation with omega-3 polyunsaturated fatty acids for 3-4 months reduces patient-reported joint pain intensity, minutes of morning stiffness, number of painful and/or tender joints, and NSAID consumption [8].
• 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 [9].
• The appropriate use of some dietary supplements can benefit the athlete, while others may harm the athlete’s health, performance, and/or livelihood and reputation if an antidoping rule violation results [12].
• 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 [11].
• Nutritional supplementation has been shown to markedly reduce hospital costs by reducing rates of ICU admissions, hospital-associated complications, and hospital-acquired infections in orthopaedic surgery [14].
• Glucosamine and chondroitin sulfate may be considered reasonable treatment options as part of a multimodal approach for symptomatic primary hand osteoarthritis if the cost is not prohibitive [15].
• 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 [32].

How It Works¶

Protein and Amino Acids¶

• Intravenous protein or amino acid supplementation offers benefits for total joint arthroplasty, while effects on muscle strength and function are mixed [3].
• 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 [9].
• Nutritional supplementation has been shown to markedly reduce hospital costs by reducing rates of ICU admissions, hospital-associated complications, and hospital-acquired infections [14].
• Protein supplementation is a low-cost intervention that is easy to incorporate into perioperative management [18].
• The beneficial effects of protein supplementation on muscle strength could potentially reduce the risk of longer-term complications, such as falls and periprosthetic fracture [18].
• 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 [21].
• Protein-containing nutrient supplementation immediately after single exercise sessions promotes the restoration of distal vasti muscle mass and knee extension muscle strength with resistance training in ACL patients [20].
• With protein supplementation, protein intakes at amounts greater than ~1.6 g/kg/day do not further contribute to resistance training-induced gains in fat-free mass [25].

Glucosamine and Chondroitin Sulfate¶

• The excellent safety profile of glucosamine and chondroitin sulfate should be discussed with patients, and they may serve a role as an initial treatment modality for many osteoarthritis patients [4].
• Glucosamine sulfate has the potential to relieve pain and improve function with low side effects [11].
• Unanswered questions regarding long-term effects and dosage preclude a definitive endorsement of glucosamine sulfate [11].
• The lack of substantial evidence currently prevents a ringing endorsement of glucosamine and chondroitin sulfate agents [11].
• Evidence supports the efficacy of non-steroidal anti-inflammatory drugs and glucosamine sulfate in reducing pain, improving function, and possibly regulating joint damage in knee osteoarthritis [7].
• If the cost is not prohibitive, glucosamine and chondroitin sulfate products may be considered reasonable treatment options as part of a multimodal approach for symptomatic primary hand osteoarthritis [15].
• High concentrations of glucosamine–chondroitin sulfate can alter the cyclic preload and acute overload responses of chondral explants [34].
• High concentrations of glucosamine–chondroitin sulfate have an effect on the mechanical properties in an in vitro model [34].
• Glucosamine sulfate restrains the TNFα-mediated up-regulation of MMP-3 in bovine nucleus pulposus intervertebral disc cells [39].
• Glucosamine provides a protective role against TNFα, an early mediator of disc degeneration [39].

Omega-3 Polyunsaturated Fatty Acids¶

• Supplementation with omega-3 PUFAs for 3-4 months reduces patient-reported joint pain intensity [8].
• Supplementation with omega-3 PUFAs for 3-4 months reduces minutes of morning stiffness [8].
• Supplementation with omega-3 PUFAs for 3-4 months reduces the number of painful and/or tender joints [8].
• Supplementation with omega-3 PUFAs for 3-4 months reduces NSAID consumption [8].
• Supplementation of n-3 PUFAs is effective to relieve pain and improve joint function in patients with osteoarthritis [19].
• EPA supplementation could offer a promising strategy for preventing post-traumatic osteoarthritis progression following acute cartilage injuries [35].

Collagen and Other Supplements¶

• 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 [5].
• Adjuvant oral supplementation containing collagen, hyaluronic acid, chondroitin sulfate, and plasma proteins may increase the efficacy of physical therapy by reducing analgesic consumption [5].
• An eight-week collagen-based supplement had a positive effect on pain levels in patients with meniscopathy [24].
• An eight-week collagen-based supplement had a positive effect on quality of life levels in patients with meniscopathy [24].
• An eight-week collagen-based supplement had a positive effect on some functional test results in patients with meniscopathy [24].
• Calcium supplements may appear to improve fracture healing of osteoporotic bone [16].
• Calcium supplements failed to improve strength in a rat osteoporotic model of fracture healing [16].
• Patients do not benefit from creatine supplementation during the first 12 weeks of rehabilitation after ACL reconstruction [28].
• Intra-articular injections of hyaluronic acid supplemented with CCL25 attenuate osteoarthritis in a guinea pig model [37].
• Supplementation with increasing concentrations of insulin-like growth factor-I enhances chondrocyte matrix synthesis [38].
• Supplementation with insulin-like growth factor-I may provide a means to enhance chondrocyte phenotypic stability and function during transplantation grafting procedures [38].
• The combination of anabolic growth factors and catabolic blockers improves the preservation of proteoglycan content of cartilage explants exposed to the depleting effects of IL-1 [40].

General Considerations¶

• Because of the lack of robust efficacy and safety data, peptide supplements should not currently be recommended as a replacement or adjunct for existing orthopaedic standard of care [1].
• The appropriate use of some supplements can benefit the athlete [12].
• Some supplements may harm the athlete’s health, performance, and/or livelihood and reputation if an antidoping rule violation results [12].

What the Evidence Shows¶

Perioperative and Postoperative Supplementation¶

• 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 [18].
• Nutrition consultation and perioperative supplementation with amino acids and micronutrients are 2 readily available interventions that orthopaedic surgeons can select for malnourished patients [22].
• Oral nutritional supplementation and dietetic assistance represent low-risk interventions that may improve morbidity and mortality in older people with hip fractures [23].
• 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 [26].
• Integrating targeted nutrition into prehabilitation pathways may help reduce complications and support faster functional gains in total joint arthroplasty [29].
• A comprehensive balanced nutrition supplement resulted in lower complication rates and mortality at 120 days postoperatively in patients with hip fractures [30].
• 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 [47].

Osteoarthritis and Joint Health¶

• The excellent safety profile of glucosamine and chondroitin sulfate should be discussed with patients, and they may serve a role as an initial treatment modality for many OA patients [4].
• The evidence supports efficacy in reducing pain, improving function, and possibly regulating joint damage when using non-steroidal anti-inflammatory drugs and glucosamine sulfate for knee osteoarthritis [7].
• 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 [11].
• Oral chondroitin is more effective than placebo on relieving pain and improving physical function, while glucosamine showed effect on stiffness outcome in osteoarthritis [43].
• Supplementation with omega-3 PUFAs for 3-4 months reduces patient reported joint pain intensity, minutes of morning stiffness, number of painful and/or tender joints, and NSAID consumption [8].
• Collagen peptides provide significant pain relief in patients with knee osteoarthritis compared to those who received placebo [45].

Musculoskeletal Injury and Rehabilitation¶

• 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 the analgesic consumption after ACL reconstruction [5].
• Restoration of the distal vasti muscle mass and knee extension muscle strength with resistance training is promoted further by protein-containing nutrient supplementation immediately after single exercise sessions in ACL patients [20].
• 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 [24].
• Bovine colostrum supplementation resulted in approximately 4 lower Oswestry Disability Index (ODI) scores than the control group over the 90-day study period, indicating improved physical function in adults with traumatic peri-trochanteric femoral fracture [46].

General Nutritional Principles and Specific Agents¶

• Specific nutritional supplementation alone might benefit geriatric patients, especially relevant for those who are unable to exercise [2].
• Calcium supplements may appear to improve fracture healing of osteoporotic bone but failed to improve strength in a rat osteoporotic model [16].
• With protein supplementation, protein intakes at amounts greater than ~1.6 g/kg/day do not further contribute resistance training-induced gains in fat-free mass in healthy adults [25].
• The appropriate use of some supplements can benefit the athlete, but others may harm the athlete’s health, performance, and/or livelihood and reputation if an antidoping rule violation results [12].
• Peer-reviewed scientific research often fails to support the efficacy of amino acids marketed as ergogenics for enhancing athletic performance [49].

Practical Considerations¶

Perioperative and Postoperative Supplementation¶

• Protein supplementation is a low-cost intervention that is easy to incorporate into perioperative management for total knee arthroplasty [18].
• The use of a low-cost commercially available amino acid supplement resulted in fewer overall complications postoperatively and was a low-risk intervention for the patient population [26].
• A comprehensive balanced nutrition supplement resulted in lower complication rates and mortality at 120 days postoperatively for hip fracture patients [30].
• Nutrition consultation and perioperative supplementation with amino acids and micronutrients are two readily available interventions that orthopaedic surgeons can select for malnourished patients [22].

Osteoarthritis and Joint Health¶

• Evidence supports the efficacy of glucosamine sulfate in reducing pain, improving function, and possibly regulating joint damage in knee osteoarthritis [7].

Specific Injury and Rehabilitation¶

• 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 [5].

General Considerations and Limitations¶

• Calcium supplements may appear to improve fracture healing of osteoporotic bone but failed to improve strength in a rat model [16].
• The appropriate use of some dietary supplements can benefit the athlete, but others may harm the athlete’s health, performance, and/or livelihood and reputation if an antidoping rule violation results [12].

Key Evidence¶

• [L5] Because of the lack of robust efficacy and safety data, peptide supplements should not currently be recommended as a replacement or adjunct for existing orthopaedic standard of care. [1] (10.1177/03635465261464420)
• [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. [2] (10.1016/j.jamda.2015.05.021)
• [L1] While effects on muscle strength and function are mixed, intravenous supplementation offers benefits. [3] (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. [4] (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. [5] (10.1177/2325967118s00040)
• [L4] The evidence supports efficacy in reducing pain, improving function, and possibly regulating joint damage. [7] (10.1186/s12891-022-06046-6)
• [L1] Supplementation with omega-3 PUFAs for 3-4 months reduces patient reported joint pain intensity, minutes of morning stiffness, number of painful and/or tender joints, and NSAID consumption. [8] (10.1016/j.pain.2007.01.020)
• [L1] CEAA supplementation has a protective effect against common complications and early skeletal muscle wasting after operative fixation of extremity and pelvic fractures. [9] (10.2106/jbjs.21.01014)
• [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. [11] (10.5435/00124635-200109000-00009)
• [Paper] The appropriate use of some supplements can benefit the athlete, but others may harm the athlete’s health, performance, and/or livelihood and reputation (if an antidoping rule violation results). [12] (10.1136/bjsports-2018-099027)
• [L4] Nutritional supplementation has been shown to markedly reduce hospital costs by reducing rates of ICU admissions, hospital-associated complications, and hospital-acquired infections. [14] (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. [15] (10.1016/j.jhsa.2013.05.017)
• [Paper] Therefore, calcium supplements may appear to improve fracture healing of osteoporotic bone but failed to improve strength. [16] (10.1002/jor.21180)
• [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. [18] (10.2106/jbjs.22.01357)
• [L1] Supplementation of n-3 PUFAs is effective to relieve pain and improve joint function in patients with OA. [19] (10.1186/s13018-023-03855-w)
• [L1] The results from this study demonstrate that restoration of the distal vasti muscle mass and knee extension muscle strength with resistance training is promoted further by protein-containing nutrient supplementation immediately after single exercise sessions. [20] (10.1002/jor.20147)
• [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. [21] (10.1177/2325967123s00326)
• [L5] Nutrition consultation and perioperative supplementation with amino acids and micronutrients are 2 readily available interventions that orthopaedic surgeons can select for malnourished patients. [22] (10.2106/jbjs.rvw.23.00242)
• [L1] However, oral nutritional supplementation and dietetic assistance represent low-risk interventions that may improve morbidity and mortality. [23] (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. [24] (10.1186/s12891-024-08244-w)
• [L1] With protein supplementation, protein intakes at amounts greater than ~1.6 g/kg/day do not further contribute RET-induced gains in FFM. [25] (10.1136/bjsports-2017-097608)
• [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. [26] (10.2106/jbjs.22.00078)
• [L1] The results demonstrate that patients do not benefit from creatine supplementation during the first 12 weeks of rehabilitation after ACL reconstruction. [28] (10.1177/0363546503261731)
• [L4] Integrating targeted nutrition into prehabilitation pathways may help reduce complications and support faster functional gains. [29] (10.1016/j.arth.2026.03.088)
• [L1] The comprehensive balanced nutrition supplement resulted in lower complication rates and mortality at 120 days postoperatively. [30] (10.1097/01.blo.0000224054.86625.06)
• [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. [32] (10.5435/jaaos-d-25-00757)
• [Paper] These data show a biological action of high concentrations of this supplement and its effect on the mechanical properties in this in vitro model. [34] (10.1002/jor.20757)
• [L5] The findings suggest that EPA supplementation could offer a promising strategy for preventing PTOA progression following acute cartilage injuries. [35] (10.1186/s13018-024-05081-4)
• [Paper] These data suggest that intra-articular injections of HA supplemented with CCL25 attenuates OA. [37] (10.1002/jor.24312)
• [Paper] Supplementation with increasing concentrations of insulin-like growth factor-I enhances chondrocyte matrix synthesis and may provide a means to enhance chondrocyte phenotypic stability and function during transplantation grafting procedures. [38] (10.1002/jor.1100170403)
• [L5] This is the first report providing evidence for the protective role of glucosamine against this early mediator of disc degeneration that could support the potential usage of this molecule as a treatment for preventing disc degenerative disorders. [39] (10.1002/jor.22725)
• [Paper] The beneficial effects of the combination of anabolic growth factors and catabolic blockers were evident in improved preservation of proteoglycan content of cartilage explants exposed to the depleting effects of IL-1. [40] (10.1016/j.orthres.2004.06.020)
• [L1] Oral chondroitin is more effective than placebo on relieving pain and improving physical function, while glucosamine showed effect on stiffness outcome. [43] (10.1186/s13018-018-0871-5)
• [L1] Our findings demonstrate significant pain relief in patients with knee osteoarthritis who received collagen peptides compared to those who received placebo. [45] (10.1186/s13018-023-04182-w)
• [L1] Additionally, patients in the colostrum group had approximately 4 lower Oswestry Disability Index (ODI) scores than the control group over the 90-day study period, indicating improved physical function. [46] (10.1016/j.injury.2023.111253)
• [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. [47] (10.5435/jaaos-d-24-01101)
• [Paper] The article highlights that while amino acids are marketed as ergogenics, peer-reviewed scientific research often fails to support their efficacy for enhancing athletic performance. [49] (10.1016/s0278-5919(05)70173-3)

References¶

[1] Peptide Supplements and Their Therapeutic Applications in Sports Medicine. The American Journal of Sports Medicine. 2026. DOI: 10.1177/03635465261464420

[2] 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

[3] 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

[4] 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

[5] 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

[7] 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

[8] A meta-analysis of the analgesic effects of omega-3 polyunsaturated fatty acid supplementation for inflammatory joint pain. Pain. 2007. DOI: 10.1016/j.pain.2007.01.020

[9] 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] 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

[12] IOC consensus statement: dietary supplements and the high-performance athlete. British Journal of Sports Medicine. 2018. DOI: 10.1136/bjsports-2018-099027

[14] 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

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

[16] Effects of calcium supplements on fracture healing in a rat osteoporotic model. Journal of Orthopaedic Research. 2010. DOI: 10.1002/jor.21180

[18] 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

[19] 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

[20] The effect of protein and carbohydrate supplementation on strength training outcome of rehabilitation in ACL patients. Journal of Orthopaedic Research. 2006. DOI: 10.1002/jor.20147

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

[22] The Role of Perioperative Nutritional Status and Supplementation in Orthopaedic Surgery. JBJS Reviews. 2024. DOI: 10.2106/jbjs.rvw.23.00242

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

[24] 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

[25] A systematic review, meta-analysis and meta-regression of the effect of protein supplementation on resistance training-induced gains in muscle mass and strength in healthy adults. British Journal of Sports Medicine. 2017. DOI: 10.1136/bjsports-2017-097608

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

[28] 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

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

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

[32] 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

[34] High levels of glucosamine–chondroitin sulfate can alter the cyclic preload and acute overload responses of chondral explants. Journal of Orthopaedic Research. 2009. DOI: 10.1002/jor.20757

[35] 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

[37] CCL25‐Supplemented Hyaluronic Acid Attenuates Cartilage Degeneration in a Guinea Pig Model of Knee Osteoarthritis. Journal of Orthopaedic Research. 2019. DOI: 10.1002/jor.24312

[38] Coordinate upregulation of cartilage matrix synthesis in fibrin cultures supplemented with exogenous insulin‐like growth factor‐I. Journal of Orthopaedic Research. 1999. DOI: 10.1002/jor.1100170403

[39] The catabolic effect of TNFα on bovine nucleus pulposus intervertebral disc cells and the restraining role of glucosamine sulfate in the TNFα-mediated up-regulation of MMP-3. Journal of Orthopaedic Research. 2014. DOI: 10.1002/jor.22725

[40] Dual transduction of insulin‐like growth factor‐I and interleukin‐l receptor antagonist protein controls cartilage degradation in an osteoarthritic culture model. Journal of Orthopaedic Research. 2005. DOI: 10.1016/j.orthres.2004.06.020

[43] 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

[45] Analgesic efficacy of collagen peptide in knee osteoarthritis: a meta-analysis of randomized controlled trials. Journal of Orthopaedic Surgery and Research. 2023. DOI: 10.1186/s13018-023-04182-w

[46] Improved physical disability and nutritional status by bovine colostrum supplementation in adults with traumatic peri-trochanteric femoral fracture: A randomized, controlled, clinical trial. Injury. 2024. DOI: 10.1016/j.injury.2023.111253

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

[49] FACTS AND FALLACIES OF PURPORTED ERGOGENIC AMINO ACID SUPPLEMENTS. Clinics in Sports Medicine. 1999. DOI: 10.1016/s0278-5919(05)70173-3