The evolving bone and joint health market speaks to a growing arsenal of nutrients and dietary supplements, delivery formats and market segments. This article analyzes science supporting both established and emerging nutrients and supplements, while providing market insight and opportunities for future developments in the industry.

One of the largest demographics in the bone and joint market is the aging population. In the U.S., low bone mass is a threat for more than 40 million people. Due to estrogen loss and lack of exercise, the American Academy of Orthopedic Surgeons said post-menopausal women are the demographic most prone to osteoporosis.

Michelle Hsu, marketing manager for AIDP, City of Industry, CA, said that’s approximately 25% of postmenopausal Caucasian women in the U.S. According to the National Osteoporosis Foundation, 15% of all women will break a bone in their lifetime.

However, women aren’t the only ones who need bone and joint support. “Osteoarthritis (OA) is by far the most prevalent joint issue facing those 65 years of age and older,” said Deanne Dolnick, science director, TR Nutritionals, Alpharetta, GA. “Many younger individuals are also suffering from OA due to the fact that they have been working out for most of their adult lives. The best way to ward off [joint problems] is to take the supplements that help support joint health.”

According to estimates, there are more than 15 million active people in Europe aged 40 to 65 who suffer from joint pain. In the U.S. this figure reaches 19 million people. Moreover, according to the World Health Organization, by 2020 osteoarthritis will become the fourth most common cause of disability worldwide because of the progressive aging of the population.

Nutrients for Bones & Joints

Calcium
The National Osteoporosis Foundation defined calcium as a necessary mineral that helps build and maintain bone health. Calcium loss happens though skin, nails, hair, sweat, urine and feces. When calcium intake is less than calcium lost, the result is bone loss, low bone density and broken bones. The American Academy of Orthopedic Surgeons noted that supplementation of calcium has been shown to improve bone health and strength.

Recommended daily values of calcium vary dependent on age. For adult women age 50 and younger, the DV is 1,000 mg per day, and over 50 it is 1,200 mg. Men are recommended to take 1,000 mg per day until the age of 70, at which point they should increase to 1,200 mg. The American Academy of Orthopedic Surgeons recommends taking calcium in doses of 500 mg or less to ensure it is efficiently absorbed through the intestines.

Magnesium
While calcium and magnesium combination sales decreased from 2014-2015, magnesium supplements on their own have seen a significant increase, according to data from SPINS, Schaumburg, IL.

An acidic body pH is common in Western diets, particularly among the aging population, and has been shown to impair bone mineralization and cause calcium loss. Magnesium, however, has the ability to neutralize this acid.

Magnesium in particular needs to be taken as recommended. Although insufficient magnesium can cause brittle and fragile bones, oxidation and inflammation, taking higher than the daily recommended value can increase inflammation, and lead to defects in mineralization as it competes with calcium, forming an insoluble salt. Postmenopausal women with high magnesium intake have also been found to have an increased incidence of wrist fracture.

The recommended intake of magnesium varies depending on age, capping at about 360 mg per day for teenagers, and 400 mg for pregnant mothers, accordin to the National Institutes of Health.

Vitamin D
The National Osteoporosis Foundation described vitamin D, which is required for calcium absorption, as an important player in bone protection. Sales of vitamin D supplements increased by almost 16% in 2015, according to SPINS.

Decreased vitamin D may result in bone loss, low bone density and a predisposition to broken bones. The recommended values for women and men are 400-800 IU each day, up to the age of 50. Fifty and older should take 800-1,000 IU daily. The safe upper limit of vitamin D is 4,000 IU daily.

High doses of vitamin D are being evaluated for the aging demographic in particular. Having a higher than recommended intake of vitamin D does not provide any additional benefits for bone and joint function, but seems to be associated with an increased risk of falls in those 70 or older.

Vitamin K
Vitamin K underwent an almost 30% increase in sales during 2015. The use of vitamin K2 optimizes calcium intake by keeping it out of arteries and utilizing it to improve bone mineral density and strength, as well as cardiovascular health.

“When taken in sufficient amounts daily, K2 ‘shuttles’ calcium to where it belongs, in bones, and prevents it from being deposited into cardiovascular arteries,” said Eric Anderson, senior vice president of global sales and marketing at NattoPharma USA Inc., Metuchen, NJ.

He added that osteocalcin helps bind calcium to bone, increasing mineral content and decreasing incidents of fracture. “As a K-dependent protein, osteocalcin needs vitamin K2 to function optimally,” Mr. Anderson said.    

Collagen
Hydrolysate collagen (HC) increases collagen synthesis and the creation of components such as glycosaminoglycans and hyaluronic acid, reducing and preventing joint pain and bone density loss.

Gary Brunet, president of Vyse Gelatin Company, Schiller Park, IL, said that his company’s hydrolyzed collagen is the same found in human bone and tissue, containing amino acids like glycine, proline and hydroxyproline that are key to joint care, and are not found in any other protein in the same quantities or configuration.  By hydrolyzing them into peptides, they become bioavailable, he claimed.

AIDP’s KoAct provides a combination of calcium for bone density, and collagen for bone structure, according to the company’s Ms. Hsu, who said the compound increases bone flexibility and bone synthesis while reducing bone resorption. When taken with calcium, collagen has also been found to reduce overall bone loss in osteopenic, postmenopausal women.

SPINS data showed that sales of collagen products increased by 70% in 2015 to reach more than $6 million.

“The largest subsection of the market is middle-aged to older men and women who are referred to this product by chiropractors and/or nutritionists because of various joint issues,” Taylor Wisnewski of Custom Collagen, Addison, IL, said of her company’ collagen peptides.

Chondroitin
Chondroitin sulfate has been found to benefit cartilage, synovial fluid and bone cells. It also increases type II collagen and proteoglycan synthesis while presenting anti-inflammatory and antioxidant properties.

Ms. Dolnick of TR Nutritionals explained that chondroitin sulfate is a glycosaminoglycan comprised of N-acetylgalactosamine and glucuronic acid, and is an important structural component of cartilage. As a supplement it may help delay the breakdown of cartilage or help to rebuild cartilage that has begun to deteriorate.

Glucosamine
Glucosamine sulfate is an amino sugar found in the fluid around joints. Ms. Dolnick said this fluid is essential for ease of movement and, like chondroitin sulfate, is effective at decreasing pain associated with OA.

Although glucosamine hydrochloride alone has been found to relieve knee pain for those with OA, studies show that when combined with chondroitin sulfate, glucosamine is also effective at improving joint functionality. Studies also seem to indicate that whether in its sulfate or hydrochloride form, glucosamine is equally bioavailable and effective.

Fatty Acids
Superba Krill from Norway-based Aker Biomarine contains omega-3 essential fatty acids EPA and DHA and the naturally occurring antioxidant astaxanthin, which also promotes joint health by balancing inflammation, according to the company.

“Marine omega-3s are some of the most sought-after nutritional ingredients, and many health experts believe these fatty acids could have a crucial role to play due to their anti-inflammatory benefits,” said Becky Wright, Aker’s marketing and communications director.

Proprietary Nutritionals, Inc., (PNI), a division of Pharmachem Laboratories, Kearny, NJ, offers a proprietary blend of esterified fatty acids in Celadrin, which PNI President Dean Mosca said reduces inflammation and increases mobility. It is marketed for joint health and can be formulated as a topical cream or in capsules.

One Celadrin study found that those using esterified fatty acids were able to walk longer distances. Use of the Celadrin cream showed similar improvements in range of movement and joint mobility.

Hyaluronic Acid
Naturally found in healthy joints, hyaluronic acid is often depleted in those with OA. Supplementation provides not only pain relief, but has also been shown to mitigate damage from wear and tear by reestablishing the natural lubricating layer in the knee joint. Its primary use has been in injections directly into the knee.

However, oral use of hyaluronic acid has been associated with improved muscle strength and improved overall knee function and quality of life. Ms. Dolnick said that manufacturers have responded favorably to the use of TR’s hyaluronic acid ingredient in their products.

Combined with collagen and polysaccharides, hyaluronic acid has also found significant success as a food additive through Mobilee, developed by Spanish biotech firm Bioiberica, demonstrating a “powerful induction of endogenous hyaluronic acid synthesis,” which reduces synovial effusion, according to the company.

MSM
Naturally occurring MSM delivers bioavailable sulfur and methyls, creating disulfide bonds that maintain the structure of connective tissue. In his book MSM: The Definitive Guide, Stanley Jacob, MD, FACS, stated that glycosaminoglycans (GAGs) are the building blocks of joint cartilage, linked together by disulfide bonds.

MSM is 34% sulfur by weight, and seems to be incorporated in the proteins of joint tissue, improving pain and function in those with knee osteoarthritis with little to no adverse affects.

MSM has also been found to reduce inflammation and oxidative stress. Use in conjunction with boswellic acids has the potential to improve MSM’s efficacy.

Whether used orally, topically, or via injection, MSM may take at least 2-3 weeks for improvement, with additional relief noted with continued use, Dr. Jacob said.

Quing Hao (Artemisia annua)
Quing hao, or Artemisia annua, has been used in Traditional Chinese Medicine for centuries. Its historical use for relief of heat in the joints indicates that it was likely utilized to treat inflammatory arthritis. More recent studies have confirmed these effects as well as analgesic and immunosuppressive properties.

Dr. Sheena Hunt, principal scientist for New Zealand-based Promisia Integrative Limited, which developed and manufacturers the quing hao supplement Arthrem, has found the herb to have anti-inflammatory properties beneficial for treatment of joint pain and stiffness.

Ashwagandha
Sensoril is a full-spectrum, standardized root and leaf extract of ashwagandha (Withania somnifera). An Ayurvedic adaptogen, ashwagandha is known for its role in supporting overall health, including joint function. Sensoril was found to significantly reduce knee swelling and joint discomfort over the course of a 12-week study, according to Bruce Abedon, PhD, director of scientific affairs, NutraGenesis LLC, Brattleboro, VT.

Other Nutrients
The American Academy of Orthopedic Surgeons also identified several other nutrients that contribute to bone health and growth, including:

• Phosphorus, an important mineral in the body’s bone crystal. Like calcium, phosphorus absorption is also improved by vitamin D;
• Vitamin C, which is essential for collagen synthesis; and
• Vitamin A, for skeletal growth.

Market Trends
Most supplements marketed for bone and joint health saw a significant increase in sales between 2013 and 2015, with ingredients such as omega-3s and vitamin D growing by as much as 13%. Data from both Euromonitor and SPINS showed minimal growth, or significant decreases for some of the other big players such as calcium, magnesium and glucosamine.

Consumers are willing to spend on vitamins and dietary supplements in order to maintain health, said Ashley Sellers, senior communications executive at Euromonitor International. In the U.S., vitamins and dietary supplements had an overall 4% growth in retail value sales reaching $27.2 billion, and continued growth is expected. There are an increasing variety of distribution channels due to improved interest in health and wellness, rising healthcare costs, and the growing population of aging consumers. Ms. Sellers said increasing distribution channels improve product accessibility, and manufacturer websites are an essential way of educating consumers on the safety and efficacy of vitamins and dietary supplements.

There’s only room for the bone and joint market to grow. “As the population ages, more and more people will require joint health supplements. Joint problems cannot be ignored,” Ms. Dolnick said.

Additionally, Dr. Hunt, from Promisia, said companies must compete with NSAIDs and analgesics by being an equally effective, but safe alternative for longer-term use.

“Customers in the bone and joint health industry are becoming very discerning in terms of natural products,” Dr. Hunt said. “They are generally very willing to try a natural alternative to NSAIDs and analgesics, but at the same time want to know that any product they buy is backed up by robust scientific data proving the product’s safety and efficacy.”

Age As A Factor
Since an active lifestyle is important to those aged 40-60, Dr. Hunt said Arthrem is largely marketed to this demographic.

“The need for natural joint support solutions is growing as Baby Boomers feel increased discomfort in their knees and other joints, which has resulted from the normal aging process,” said Dr. Abedon of Nutragenesis.

With the growing interest in collagen for both bone and joint health, as well as skin care, there is ample opportunity for products that address both issues simultaneously in one aging-gracefully product.

However, consumers of all ages can benefit from a supportive bone care regime. Nattopharma’s Mr. Anderson said 90% of bone mass is attained in the late teen years. Over the past half decade childhood intake of vitamin K, which is essential in childhood to activate proteins for bone health, has significantly decreased. Additionally, children have been shown to have less active osteocalcin than adults.

“A 10% increase in peak bone mass is estimated to reduce the risk of osteoporotic fracture in adult life by 50%,” Mr. Anderson said. “Therefore, the consumer market for K2 is universal: children, men, women, younger and middle age. It’s never too late to incorporate daily intake of vitamin K2.”

Formulating & Packaging
Delivery formats and packaging have come a long way since bone and joint products first came on the market. Some consumers prefer bulk powder that can be added to food and beverages, while others want gummies or fortified, ready-to-eat options.

Sometimes the product itself dictates the packaging and delivery. For example, Arthrem’s extract is combined with grapeseed oil and marketed as an easy-to-swallow soft gelatin capsule, and Custom Collagen’s eggshell membrane collagen is only offered in capsule form because of its potency and price.

Although natural supplement manufacturing is at the mercy of factors such as quality and dosing, consumer demand is paramount when it comes to packaging.

Custom Collagen discovered this when it began selling its beef collagen peptides to consumers in a bulk five-pound box. As demand grew, so did the request for smaller packaging suitable for personal use. Creating a two-pound jar of beef collagen helped increase the market for its products.

Today, both Vyse and Custom Collagen have created convenient, one-serving-size stick packs that can be added to a water bottle on-the-go, answering customer demand for portable packaging suitable for traveling or going to the gym.

The high water-solubility of ashwagandha allows for use in a variety of delivery systems including capsules, tablets, stick packs, shots, RTD formulas, strips and more, according to Dr. Abedon.

“We are seeing a trend in consumers gravitating toward novel combinations of ingredients, leading to new delivery forms,” noted Aker’s Ms. Wright. “The opportunities are endless for omega-3 products in terms of new combination products and delivery formats and I am sure we will see interesting developments in the future.”

Functional Foods & Beverages
Fortified/functional food and beverages are also gaining traction. Euromonitor noted that Procter and Gamble’s Metamucil Fiber bars are competing successfully against other breakfast and nutrition bars.

Vyse began providing collagen for the protein bar industry to answer growing market demand in the 1980s. “Educated people want to use non-pharmaceutical ways to feel better as they age,” Mr. Brunet said. “We put out a consumer-based product sold online and in health food stores, and we watched that market explode. We could see the consumer demand for this was tremendous, and it continues to be demonstrating great growth.”

MenaQ7 absorbs well through yogurt, according to Mr. Anderson, making it more marketable as a food-based ingredient.

Nutritive drinks, on the other hand, have experienced an overall decline in sales over the past few years, likely due to competition from the sports and energy drink market. Yet this isn’t the entire story.

“The overall growth we have been seeing for calcium and magnesium has been in the area of powdered beverages, liquid supplements and beverages, while solid dose forms seem to be strong but flat,” said Patrick Stano, vice president of sales and marketing, for DPL-US, a division of Dr. Paul Lohmann Inc., Islandia, NY.

In response to this growth, DPL-US’s highly soluble, neutral tasting Calcium Lactate Plus and its highly absorbable Magnesium Aspartate Plus and Magnesium Bisglycinate have been formulated for use in liquid supplements and beverages.

When it comes to collagen, Mr. Brunet said consumers are looking for a tasteless product that dissolves rapidly and completely so it can be added to water on the go. 

In the dairy department, Bioiberica has created a nutritional combination of hyaluronic acid, collagen and other polysaccharides, that has been added to a milk drink called Mobilee. Marketed by Spain’s Central Lechera Asturiana to preserve and improve athlete’s joint health, Mobilee has taken advantage of the dairy industry and athletic demographic, while capitalizing on the beverage market for nutritional products.

Euromonitor noted that last year Olly Public Benefit Corporation, San Francisco, CA, began marketing gummies to Millennials, who are largely supportive of and educated in nutritional supplements and alternative healthcare. Meanwhile, companies like Aker BioMarine and NutraGenesis have added gummies and chews to their product lines as well.

Bioavailability
While delivery format is important in appealing to consumer demands, product efficacy remains a crucial factor in gaining market success. Easily absorbable, bioavailable ingredients are essential when formulating bone and joint formulas.

“It seems that formulators are becoming more willing to use higher-value ingredients that offer benefits not found in lower cost ingredients,” Mr. Stano said. DPL-US’s highly soluble and concentrated Calcium Lactate Plus has seen significant success, he added. 

AIDP also actively markets KoAct as an easy and more direct absorption version of calcium and collagen.

Sourcing
Dietary supplements continue to battle negative attention after concerns regarding adulteration, contamination and mislabeling of certain products made headlines last year, said Euromonitor’s Ms. Sellers. Sourcing and quality remain important concerns for nutraceutical ingredients.

Extracted from animal cartilage, chondroitin offers a number of different molecular patterns—the amount of sulfate may also vary greatly from one form to another. The debate as to chondroitin’s anti-inflammatory efficacy (and whether or not it can cause inflammation) is believed to stem, in large part, from these discrepancies in the quality of the raw product.

“Consumers are also becoming more knowledgeable and even discriminating in terms of where their products are coming from and if they were sustainably sourced,” said Aker’s Ms. Wright. “Businesses should be prepared to tell consumers the truth in this regard.” Aker sources its krill from the Southern Antarctic Ocean.

Ms. Dolnick said TR is one of the first chondroitin sulfate suppliers to undergo multiple product quality assessments.

People also want to know if their animal-based products contain antibiotics or GMOs, and how the animals were treated, said Vyse’s Mr. Brunet. As part of its Global Food Safety Initiative, Vyse visits and inspects its farms, audits suppliers and processors, and ensures that sourcing and handling are done properly.

Custom Collagen and its parent company Vyse began offering eggshell membrane and fish collagen peptides for those who do not eat beef. Because some consumers prefer wild-caught fish, and others require farm-raised kosher and halal compliant products, Vyse offers both options—pollock from the Bering Sea, and tilapia from an Israeli filtered-water farm.

Likewise, PNI created a comparable vegetable-based version of fatty acids, and Sensoril comes in both conventionally grown and certified organic ashwagandha.

Market Appeal
In addition to a middle-aged population interested in maintaining an active lifestyle, PNI’s Mr. Mosca has found that the athlete and fitness demographics comprise a large portion of buyers.

MSM is used in athletics for improved performance, pain release and enhanced tissue repair, speeding relief from inflammation, according to Dr. Jacob.

“Sports performance is another category with large growth potential for joint support ingredients because athletes increasingly seek natural, non-drug/steroid options for enhancing their recovery time, reducing discomfort and promoting the health of their bones and joints,” Dr. Abedon said. 

Another emerging market for joint health is the pet industry. Mr. Brunet said many customers have asked for advice on administering their products to pets, reporting back with excellent results. Vyse already has a presence in the equine market, and will soon begin marketing its collagen specifically for pets.

Promisia is also expected to launch an Arthrem product marketed for dogs with osteoarthritis.

“[Bone and joint health] is a unique category in that the consumer can truly feel if a product is working,” Ms. Dolnick said. “This is not the kind of product where a company can sprinkle in ingredients for label claim. The manufacturers and marketers must use the efficacious dose or their customers will not purchase the product again.”