Skip to content

Patients › General-Health

骨骼肌肉健康的营养补充剂

PDF Evidence

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 Aug 2026
一片叶子旁边的一粒补充剂胶囊。
一些补充剂有助于骨骼和关节健康，但许多被过度宣传——了解哪些有科学依据是有帮助的。 Kieran Hirpara 4.0

本页面由机器翻译，尚未经临床医生审核。英文版本为权威版本。

您的感受

您可能会注意到关节出现僵硬和疼痛，尤其是在休息后或清晨刚醒来时。这种退行性关节炎常使日常活动变得困难。您可能在完成简单动作时遇到困难，例如伸手到背后扣文胸或把衬衫塞进裤子里。疼痛可能在活动后或侧卧睡觉时加剧，从而干扰您的休息。

您的外科医生可能会讨论使用营养补充剂来帮助管理这些症状。氨基葡萄糖和硫酸软骨素是常见的选择。它们具有极佳的安全性，可能作为许多骨关节炎患者的初始治疗手段。证据支持硫酸氨基葡萄糖在减轻疼痛和改善功能方面的作用。它还可能有助于调节膝关节的损伤。然而，关于长期影响和剂量的未解问题阻止了对其的明确推荐。此外，也缺乏充分证据来全面推荐所有患者使用这些制剂。

如果费用不是问题，这些补充剂可能是合理的选项，作为手部原发性骨关节炎症状管理综合计划的一部分。此外，n-3 多不饱和脂肪酸在缓解骨关节炎患者疼痛和改善关节功能方面有效。对于无法进行锻炼的老年患者，单独进行特定的营养补充可能带来益处。

手术后，如前交叉韧带重建术，含有胶原蛋白、透明质酸、硫酸软骨素和血浆蛋白的辅助口服补充剂可提高物理治疗的疗效。这种方法可以缩短恢复至受伤前活动水平所需的时间，并减少对止痛药的需求。静脉注射蛋白质或氨基酸补充剂也为接受全关节置换术的患者带来益处，尽管其对肌肉力量和功能的影响不一。

营养优化与脊柱手术患者更好的预后相关。它通过降低重症监护室入院率、医院相关并发症和医院获得性感染的发生率，显著降低了医院成本。条件必需氨基酸补充剂对四肢和骨盆骨折切开复位内固定术后常见的并发症和早期骨骼肌萎缩具有保护作用。

尽管存在这些益处，脊柱手术中营养优化的主要障碍包括方案不一致和患者依从性差。需要标准化多学科营养方案。还需要进一步研究以确定脊柱手术有效的围手术期营养方案。您的外科医生将根据您的具体需求和循证指南帮助您了解这些选择。

实际情况

您的关节被设计为能够顺畅运动。软骨充当骨骼之间的减震器。它是覆盖在骨端的平滑涂层，可防止摩擦。当这种涂层磨损时，您会感到疼痛和僵硬。这种磨损在骨关节炎中很常见。您的身体试图修复损伤，但往往无法跟上。

营养补充剂旨在支持这一修复过程。例如，氨基葡萄糖和硫酸软骨素可能有助于维持软骨健康。它们具有极好的安全性特征和较低的副作用。一些患者发现它们可以减轻疼痛并改善功能。然而，证据尚不足以保证对所有人都有效。我们目前还不知道这些补充剂的最佳长期剂量。因此，我们不能明确地推荐它们作为治愈手段。

其他补充剂针对炎症和肌肉健康。N-3 多不饱和脂肪酸可能缓解疼痛并改善关节功能。胶原蛋白和透明质酸可能有助于您的身体在手术后更快愈合。它们可以缩短恢复到受伤前活动所需的时间。如果您正在接受前交叉韧带重建术，这尤其有帮助。

对于老年人或无法锻炼的人，特定的补充剂可能会提供直接益处。静脉注射蛋白质或氨基酸可以支持全关节置换术后的恢复。这有助于对抗肌肉萎缩，即手术后肌肉质量的流失。适当的营养还可以通过降低并发症和感染的风险来减少医院费用。

在脊柱手术中，营养优化可以改善结果。然而，不一致的方案和患者依从性差仍然是重大障碍。我们仍在调查脊柱患者的最佳方案。目前，补充剂只是更广泛计划的一部分。它们与物理治疗和其他治疗结合使用时效果最佳。您的外科医生将帮助您决定它们是否适合您的具体情况。

预期效果

营养补充剂在您的肌肉骨骼健康方面可能发挥有益作用，尽管效果因人而异。对于无法进行锻炼的老年人，特定的补充剂可能会带来明显益处。如果您即将接受关节置换手术，静脉注射蛋白质或氨基酸可能有助于您的恢复，即使肌肉力量的提升并不确定。对于一般的关节疼痛，氨基葡萄糖和硫酸软骨素等补充剂具有极佳的安全性。它们可作为管理磨损性关节炎的第一步。您可能会发现，它们能在副作用较少的情况下减轻疼痛并改善功能。然而，我们目前尚未完全了解其长期影响或最佳剂量。这种不确定性意味着我们无法向所有人提供明确的推荐。

如果您患有手部骨关节炎，且费用不是障碍，这些补充剂可能是您治疗计划中合理的一部分。对于膝关节骨关节炎，硫酸氨基葡萄糖可能有助于调节关节损伤并缓解疼痛。Omega-3 脂肪酸（n-3 多不饱和脂肪酸）在缓解疼痛和改善关节功能方面也有效。膝关节韧带重建术后，含有胶原蛋白、透明质酸和其他蛋白质的补充剂可能有助于您更快地恢复受伤前的活动水平。在此期间，您可能还需要服用较少的止痛药物。

对于脊柱手术患者，术前通过适当营养为身体做好准备与更好的手术结果相关。这被称为围手术期营养优化。它通过降低重症监护入院和感染的风险，从而降低医院成本。然而，由于指南不一致或个人依从性问题，坚持这些营养计划可能很困难。我们仍在研究脊柱手术的最佳方案。最终，虽然补充剂可以支持您的愈合过程并减轻疼痛，但它们作为包含物理治疗和专业医疗指导的更广泛护理计划的一部分时效果最佳。

Reviewed by Kieran Hirpara · 12 June 2026.

Want the clinical detail? Read the clinician version.

Talk to your treating clinician for advice specific to you.

For an appointment with the CQ Hand + Upper Limb team, ask your GP about a referral or visit www.cqupperlimb.com.

Evidence & references

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

  • 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

  • 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].
  • 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].
  • 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 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].
  • 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].
  • 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].
  • 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].
  • 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

  • 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].
  • Lack of substantial evidence currently prevents a ringing endorsement of glucosamine and chondroitin sulfate agents [6].
  • 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 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].
  • 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

Creative Commons BY-NC 4.0

CC Creative Commons licence
BY Attribution — you must credit the source
NC NonCommercial — not for commercial use

Attribution-NonCommercial 4.0 International

Creative Commons Corporation ("Creative Commons") is not a law firm and does not provide legal services or legal advice. Distribution of Creative Commons public licenses does not create a lawyer-client or other relationship. Creative Commons makes its licenses and related information available on an "as-is" basis. Creative Commons gives no warranties regarding its licenses, any material licensed under their terms and conditions, or any related information. Creative Commons disclaims all liability for damages resulting from their use to the fullest extent possible.

Using Creative Commons Public Licenses

Creative Commons public licenses provide a standard set of terms and conditions that creators and other rights holders may use to share original works of authorship and other material subject to copyright and certain other rights specified in the public license below. The following considerations are for informational purposes only, are not exhaustive, and do not form part of our licenses.

Considerations for licensors: Our public licenses are intended for use by those authorized to give the public permission to use material in ways otherwise restricted by copyright and certain other rights. Our licenses are irrevocable. Licensors should read and understand the terms and conditions of the license they choose before applying it. Licensors should also secure all rights necessary before applying our licenses so that the public can reuse the material as expected. Licensors should clearly mark any material not subject to the license. This includes other CC- licensed material, or material used under an exception or limitation to copyright. More considerations for licensors: wiki.creativecommons.org/Considerations_for_licensors

Considerations for the public: By using one of our public licenses, a licensor grants the public permission to use the licensed material under specified terms and conditions. If the licensor's permission is not necessary for any reason--for example, because of any applicable exception or limitation to copyright--then that use is not regulated by the license. Our licenses grant only permissions under copyright and certain other rights that a licensor has authority to grant. Use of the licensed material may still be restricted for other reasons, including because others have copyright or other rights in the material. A licensor may make special requests, such as asking that all changes be marked or described. Although not required by our licenses, you are encouraged to respect those requests where reasonable. More considerations for the public: wiki.creativecommons.org/Considerations_for_licensees

Creative Commons Attribution-NonCommercial 4.0 International Public License

By exercising the Licensed Rights (defined below), You accept and agree to be bound by the terms and conditions of this Creative Commons Attribution-NonCommercial 4.0 International Public License ("Public License"). To the extent this Public License may be interpreted as a contract, You are granted the Licensed Rights in consideration of Your acceptance of these terms and conditions, and the Licensor grants You such rights in consideration of benefits the Licensor receives from making the Licensed Material available under these terms and conditions.

Section 1 -- Definitions.

a. Adapted Material means material subject to Copyright and Similar Rights that is derived from or based upon the Licensed Material and in which the Licensed Material is translated, altered, arranged, transformed, or otherwise modified in a manner requiring permission under the Copyright and Similar Rights held by the Licensor. For purposes of this Public License, where the Licensed Material is a musical work, performance, or sound recording, Adapted Material is always produced where the Licensed Material is synched in timed relation with a moving image.

b. Adapter's License means the license You apply to Your Copyright and Similar Rights in Your contributions to Adapted Material in accordance with the terms and conditions of this Public License.

c. Copyright and Similar Rights means copyright and/or similar rights closely related to copyright including, without limitation, performance, broadcast, sound recording, and Sui Generis Database Rights, without regard to how the rights are labeled or categorized. For purposes of this Public License, the rights specified in Section 2(b)(1)-(2) are not Copyright and Similar Rights.

d. Effective Technological Measures means those measures that, in the absence of proper authority, may not be circumvented under laws fulfilling obligations under Article 11 of the WIPO Copyright Treaty adopted on December 20, 1996, and/or similar international agreements.

e. Exceptions and Limitations means fair use, fair dealing, and/or any other exception or limitation to Copyright and Similar Rights that applies to Your use of the Licensed Material.

f. Licensed Material means the artistic or literary work, database, or other material to which the Licensor applied this Public License.

g. Licensed Rights means the rights granted to You subject to the terms and conditions of this Public License, which are limited to all Copyright and Similar Rights that apply to Your use of the Licensed Material and that the Licensor has authority to license.

h. Licensor means the individual(s) or entity(ies) granting rights under this Public License.

i. NonCommercial means not primarily intended for or directed towards commercial advantage or monetary compensation. For purposes of this Public License, the exchange of the Licensed Material for other material subject to Copyright and Similar Rights by digital file-sharing or similar means is NonCommercial provided there is no payment of monetary compensation in connection with the exchange.

j. Share means to provide material to the public by any means or process that requires permission under the Licensed Rights, such as reproduction, public display, public performance, distribution, dissemination, communication, or importation, and to make material available to the public including in ways that members of the public may access the material from a place and at a time individually chosen by them.

k. Sui Generis Database Rights means rights other than copyright resulting from Directive 96/9/EC of the European Parliament and of the Council of 11 March 1996 on the legal protection of databases, as amended and/or succeeded, as well as other essentially equivalent rights anywhere in the world.

l. You means the individual or entity exercising the Licensed Rights under this Public License. Your has a corresponding meaning.

Section 2 -- Scope.

a. License grant.

1. Subject to the terms and conditions of this Public License, the Licensor hereby grants You a worldwide, royalty-free, non-sublicensable, non-exclusive, irrevocable license to exercise the Licensed Rights in the Licensed Material to:

a. reproduce and Share the Licensed Material, in whole or in part, for NonCommercial purposes only; and

b. produce, reproduce, and Share Adapted Material for NonCommercial purposes only.

2. Exceptions and Limitations. For the avoidance of doubt, where Exceptions and Limitations apply to Your use, this Public License does not apply, and You do not need to comply with its terms and conditions.

3. Term. The term of this Public License is specified in Section 6(a).

4. Media and formats; technical modifications allowed. The Licensor authorizes You to exercise the Licensed Rights in all media and formats whether now known or hereafter created, and to make technical modifications necessary to do so. The Licensor waives and/or agrees not to assert any right or authority to forbid You from making technical modifications necessary to exercise the Licensed Rights, including technical modifications necessary to circumvent Effective Technological Measures. For purposes of this Public License, simply making modifications authorized by this Section 2(a) (4) never produces Adapted Material.

5. Downstream recipients.

a. Offer from the Licensor -- Licensed Material. Every recipient of the Licensed Material automatically receives an offer from the Licensor to exercise the Licensed Rights under the terms and conditions of this Public License.

b. No downstream restrictions. You may not offer or impose any additional or different terms or conditions on, or apply any Effective Technological Measures to, the Licensed Material if doing so restricts exercise of the Licensed Rights by any recipient of the Licensed Material.

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.