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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.

32 citationsUpdated Sep 2026

For patients: a plain-language version of this topic is available. See the patient guide.

Overview

Nutritional supplementation serves as a targeted adjunct to standard orthopaedic care, particularly for geriatric patients who are unable to exercise [2]. While peptide supplements should not currently be recommended as a replacement or adjunct for existing standard of care due to the lack of robust efficacy and safety data [1], specific interventions demonstrate distinct clinical benefits. Intravenous peri-operative protein or amino acid supplementation offers benefits for total joint arthroplasty, although effects on muscle strength and function remain mixed [3]. For malnourished patients, nutrition consultation and perioperative supplementation with amino acids and micronutrients are readily available interventions that orthopaedic surgeons can select [11]. The use of low-cost commercially available amino acid supplements resulted in fewer overall complications postoperatively and was a low-risk intervention for the patient population [19]. Furthermore, nutritional supplementation has been shown to markedly reduce hospital costs by reducing rates of ICU admissions, hospital-associated complications, and hospital-acquired infections [13].

In the management of osteoarthritis, glucosamine and chondroitin sulfate possess an excellent safety profile and may serve as an initial treatment modality [4]. Glucosamine sulfate has the potential to relieve pain and improve function with low side effects, though unanswered questions regarding long-term effects and dosage preclude a definitive endorsement [10]. The combination of non-steroidal anti-inflammatory drugs and glucosamine sulfate supports efficacy in reducing pain, improving function, and possibly regulating joint damage in knee osteoarthritis [7]. Supplementation of n-3 polyunsaturated fatty acids is effective to relieve pain and improve joint function in patients with osteoarthritis [6]. Specifically, 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]. 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 [14].

For musculoskeletal injuries and surgical optimization, 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]. 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]. 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]. Substantial barriers such as inconsistent protocols and patient nonadherence remain in nutritional optimization for spine surgery, highlighting the need for multifactorial assessment and standardization of multidisciplinary nutritional protocols [22]. In athletic populations, 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]. Recommendations for data capture relating to female athlete population characteristics, injuries, illnesses, and other health consequences will improve the quality of epidemiological studies to inform better injury and illness prevention strategies [15].

How It Works

Mechanisms of Action

Glucosamine exerts analgesic properties by stimulating hyaluronic acid production in human osteoarthritic synovium [32]. Omega-3 fatty acids protect cartilage from acute injury by reducing the mechanical sensitivity of chondrocytes [16].

Perioperative and Postoperative Recovery

Perioperative essential amino acid supplementation prevents rectus femoris muscle atrophy and accelerates early functional recovery after total knee arthroplasty [30]. Protein supplementation mitigates muscle atrophy in the postoperative period following ACL reconstruction, total hip arthroplasty, total knee arthroplasty, and surgical treatment of hip fracture [24]. Intravenous perioperative protein or amino acid supplementation offers benefits for total joint arthroplasty, although effects on muscle strength and function are mixed [3]. Protein supplementation is a low-cost intervention that is easy to incorporate into perioperative management; its beneficial effects on muscle strength could potentially reduce the risk of longer-term complications such as falls and periprosthetic fracture [20]. Oral nutritional supplementation and dietetic assistance represent low-risk interventions that may improve morbidity and mortality in older people after hip fracture [17].

Osteoarthritis and Joint Pain

Collagen peptides provide significant pain relief in patients with knee osteoarthritis compared to placebo [27]. An eight-week collagen-based supplement has a positive effect on pain, quality of life levels, and some functional test results in patients with meniscopathy [25]. The evidence supports the efficacy of glucosamine sulfate in reducing pain, improving function, and possibly regulating joint damage in knee osteoarthritis [7]. Glucosamine sulfate has the potential to relieve pain and improve function with low side effects, though unanswered questions regarding long-term effects and dosage preclude a definitive endorsement [10]. 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].

Musculoskeletal Function and Sarcopenia

Specific nutritional supplementation with vitamin D and leucine-enriched whey protein provides proof-of-principle that it might benefit geriatric patients, especially those who are unable to exercise [2]. 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 [18]. Subacromial injection of hydrolyzed collagen is effective in reducing pain and supporting functional recovery in patients with rotator cuff tendinopathy, with effects observed after the first injection and persisting up to six months [29].

Limitations and Safety

Patients do not benefit from creatine supplementation during the first 12 weeks of rehabilitation after anterior cruciate ligament reconstruction [26]. 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].

What the Evidence Shows

Perioperative and Postoperative Supplementation

Intravenous protein or amino acid supplementation offers benefits for total joint arthroplasty, although effects on muscle strength and function remain mixed [3]. For malnourished orthopaedic patients, perioperative nutritional optimization with amino acids and micronutrients serves as a readily available intervention [11]. Integrating targeted nutrition into prehabilitation pathways may help reduce complications and support faster functional gains in total joint arthroplasty [21]. In spine surgery, perioperative nutritional optimization has been associated with improved outcomes, but additional investigation is needed to determine effective protocols [23]. Substantial barriers to nutritional optimization in this population include inconsistent protocols and patient nonadherence [22]. Regarding hip fractures, a comprehensive balanced nutrition supplement resulted in lower complication rates and mortality at 120 days postoperatively [31]. Additionally, 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 [19].

Osteoarthritis and Joint Health

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]. If the cost is not prohibitive, glucosamine and chondroitin sulfate may be considered reasonable treatment options as part of a multimodal approach for symptomatic primary hand osteoarthritis [14]. Oral chondroitin is more effective than placebo on relieving pain and improving physical function, while glucosamine showed an effect on stiffness outcome in osteoarthritis [33]. Collagen peptides demonstrate significant pain relief in patients with knee osteoarthritis compared to those who received placebo [27]. 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 [25]. EPA supplementation could offer a promising strategy for preventing post-traumatic osteoarthritis progression following acute cartilage injuries [16].

Sports Medicine and Rehabilitation

Specific nutritional supplementation alone might benefit geriatric patients, especially those who are unable to exercise, as shown by a vitamin D and leucine-enriched whey protein study [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 ACL reconstruction [5]. 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]. 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 in healthy adults [18]. Patients do not benefit from creatine supplementation during the first 12 weeks of rehabilitation after ACL reconstruction [26]. Subacromial injection of hydrolyzed collagen was effective in reducing pain and supporting functional recovery in patients with rotator cuff tendinopathy, with effects observed after the first injection and persisting up to six months [29].

Practical Considerations

Perioperative and Fracture Care

In the management of hip fractures, a comprehensive balanced nutrition supplement is associated with lower complication rates and mortality at 120 days postoperatively [31]. Oral nutritional supplementation and dietetic assistance represent low-risk interventions that may improve morbidity and mortality in older people with hip fractures [17].

For spine surgery, substantial barriers to nutritional optimization include inconsistent protocols and patient nonadherence. These challenges highlight the need for multifactorial assessment and standardization of multidisciplinary nutritional protocols [22].

Osteoarthritis and Joint Health

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 [14].

Rehabilitation and Sarcopenia

Specific nutritional supplementation alone might benefit geriatric patients with sarcopenia, especially those who are unable to exercise [2].

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)
  • [L1] Supplementation of n-3 PUFAs is effective to relieve pain and improve joint function in patients with OA. [6] (10.1186/s13018-023-03855-w)
  • [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. [10] (10.5435/00124635-200109000-00009)
  • [L5] Nutrition consultation and perioperative supplementation with amino acids and micronutrients are 2 readily available interventions that orthopaedic surgeons can select for malnourished patients. [11] (10.2106/jbjs.rvw.23.00242)
  • [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. [13] (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. [14] (10.1016/j.jhsa.2013.05.017)
  • [L5] Our recommendations for data capture relating to female athlete population characteristics, and injuries, illnesses and other health consequences, will improve the quality of epidemiological studies, to inform better injury and illness prevention strategies. [15] (10.1136/bjsports-2022-106620)
  • [L5] The findings suggest that EPA supplementation could offer a promising strategy for preventing PTOA progression following acute cartilage injuries. [16] (10.1186/s13018-024-05081-4)
  • [L1] However, oral nutritional supplementation and dietetic assistance represent low-risk interventions that may improve morbidity and mortality. [17] (10.1097/corr.0000000000000658)
  • [L1] With protein supplementation, protein intakes at amounts greater than ~1.6 g/kg/day do not further contribute RET-induced gains in FFM. [18] (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. [19] (10.2106/jbjs.22.00078)
  • [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. [20] (10.2106/jbjs.22.01357)
  • [L4] Integrating targeted nutrition into prehabilitation pathways may help reduce complications and support faster functional gains. [21] (10.1016/j.arth.2026.03.088)
  • [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. [22] (10.5435/jaaos-d-25-00757)
  • [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)
  • [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. [24] (10.1177/2325967123s00326)
  • [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. [25] (10.1186/s12891-024-08244-w)
  • [L1] The results demonstrate that patients do not benefit from creatine supplementation during the first 12 weeks of rehabilitation after ACL reconstruction. [26] (10.1177/0363546503261731)
  • [L1] Our findings demonstrate significant pain relief in patients with knee osteoarthritis who received collagen peptides compared to those who received placebo. [27] (10.1186/s13018-023-04182-w)
  • [L4] The treatment with hydrolyzed collagen was effective in reducing pain and supporting functional recovery in patients with rotator cuff tendinopathy, with effects observed after the first injection and persisting up to six months. [29] (10.1016/j.jseint.2023.06.009)
  • [L1] Perioperative essential amino acid supplementation prevents rectus femoris muscle atrophy and accelerates early functional recovery after total knee arthroplasty. [30] (10.1302/0301-620x.102b6.bjj-2019-1370.r1)
  • [L1] The comprehensive balanced nutrition supplement resulted in lower complication rates and mortality at 120 days postoperatively. [31] (10.1097/01.blo.0000224054.86625.06)
  • [L5] This might indicate that GlcN exerts its potential analgesic properties through stimulation of synovial HA production. [32] (10.1186/1471-2474-9-120)
  • [L1] Oral chondroitin is more effective than placebo on relieving pain and improving physical function, while glucosamine showed effect on stiffness outcome. [33] (10.1186/s13018-018-0871-5)

See Also

  • Osteoarthritis

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

[6] 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

[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

[10] 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

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

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

[13] 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

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

[15] Female athlete health domains: a supplement to the International Olympic Committee consensus statement on methods for recording and reporting epidemiological data on injury and illness in sport. British Journal of Sports Medicine. 2023. DOI: 10.1136/bjsports-2022-106620

[16] 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

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

[18] 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

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

[20] 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

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

[22] 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

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

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

[25] 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

[26] 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

[27] 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

[29] Subacromial injection of hydrolyzed collagen in the symptomatic treatment of rotator cuff tendinopathy: an observational multicentric prospective study on 71 patients. JSES International. 2023. DOI: 10.1016/j.jseint.2023.06.009

[30] 2020 Chitranjan S. Ranawat Award: Perioperative essential amino acid supplementation suppresses rectus femoris muscle atrophy and accelerates early functional recovery following total knee arthroplasty. The Bone & Joint Journal. 2020. DOI: 10.1302/0301-620x.102b6.bjj-2019-1370.r1

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

[32] Glucosamine increases hyaluronic acid production in human osteoarthritic synovium explants. BMC Musculoskeletal Disorders. 2008. DOI: 10.1186/1471-2474-9-120

[33] 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

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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.

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