Rebecca Wright, Editor04.01.11
Adult joint health supplement use has been relatively flat since 1996, according to the Natural Marketing Institute’s (NMI) 2010 Health and Wellness Trends Database. And Larry Kolb, president, TSI Health Sciences, Missoula, MT, believes category crowding is to blame. “The mass market continues to increase the quantity of product offerings at the same or even lower pricing at retail,” he explained. “This has placed significant pressure on the costs and overall supply chain integrity.”
Nonetheless, Christian Artaria, marketing director and head of functional food development for Italy-based Indena S.p.A., said the category continues to be a top priority for companies, especially with Baby Boomers and the elderly experiencing joint problems in growing numbers. “Sales of products in the joint health category are very important for most manufacturers,” he said. “Therefore, each manufacturer wants to maintain its market share or increase it by further differentiating its products through new ingredients and technologies.”
Further, he said, it’s the ideal time for other joint health ingredients to play a bigger part in the market, especially since glucosamine has matured.
Eric Anderson, vice president of sales and marketing for Aker BioMarine Antarctic US, Inc., which is wholly owned by Norway-based Aker BioMarine ASA, agreed. “We are seeing expanded formulations and new offerings as the market for glucosamine and chondroitin is softening and consumers are looking for alternative products with demonstrated efficacy,” he said. “Also, consumers don’t just want products that relieve pain; they are looking for nutrients that improve their health and have positive benefits not only on symptoms, but also on function.”
As for where other pockets of growth might lie, Holly Harmon, marketing director, Bergstrom Nutrition, Vancouver, WA, said while consumers believe strongly that reducing inflammation is critical to their body’s well-being, NMI reports they are dissatisfied with the lack of supplements in forms other than pills and capsules. As a result, she said, “Alternative-form methods of delivery, like quick dissolve strips, are showing the most growth.”
Describing the impact of joint-related illnesses on quality of life, Paul Dijkstra, president and CEO, InterHealth Nutraceuticals, Benicia, CA, offered some sobering statistics. “According to an October 2010 CDC report, data analyzed from the 2007-2009 National Health Interview Survey showed that more than 22% (nearly 50 million) of adults had self-reported doctor-diagnosed arthritis and 9% (21 million or 42% of those with arthritis) had arthritis-attributable activity limitation (AAAL),” he explained. “Among those with arthritis, the age-adjusted prevalence of AAAL also increased significantly with increasing BMI, from nearly 35% for those who are underweight/normal weight to almost 45% for those considered obese.”
With up to 40 million Americans suffering from arthritis, 16 million of whom have been diagnosed with osteoarthritis, Olaf Weitz, head of business development—Supplements Group, Martin Bauer Inc., Secaucus, NJ, said the need for anti-inflammatory supplements as well as chondroprotective supplements to stimulate the production of cartilage tissue is growing.
And just in time, as many end users are relying on painkillers and/or strong anti-inflammatory compounds to deal with dysfunctional joints, according to Vladimir Badmaev, MD, PhD, director of medical and scientific affairs, PL Thomas, Morristown, NJ. As a consequence, he said this practice might deter proper diagnosis of the condition and postpone intervention, including appropriate nutritional help. “In fact, a diet lowering potential inflammatory factors should be considered as beneficial to overall skeletal health,” he asserted.
Chris Haynes, director of marketing, ESM Technologies, Carthage, MO, says being a success in the joint health market is all about messaging—pain and flexibility relief and speed of results are critical elements at the consumer level. He said simply: “Consumers need cost-conscious products that deliver results.”
Taking this into consideration, Dean Mosca, president, Proprietary Nutritionals Inc., Kearny, NJ, believes messaging has become more assertive and dynamic, as well as more niche oriented. As an example of the former, he said the maker of a branded liquid joint-support supplement recently contracted with a widely known endurance athlete who is participating in a cross-country run and will appear on the “Live with Regis and Kelly” morning show, where his joints will be monitored by the physician who created the product. Throughout his run, which commenced in February, viewers will be able to track his progress through the show as well as through the athlete’s Twitter and Facebook pages.
“Because the joint-health category is so crowded—reflecting now both Gen-X and Boomer consumers’ desires to maintain active lifestyles—marketers need to follow examples like this,” Mr. Mosca said, adding, “You can no longer act upon the assumption that one joint health product will engender loyalty from all consumers seeking joint support supplements.”
Reinvigorating the Category
Glucosamine, chondroitin and MSM continue to capture most of the market share in the joint health category. But as these ingredient segments continue to mature, newer entrants offering similar safety and efficacy profiles and consumer-friendly delivery formats are moving in.
One such ingredient is UC-II from InterHealth. Mr. Dijkstra discussed its benefits. “Arthritis-attributable activity limitation can severely affect quality of life. In a peer-reviewed published, randomized, double-blind, clinical study, UC-II was shown to improve quality of life—significantly improving comfort during daily activities. The improvements in joint comfort and function seen in the clinical study demonstrate that increased quality of life is possible with just 40 mg of UC-II.”
Mr. Dijkstra went on to note that 40 mg of UC-II a day is also more effective than 1500 mg of glucosamine + 1200 mg of chondroitin in promoting joint health.
Kevin Ruff, PhD, MBA, director of scientific and regulatory affairs, ESM, said while consumers still recognize glucosamine and chondroitin as the “go-to” joint health ingredients, the Glucosamine Arthritis Intervention Trial (GAIT) study and others show that there is definitely room for improvement with respect to efficacy and the time needed to see any effect.
“Manufacturers of joint health products are searching for new ingredients that are both safe and effective and that can improve on what glucosamine and chondroitin can do,” Mr. Ruff explained. “That’s where NEM (Natural Eggshell Membrane) comes in. It is clinically proven to reduce pain and stiffness associated with osteoarthritis in as little as seven to 10 days. It’s also about five times more clinically effective than glucosamine and chondroitin, alone or in combination, according to a 2009 study published in Clinical Rheumatology.”
Another relative newcomer to the joint health market is Indena’s Meriva, which is comprised of curcumin and soy phospholipids. “The joint health benefits of Meriva were proven in two long-term studies published in 2010. These studies included 150 participants and demonstrated the effectiveness of Meriva for pain relief and increased mobility in patients with osteoarthritis,” Mr. Artaria offered.
“The results of both studies showed that the Meriva-treated group had a statistically significant reduction in all primary clinical endpoints—the Western Ontario and McMaster Universities (WOMAC) score, the Karnofsky Performance Scale, and the treadmill walking performance test,” he added. “These results were complemented by the evaluation of a series of inflammatory markers that also showed a marked reduction in the Meriva-treated group, while no significant variation was observed in the ‘best available treatment’ group.”
In order to bring new consumers to the category, PL Thomas’ Dr. Badmaev suggested manufacturers address joint and bone health together, since mobility and performance associated with joint health depends on healthy bone structures. “The research on the health of the skeletal system, while recognizing the important role of calcium and vitamin D3, goes beyond these nutritional standards in maintaining bone health,” he said. “Preclinical and clinical studies indicate that essential fatty acids (especially docosahexaenoic acid, DHA), carotenoids (such as lycopene) and most significantly vitamin K2 (menaquinone) may contribute independently and collectively to bone health.”
For joint health in particular, Dr. Badmaev said Boswellia serrata (boswellic acids) is a favorite among botanicals for its anti-inflammatory benefits, as well as its safety.
In a 2010 published clinical study, a composition including Boswellia serrata gum resin, known as Aflapin (Indian Patent Application No. 2229/CHE/2008), was evaluated in patients with osteoarthritis of the knee. In this 90-day, double-blind, randomized, placebo-controlled study, the efficacy and tolerability of Aflapin was evaluated along with 5-Loxin (another Boswellia preparation). The subjects received either 100 mg of 5-Loxin or 100 mg of Aflapin or a placebo for 90 days.
At the end of the study, both 5-Loxin and Aflapin produced statistically significant improvements in pain scores and physical function scores in osteoarthritis subjects. “Importantly,” Dr. Badmaev pointed out, “the significant improvements in pain score and joint functionality were recorded as early as seven days after initiation of the study supplements.
Another botanical worth discussing, according to Mr. Weitz of Martin Bauer, is rose hips, along with its role as an inflammation reducer. During the past few years, he claims several human studies have demonstrated its pain-reducing properties as well as its ability to reduce symptoms such as joint stiffness—even the need for additional medication. But because herbal powders are typically not as stable and uniform as extracts, scientists at the Martin Bauer Group investigated the effect of transferring the active principal into an extract.
“From these investigations came the Nutrifin Motion Plus Concept, which is based on a (patent-pending) combination of cartilage protective compounds—collagen hydrolysate—with a special purified extract of rose hip peels cultivated by the Martin Bauer Group,” Mr. Weitz explained. “It is processed and concentrated in multiple stages, including aqueous extraction, special purification and spray-drying. This purified rose hip extract differs from other rose hip preparations due to its anti-inflammatory, pain-reducing and cartilage protective functionality.”
Mr. Weitz offered more details on the combination’s functional value. “A special type 1 hydrolyzed collagen matrix used in Nutrifin Motion Plus stimulates the biosynthesis of the extracellular matrix of chondrocytes and enhances the production of cartilage tissue,” he said. “It was found that in comparison to the use of the hydrolyzed collagen matrix alone, the cartilage protective and regenerative effects were significantly improved in the Nutrifin Motion Plus concept.”
Speaking of collagen, in September 2010, BioCell Technology, Newport Beach, CA, announced the successful completion of a clinical trial of BioCell Collagen II in subjects suffering from osteoarthritis. “This multi-center, double-blind, placebo-controlled trial demonstrated the ingredient’s safety and efficacy in reducing the disease-associated symptoms such as pain and in improving various physical activities, confirming results from a previous pilot study,” said BioCell’s Joosang Park, vice president of scientific affairs.
Further, he said, a more recent study including 80 subjects showed that a majority experienced substantial improvement of their joint conditions as measured by VAS pain and WOMAC scores. This study outcome is in the process of being published.
“Together with other independent studies on collagen-derived peptides and hyaluronic acid, these two trials raise a very interesting hypothesis that BioCell Collagen II containing both bioactive molecules may facilitate the re-growth of degraded cartilage via stimulation of the chondrocytes, the only resident cells in the cartilage, as well as stimulate the synovium cells surrounding the joint,” Mr. Park added.
Clinical substantiation is a priority for Ben Winters, director, Aroma New Zealand, Christchurch, New Zealand, who discussed the most recent research developments with his company’s joint health ingredient, GlycOmega-PLUS. “We carried out a human clinical on our GlycOmega-PLUS green-lipped mussel extract on patients with osteoarthritis of the knee. Patients experienced a significant increase in joint mobility, reduced pain and overall improvement in gut health as a result of stopping their previous drug medications for arthritis,” he said. “GlycOmega-PLUS is a new generation mussel extract that is cold processed and has significant anti-inflammatory activity over steamed opened mussel powders.”
At India-based Sami Labs Limited, a company associated with Sabinsa Corporation, East Windsor, NJ, formulators have been busy focusing on dosage, delivery and bioavailability. “Joint health products usually require large doses (generally above 1 gram). And if it is a multi-ingredient product, it becomes even more challenging for the formulator to address the product’s mode and means of delivery to derive its maximum benefits,” said Dr. Ria Biswas, senior manager, Technical Marketing.
“Nilitis or NilPain SR is a sustained release bi-layered tablet containing a proprietary composition from Sabinsa that includes Curcumin C3 Complex (95% curcuminoids), Boswellin (40% AKBA) and ginger extract (35% gingerols), which naturally supports the management of pain and discomfort without undesirable side effects,” she said. “The sustained release delivery ensures that the nutrients are released and absorbed in efficacious amounts over a period of eight hours, to support the management of inflammation and pain throughout the day.”
During the last year, Dr. Biswas added, the thrust in research activities in the joint health category at Sabinsa Corporation has been on Boswellin PS. “A considerable amount of research muscle was spent on developing this product to elicit its underlying mechanisms of action by which it shows its healthful effects. Boswellin PS—PS for PolySal—contains the active boswellic acids along with Polysal, a polysaccharide with proven anti-inflammatory activity.”
Sabinsa’s answer to the GAIT controversy was its registered and patent pending ingredient Boswellin PS, which was developed in early 2009 and marketed in 2010. Sabinsa was able to replace glucosamine in existing formulations and offer Boswellin PS, which has shown advantages in three areas, over conventional Boswellia serrata extracts that are standardized for one or more boswellic acids alone: enhanced water solubility; unique two-stage release profile for actives that support immediate and sustained action; and enhanced activity against pro-inflammatory cytokines, which translates to added benefits in supporting joint health and mobility.
As a producer of established joint health ingredients like chondroitin and glucosamine, TSI is focusing on value in today’s market. “Since we are a fully integrated manufacturer, our customers are benefiting from our value services, which allow us to incorporate these ingredients into a drum-to-hopper blend or granulation that is either encapsulated or pressed into tablets,” said Mr. Kolb. “This appears to add significant value for companies that want to achieve manufacturing efficiencies through easy-to-use granulations, with a closed-down supply chain in which the ingredients are tested and quality-verified.
Educational Opportunities
Dr. Badmaev of PL Thomas said one of the most important issues in today’s joint health market is educating end users and product formulators that only a total approach to skeletal health will effectively address joint mobility and flexibility. “The total approach starts with proper care and age-appropriate prevention of deteriorating of bone health,” he explained. “Sometimes an obvious sign(s) of deteriorating bone health can be missed if we do not recognize it.”
He went on to discuss the interesting correlation between oral bone and tooth loss and bone loss at non-oral sites in the body. In one study, Dr. Badmaev recalled, tooth loss was examined in 145 healthy subjects aged 65 years and older who completed a three-year, randomized, placebo-controlled trial of the effect of calcium and vitamin D supplementation on bone loss from the hips.
“During the two-year follow-up period, 40% of subjects with a total calcium intake of at least 1000 mg per day lost one or more teeth compared with 59% who consumed less calcium,” Dr. Badmaev stated. “These findings suggest that dental health is indicative of skeletal health and that intake levels of calcium and vitamin D aimed at preventing osteoporosis also have a beneficial effect on tooth retention.”
Switching gears, TSI’s Mr. Kolb offered some words of caution regarding adulteration. “Economic adulteration of chondroitin continues throughout the ingredient supply chain. Fillers and adulterants that fly under the most sophisticated radar remain common and undetected,” he said. “There have been strides with new analytical tests, however, there remains a lack of industry-wide validation methods and the industry continues to suffer—with low cost, inferior quality ingredients winning the price battles.”
Eric Brown, sales director, Bergstrom Nutrition, offered a similar point of view. “An issue in our industry is the influx of low-cost and inferior product. There are big differences in the source material and processes used between MSM manufacturers and we need to continue to educate and demonstrate those differences to brand manufacturers,” he said. “Our own OptiMSM offers ease of formulation, stability and other production benefits that others can’t match, and there’s still a lot of communication to do around the dangers of contaminants in cheap, commodity products."
Leaving GAIT in the Past
While the results from GAIT in general were disappointing, especially given the size, duration and wide publication of the study, most experts believe the players in the joint health market have moved on.
“The GAIT results did nothing to help the joint health market. If the results had been positive, the market could have publicized the results to take the market to an even higher level for several more years. This did not happen. And the fact that the findings were not positive resulted in the overall maturation of the category,” said Indena’s Mr. Artaria. “Now manufacturers are looking for new ingredients to revitalize their joint health product lines.”
In other cases, the GAIT results may have helped companies. “The results of GAIT have had little, if any, impact on MSM sales. If anything, it may have helped. The work published in Clinical Drug Investigation in 2004 by Usha and Naidu showed that combination therapy with MSM and glucosamine demonstrated higher efficacy than either of the compounds alone,” said Rod Benjamin, technical director, Bergstrom Nutrition. “Although the mechanism of the body’s sulfur cycle is still poorly understood, MSM may play a pivotal role in helping the body utilize both glucosamine and chondroitin.
“In a 2008 pharmacokinetic study, it was shown that urinary sulfate levels decreased in an inversely dose-dependent manner with MSM supplementation. Although further research is needed, that does suggest MSM may play a positive synergistic role with other compounds to support joint health.”
Mr. Dijkstra of InterHealth said regardless of the GAIT findings joint health would continue to be an important category for consumers who are looking for new ingredients that are more effective than existing products. “Joint-care ingredients backed by research should be extremely successful as consumers are increasingly concerned about efficacy and safety of the ingredients in their dietary supplements,” he said. “Even though glucosamine and chondroitin have become household names at the consumer level, they seem to lack a level of long-term efficacy consumers seek.”
Still, according to BioCell’s Mr. Park, clinical substantiation will always be an evolutionary process. “Continuous studies on existing ingredients enrolling more subjects in higher quality clinical trials have made market players, healthcare professionals and consumers better understand not only which ingredients actually provide clinically relevant benefits, but also which mechanisms may be behind the efficacy.”
Modern medicine has not quite hit the mark when it comes to finding the one-size-fits-all approach to joint health, but it seems supplements are doing a good job picking up where pharmaceuticals left off. Growth might be flat, but the market remains wide open for innovative ingredient combinations and delivery formats.
Sales are down 3% to $746 million due to negative efficacy reports and increasing competition, but liquid supplements may hold key to future growth.
By Chris Allan, Editor, Nicholas Hall’s INSIGHT North America
Dollar sales of joint health supplements—comprising mainly glucosamine/chondroitin options—continued to fall in 2010. Industry sources suggest a number of contributing factors to the decline, including price competition between brands and private label, well-publicized reports questioning the efficacy of glucosamine/chondroitin and encroachment from other joint health options, such as fish oil and topical analgesics/heat pads.
The Council for Responsible Nutrition (CRN), Washington, D.C., defended glucosamine/chondroitin supplements in September 2010 after a meta-analysis (conducted by the University of Bern and published in British Medical Journal) concluded that the ingredients, taken individually or together, provided no clinical benefit for joint pain or joint space narrowing. The industry association questioned the depth and scope of the study and referred to the “large body of scientific research that demonstrates glucosamine and chondroitin provide benefits for consumers coping with certain types of joint pain or immobility.”
Despite the overall declining trend, demographic factors—especially the aging Baby Boomer population and rising obesity levels—provide a strong growth opportunity for joint health supplements in the U.S. Education, which marketers can drive through advertising and promotional activities, will be essential to raise awareness about the importance of joint health and the natural solutions that are available.
Osteo Bi-Flex Leads the Market
Leading brand Osteo Bi-Flex (Rexall Sundown/NBTY, recently acquired by The Carlyle Group) managed to buck the overall negative sales trend, advancing nearly 4% to $117 million in sales. Line extensions and advertising investment were key factors behind the brand’s success. Joint Aid liquid, positioned as an on-the-go product ideal for consumers who don’t like swallowing pills, rolled out in late 2009. Meanwhile, the most recent version is One Per Day glucosamine + vitamin D3, which is claimed to provide full joint health support in just one caplet.
NBTY uses strong efficacy claims on packaging and in advertising to gain consumer confidence. Its position as the No.1 doctor & pharmacist recommended glucosamine/chondroitin branded supplement features heavily, while its 5-Loxin Advanced patent-pending formula is claimed to improve joint comfort within seven days. TV ads feature middle-aged people happily conducting their favorite outdoor hobbies helped by Osteo Bi-Flex. NBTY also markets Flex-A-Min under its Nature’s Bounty long-line range, although it struggled in the competitive environment and sales slipped to $21 million.
Move Free Advanced (Schiff) fell further behind Osteo Bi-Flex in sales terms, declining by around 10% to $38 million. In his summary of the company’s fiscal Q2 2011 results, Schiff president and CEO Bruce Wood noted the overall negative glucosamine/chondroitin category trend as a factor but pointed out that the brand still outperformed several rivals.
TV ads in support of Move Free Advanced claim that millions of people use the brand because “it works!”, while packaging claims it can start comforting sore joints within seven days.
Cosamin (Nutramax) recorded a relatively strong performance in the difficult environment, with sales remaining steady at around $14 million. Cosamin ASU, marketed as an advanced formula combining avocado/soybean unsaponifiable with glucosamine/chondroitin, grew strongly but may have cannibalized sales of stable mate Cosamin DS. Cosamin is positioned as a premium brand—No.1 recommended by orthopedic specialists—and Nutramax backs it with consistent advertising and promotional support. The Start Cosamin ASU campaign, which began in April 2010, gave consumers the opportunity to receive a free sample bottle through their doctor. Spokespersons for the brand include retired baseball star Jim Palmer and world champion figure skater Kimmie Meissner.
Relying on Innovation for Future Growth
Industry sources believe that innovation can help brands fight low-cost rivals, with delivery format a common theme. Liquid supplements are becoming increasingly popular, largely in response to consumer feedback expressing difficulty or a dislike of swallowing pills.
One liquid joint care brand performing well is glucosamine/chondroitin supplement Joint Juice (Joint Juice Inc.). The original supplement drink was joined on shelves by line extensions On-The-Go drink mix in summer 2010 and Easy Shot in January 2011. The brand was supported by a national ad campaign in 2010 targeting active adults looking for joint support to keep doing the things they love. The company is keen to educate consumers about the importance of joint health and uses in-store displays and informative takeaways to pass on joint health advice.
Meanwhile, Botanical Labs gave consumers a chance to win up to one year’s supply of Wellesse Joint Movement glucosamine and vitamin D3 fast-absorbing liquid formula as part of its Discover the Liquid Advantage online sweepstakes campaign, which ran between September-December 2010.
It is possible that we will see more liquid supplement launches during the coming years, which may provide some of the innovation necessary to return the glucosamine/chondroitin-led joint health category to growth.
Editor’s Note: All data in this report 12 months to November 2010 (MSP), sourced to Nicholas Hall’s INSIGHT based on industry estimates and Nicholas Hall’s DB6 2010 OTC database, in partnership with Nielsen in specific countries. DB6 is an important strategic planning tool for the OTC industry, going far beyond traditional audits to provide astute market intelligence covering all channels of retail distribution.
About the author: Chris Allan is the editor of Nicholas Hall’s INSIGHT North America. He can be reached at 44-1702-220-226; E-mail: chris.allan@nicholashall.com; Website: www.nicholashall.com
Nonetheless, Christian Artaria, marketing director and head of functional food development for Italy-based Indena S.p.A., said the category continues to be a top priority for companies, especially with Baby Boomers and the elderly experiencing joint problems in growing numbers. “Sales of products in the joint health category are very important for most manufacturers,” he said. “Therefore, each manufacturer wants to maintain its market share or increase it by further differentiating its products through new ingredients and technologies.”
Further, he said, it’s the ideal time for other joint health ingredients to play a bigger part in the market, especially since glucosamine has matured.
Eric Anderson, vice president of sales and marketing for Aker BioMarine Antarctic US, Inc., which is wholly owned by Norway-based Aker BioMarine ASA, agreed. “We are seeing expanded formulations and new offerings as the market for glucosamine and chondroitin is softening and consumers are looking for alternative products with demonstrated efficacy,” he said. “Also, consumers don’t just want products that relieve pain; they are looking for nutrients that improve their health and have positive benefits not only on symptoms, but also on function.”
As for where other pockets of growth might lie, Holly Harmon, marketing director, Bergstrom Nutrition, Vancouver, WA, said while consumers believe strongly that reducing inflammation is critical to their body’s well-being, NMI reports they are dissatisfied with the lack of supplements in forms other than pills and capsules. As a result, she said, “Alternative-form methods of delivery, like quick dissolve strips, are showing the most growth.”
Describing the impact of joint-related illnesses on quality of life, Paul Dijkstra, president and CEO, InterHealth Nutraceuticals, Benicia, CA, offered some sobering statistics. “According to an October 2010 CDC report, data analyzed from the 2007-2009 National Health Interview Survey showed that more than 22% (nearly 50 million) of adults had self-reported doctor-diagnosed arthritis and 9% (21 million or 42% of those with arthritis) had arthritis-attributable activity limitation (AAAL),” he explained. “Among those with arthritis, the age-adjusted prevalence of AAAL also increased significantly with increasing BMI, from nearly 35% for those who are underweight/normal weight to almost 45% for those considered obese.”
With up to 40 million Americans suffering from arthritis, 16 million of whom have been diagnosed with osteoarthritis, Olaf Weitz, head of business development—Supplements Group, Martin Bauer Inc., Secaucus, NJ, said the need for anti-inflammatory supplements as well as chondroprotective supplements to stimulate the production of cartilage tissue is growing.
And just in time, as many end users are relying on painkillers and/or strong anti-inflammatory compounds to deal with dysfunctional joints, according to Vladimir Badmaev, MD, PhD, director of medical and scientific affairs, PL Thomas, Morristown, NJ. As a consequence, he said this practice might deter proper diagnosis of the condition and postpone intervention, including appropriate nutritional help. “In fact, a diet lowering potential inflammatory factors should be considered as beneficial to overall skeletal health,” he asserted.
Chris Haynes, director of marketing, ESM Technologies, Carthage, MO, says being a success in the joint health market is all about messaging—pain and flexibility relief and speed of results are critical elements at the consumer level. He said simply: “Consumers need cost-conscious products that deliver results.”
Taking this into consideration, Dean Mosca, president, Proprietary Nutritionals Inc., Kearny, NJ, believes messaging has become more assertive and dynamic, as well as more niche oriented. As an example of the former, he said the maker of a branded liquid joint-support supplement recently contracted with a widely known endurance athlete who is participating in a cross-country run and will appear on the “Live with Regis and Kelly” morning show, where his joints will be monitored by the physician who created the product. Throughout his run, which commenced in February, viewers will be able to track his progress through the show as well as through the athlete’s Twitter and Facebook pages.
“Because the joint-health category is so crowded—reflecting now both Gen-X and Boomer consumers’ desires to maintain active lifestyles—marketers need to follow examples like this,” Mr. Mosca said, adding, “You can no longer act upon the assumption that one joint health product will engender loyalty from all consumers seeking joint support supplements.”
Reinvigorating the Category
Glucosamine, chondroitin and MSM continue to capture most of the market share in the joint health category. But as these ingredient segments continue to mature, newer entrants offering similar safety and efficacy profiles and consumer-friendly delivery formats are moving in.
One such ingredient is UC-II from InterHealth. Mr. Dijkstra discussed its benefits. “Arthritis-attributable activity limitation can severely affect quality of life. In a peer-reviewed published, randomized, double-blind, clinical study, UC-II was shown to improve quality of life—significantly improving comfort during daily activities. The improvements in joint comfort and function seen in the clinical study demonstrate that increased quality of life is possible with just 40 mg of UC-II.”
Mr. Dijkstra went on to note that 40 mg of UC-II a day is also more effective than 1500 mg of glucosamine + 1200 mg of chondroitin in promoting joint health.
Kevin Ruff, PhD, MBA, director of scientific and regulatory affairs, ESM, said while consumers still recognize glucosamine and chondroitin as the “go-to” joint health ingredients, the Glucosamine Arthritis Intervention Trial (GAIT) study and others show that there is definitely room for improvement with respect to efficacy and the time needed to see any effect.
“Manufacturers of joint health products are searching for new ingredients that are both safe and effective and that can improve on what glucosamine and chondroitin can do,” Mr. Ruff explained. “That’s where NEM (Natural Eggshell Membrane) comes in. It is clinically proven to reduce pain and stiffness associated with osteoarthritis in as little as seven to 10 days. It’s also about five times more clinically effective than glucosamine and chondroitin, alone or in combination, according to a 2009 study published in Clinical Rheumatology.”
Another relative newcomer to the joint health market is Indena’s Meriva, which is comprised of curcumin and soy phospholipids. “The joint health benefits of Meriva were proven in two long-term studies published in 2010. These studies included 150 participants and demonstrated the effectiveness of Meriva for pain relief and increased mobility in patients with osteoarthritis,” Mr. Artaria offered.
“The results of both studies showed that the Meriva-treated group had a statistically significant reduction in all primary clinical endpoints—the Western Ontario and McMaster Universities (WOMAC) score, the Karnofsky Performance Scale, and the treadmill walking performance test,” he added. “These results were complemented by the evaluation of a series of inflammatory markers that also showed a marked reduction in the Meriva-treated group, while no significant variation was observed in the ‘best available treatment’ group.”
In order to bring new consumers to the category, PL Thomas’ Dr. Badmaev suggested manufacturers address joint and bone health together, since mobility and performance associated with joint health depends on healthy bone structures. “The research on the health of the skeletal system, while recognizing the important role of calcium and vitamin D3, goes beyond these nutritional standards in maintaining bone health,” he said. “Preclinical and clinical studies indicate that essential fatty acids (especially docosahexaenoic acid, DHA), carotenoids (such as lycopene) and most significantly vitamin K2 (menaquinone) may contribute independently and collectively to bone health.”
For joint health in particular, Dr. Badmaev said Boswellia serrata (boswellic acids) is a favorite among botanicals for its anti-inflammatory benefits, as well as its safety.
In a 2010 published clinical study, a composition including Boswellia serrata gum resin, known as Aflapin (Indian Patent Application No. 2229/CHE/2008), was evaluated in patients with osteoarthritis of the knee. In this 90-day, double-blind, randomized, placebo-controlled study, the efficacy and tolerability of Aflapin was evaluated along with 5-Loxin (another Boswellia preparation). The subjects received either 100 mg of 5-Loxin or 100 mg of Aflapin or a placebo for 90 days.
At the end of the study, both 5-Loxin and Aflapin produced statistically significant improvements in pain scores and physical function scores in osteoarthritis subjects. “Importantly,” Dr. Badmaev pointed out, “the significant improvements in pain score and joint functionality were recorded as early as seven days after initiation of the study supplements.
Another botanical worth discussing, according to Mr. Weitz of Martin Bauer, is rose hips, along with its role as an inflammation reducer. During the past few years, he claims several human studies have demonstrated its pain-reducing properties as well as its ability to reduce symptoms such as joint stiffness—even the need for additional medication. But because herbal powders are typically not as stable and uniform as extracts, scientists at the Martin Bauer Group investigated the effect of transferring the active principal into an extract.
“From these investigations came the Nutrifin Motion Plus Concept, which is based on a (patent-pending) combination of cartilage protective compounds—collagen hydrolysate—with a special purified extract of rose hip peels cultivated by the Martin Bauer Group,” Mr. Weitz explained. “It is processed and concentrated in multiple stages, including aqueous extraction, special purification and spray-drying. This purified rose hip extract differs from other rose hip preparations due to its anti-inflammatory, pain-reducing and cartilage protective functionality.”
Mr. Weitz offered more details on the combination’s functional value. “A special type 1 hydrolyzed collagen matrix used in Nutrifin Motion Plus stimulates the biosynthesis of the extracellular matrix of chondrocytes and enhances the production of cartilage tissue,” he said. “It was found that in comparison to the use of the hydrolyzed collagen matrix alone, the cartilage protective and regenerative effects were significantly improved in the Nutrifin Motion Plus concept.”
Speaking of collagen, in September 2010, BioCell Technology, Newport Beach, CA, announced the successful completion of a clinical trial of BioCell Collagen II in subjects suffering from osteoarthritis. “This multi-center, double-blind, placebo-controlled trial demonstrated the ingredient’s safety and efficacy in reducing the disease-associated symptoms such as pain and in improving various physical activities, confirming results from a previous pilot study,” said BioCell’s Joosang Park, vice president of scientific affairs.
Further, he said, a more recent study including 80 subjects showed that a majority experienced substantial improvement of their joint conditions as measured by VAS pain and WOMAC scores. This study outcome is in the process of being published.
“Together with other independent studies on collagen-derived peptides and hyaluronic acid, these two trials raise a very interesting hypothesis that BioCell Collagen II containing both bioactive molecules may facilitate the re-growth of degraded cartilage via stimulation of the chondrocytes, the only resident cells in the cartilage, as well as stimulate the synovium cells surrounding the joint,” Mr. Park added.
Clinical substantiation is a priority for Ben Winters, director, Aroma New Zealand, Christchurch, New Zealand, who discussed the most recent research developments with his company’s joint health ingredient, GlycOmega-PLUS. “We carried out a human clinical on our GlycOmega-PLUS green-lipped mussel extract on patients with osteoarthritis of the knee. Patients experienced a significant increase in joint mobility, reduced pain and overall improvement in gut health as a result of stopping their previous drug medications for arthritis,” he said. “GlycOmega-PLUS is a new generation mussel extract that is cold processed and has significant anti-inflammatory activity over steamed opened mussel powders.”
At India-based Sami Labs Limited, a company associated with Sabinsa Corporation, East Windsor, NJ, formulators have been busy focusing on dosage, delivery and bioavailability. “Joint health products usually require large doses (generally above 1 gram). And if it is a multi-ingredient product, it becomes even more challenging for the formulator to address the product’s mode and means of delivery to derive its maximum benefits,” said Dr. Ria Biswas, senior manager, Technical Marketing.
“Nilitis or NilPain SR is a sustained release bi-layered tablet containing a proprietary composition from Sabinsa that includes Curcumin C3 Complex (95% curcuminoids), Boswellin (40% AKBA) and ginger extract (35% gingerols), which naturally supports the management of pain and discomfort without undesirable side effects,” she said. “The sustained release delivery ensures that the nutrients are released and absorbed in efficacious amounts over a period of eight hours, to support the management of inflammation and pain throughout the day.”
During the last year, Dr. Biswas added, the thrust in research activities in the joint health category at Sabinsa Corporation has been on Boswellin PS. “A considerable amount of research muscle was spent on developing this product to elicit its underlying mechanisms of action by which it shows its healthful effects. Boswellin PS—PS for PolySal—contains the active boswellic acids along with Polysal, a polysaccharide with proven anti-inflammatory activity.”
Sabinsa’s answer to the GAIT controversy was its registered and patent pending ingredient Boswellin PS, which was developed in early 2009 and marketed in 2010. Sabinsa was able to replace glucosamine in existing formulations and offer Boswellin PS, which has shown advantages in three areas, over conventional Boswellia serrata extracts that are standardized for one or more boswellic acids alone: enhanced water solubility; unique two-stage release profile for actives that support immediate and sustained action; and enhanced activity against pro-inflammatory cytokines, which translates to added benefits in supporting joint health and mobility.
As a producer of established joint health ingredients like chondroitin and glucosamine, TSI is focusing on value in today’s market. “Since we are a fully integrated manufacturer, our customers are benefiting from our value services, which allow us to incorporate these ingredients into a drum-to-hopper blend or granulation that is either encapsulated or pressed into tablets,” said Mr. Kolb. “This appears to add significant value for companies that want to achieve manufacturing efficiencies through easy-to-use granulations, with a closed-down supply chain in which the ingredients are tested and quality-verified.
Educational Opportunities
Dr. Badmaev of PL Thomas said one of the most important issues in today’s joint health market is educating end users and product formulators that only a total approach to skeletal health will effectively address joint mobility and flexibility. “The total approach starts with proper care and age-appropriate prevention of deteriorating of bone health,” he explained. “Sometimes an obvious sign(s) of deteriorating bone health can be missed if we do not recognize it.”
He went on to discuss the interesting correlation between oral bone and tooth loss and bone loss at non-oral sites in the body. In one study, Dr. Badmaev recalled, tooth loss was examined in 145 healthy subjects aged 65 years and older who completed a three-year, randomized, placebo-controlled trial of the effect of calcium and vitamin D supplementation on bone loss from the hips.
“During the two-year follow-up period, 40% of subjects with a total calcium intake of at least 1000 mg per day lost one or more teeth compared with 59% who consumed less calcium,” Dr. Badmaev stated. “These findings suggest that dental health is indicative of skeletal health and that intake levels of calcium and vitamin D aimed at preventing osteoporosis also have a beneficial effect on tooth retention.”
Switching gears, TSI’s Mr. Kolb offered some words of caution regarding adulteration. “Economic adulteration of chondroitin continues throughout the ingredient supply chain. Fillers and adulterants that fly under the most sophisticated radar remain common and undetected,” he said. “There have been strides with new analytical tests, however, there remains a lack of industry-wide validation methods and the industry continues to suffer—with low cost, inferior quality ingredients winning the price battles.”
Eric Brown, sales director, Bergstrom Nutrition, offered a similar point of view. “An issue in our industry is the influx of low-cost and inferior product. There are big differences in the source material and processes used between MSM manufacturers and we need to continue to educate and demonstrate those differences to brand manufacturers,” he said. “Our own OptiMSM offers ease of formulation, stability and other production benefits that others can’t match, and there’s still a lot of communication to do around the dangers of contaminants in cheap, commodity products."
Leaving GAIT in the Past
While the results from GAIT in general were disappointing, especially given the size, duration and wide publication of the study, most experts believe the players in the joint health market have moved on.
“The GAIT results did nothing to help the joint health market. If the results had been positive, the market could have publicized the results to take the market to an even higher level for several more years. This did not happen. And the fact that the findings were not positive resulted in the overall maturation of the category,” said Indena’s Mr. Artaria. “Now manufacturers are looking for new ingredients to revitalize their joint health product lines.”
In other cases, the GAIT results may have helped companies. “The results of GAIT have had little, if any, impact on MSM sales. If anything, it may have helped. The work published in Clinical Drug Investigation in 2004 by Usha and Naidu showed that combination therapy with MSM and glucosamine demonstrated higher efficacy than either of the compounds alone,” said Rod Benjamin, technical director, Bergstrom Nutrition. “Although the mechanism of the body’s sulfur cycle is still poorly understood, MSM may play a pivotal role in helping the body utilize both glucosamine and chondroitin.
“In a 2008 pharmacokinetic study, it was shown that urinary sulfate levels decreased in an inversely dose-dependent manner with MSM supplementation. Although further research is needed, that does suggest MSM may play a positive synergistic role with other compounds to support joint health.”
Mr. Dijkstra of InterHealth said regardless of the GAIT findings joint health would continue to be an important category for consumers who are looking for new ingredients that are more effective than existing products. “Joint-care ingredients backed by research should be extremely successful as consumers are increasingly concerned about efficacy and safety of the ingredients in their dietary supplements,” he said. “Even though glucosamine and chondroitin have become household names at the consumer level, they seem to lack a level of long-term efficacy consumers seek.”
Still, according to BioCell’s Mr. Park, clinical substantiation will always be an evolutionary process. “Continuous studies on existing ingredients enrolling more subjects in higher quality clinical trials have made market players, healthcare professionals and consumers better understand not only which ingredients actually provide clinically relevant benefits, but also which mechanisms may be behind the efficacy.”
Modern medicine has not quite hit the mark when it comes to finding the one-size-fits-all approach to joint health, but it seems supplements are doing a good job picking up where pharmaceuticals left off. Growth might be flat, but the market remains wide open for innovative ingredient combinations and delivery formats.
Sales are down 3% to $746 million due to negative efficacy reports and increasing competition, but liquid supplements may hold key to future growth.
By Chris Allan, Editor, Nicholas Hall’s INSIGHT North America
Dollar sales of joint health supplements—comprising mainly glucosamine/chondroitin options—continued to fall in 2010. Industry sources suggest a number of contributing factors to the decline, including price competition between brands and private label, well-publicized reports questioning the efficacy of glucosamine/chondroitin and encroachment from other joint health options, such as fish oil and topical analgesics/heat pads.
The Council for Responsible Nutrition (CRN), Washington, D.C., defended glucosamine/chondroitin supplements in September 2010 after a meta-analysis (conducted by the University of Bern and published in British Medical Journal) concluded that the ingredients, taken individually or together, provided no clinical benefit for joint pain or joint space narrowing. The industry association questioned the depth and scope of the study and referred to the “large body of scientific research that demonstrates glucosamine and chondroitin provide benefits for consumers coping with certain types of joint pain or immobility.”
Despite the overall declining trend, demographic factors—especially the aging Baby Boomer population and rising obesity levels—provide a strong growth opportunity for joint health supplements in the U.S. Education, which marketers can drive through advertising and promotional activities, will be essential to raise awareness about the importance of joint health and the natural solutions that are available.
Osteo Bi-Flex Leads the Market
Leading brand Osteo Bi-Flex (Rexall Sundown/NBTY, recently acquired by The Carlyle Group) managed to buck the overall negative sales trend, advancing nearly 4% to $117 million in sales. Line extensions and advertising investment were key factors behind the brand’s success. Joint Aid liquid, positioned as an on-the-go product ideal for consumers who don’t like swallowing pills, rolled out in late 2009. Meanwhile, the most recent version is One Per Day glucosamine + vitamin D3, which is claimed to provide full joint health support in just one caplet.
NBTY uses strong efficacy claims on packaging and in advertising to gain consumer confidence. Its position as the No.1 doctor & pharmacist recommended glucosamine/chondroitin branded supplement features heavily, while its 5-Loxin Advanced patent-pending formula is claimed to improve joint comfort within seven days. TV ads feature middle-aged people happily conducting their favorite outdoor hobbies helped by Osteo Bi-Flex. NBTY also markets Flex-A-Min under its Nature’s Bounty long-line range, although it struggled in the competitive environment and sales slipped to $21 million.
Move Free Advanced (Schiff) fell further behind Osteo Bi-Flex in sales terms, declining by around 10% to $38 million. In his summary of the company’s fiscal Q2 2011 results, Schiff president and CEO Bruce Wood noted the overall negative glucosamine/chondroitin category trend as a factor but pointed out that the brand still outperformed several rivals.
TV ads in support of Move Free Advanced claim that millions of people use the brand because “it works!”, while packaging claims it can start comforting sore joints within seven days.
Cosamin (Nutramax) recorded a relatively strong performance in the difficult environment, with sales remaining steady at around $14 million. Cosamin ASU, marketed as an advanced formula combining avocado/soybean unsaponifiable with glucosamine/chondroitin, grew strongly but may have cannibalized sales of stable mate Cosamin DS. Cosamin is positioned as a premium brand—No.1 recommended by orthopedic specialists—and Nutramax backs it with consistent advertising and promotional support. The Start Cosamin ASU campaign, which began in April 2010, gave consumers the opportunity to receive a free sample bottle through their doctor. Spokespersons for the brand include retired baseball star Jim Palmer and world champion figure skater Kimmie Meissner.
Relying on Innovation for Future Growth
Industry sources believe that innovation can help brands fight low-cost rivals, with delivery format a common theme. Liquid supplements are becoming increasingly popular, largely in response to consumer feedback expressing difficulty or a dislike of swallowing pills.
One liquid joint care brand performing well is glucosamine/chondroitin supplement Joint Juice (Joint Juice Inc.). The original supplement drink was joined on shelves by line extensions On-The-Go drink mix in summer 2010 and Easy Shot in January 2011. The brand was supported by a national ad campaign in 2010 targeting active adults looking for joint support to keep doing the things they love. The company is keen to educate consumers about the importance of joint health and uses in-store displays and informative takeaways to pass on joint health advice.
Meanwhile, Botanical Labs gave consumers a chance to win up to one year’s supply of Wellesse Joint Movement glucosamine and vitamin D3 fast-absorbing liquid formula as part of its Discover the Liquid Advantage online sweepstakes campaign, which ran between September-December 2010.
It is possible that we will see more liquid supplement launches during the coming years, which may provide some of the innovation necessary to return the glucosamine/chondroitin-led joint health category to growth.
Editor’s Note: All data in this report 12 months to November 2010 (MSP), sourced to Nicholas Hall’s INSIGHT based on industry estimates and Nicholas Hall’s DB6 2010 OTC database, in partnership with Nielsen in specific countries. DB6 is an important strategic planning tool for the OTC industry, going far beyond traditional audits to provide astute market intelligence covering all channels of retail distribution.
About the author: Chris Allan is the editor of Nicholas Hall’s INSIGHT North America. He can be reached at 44-1702-220-226; E-mail: chris.allan@nicholashall.com; Website: www.nicholashall.com
