Is undenatured type 2 collagen effective in treating knee osteoarthritis?

Is undenatured type 2 collagen effective in treating knee osteoarthritis?

Physical activity is an essential part of leading an active and healthy lifestyle that keeps chronic diseases, such as obesity, diabetes, cardiovascular diseases, osteoporosis, falls and fractures, depression and osteoarthritis at bay. Hence, immobility due to any reason is considered as a serious public health burden1,2.

The 2017 Global Burden of Disease (GBD) study estimates global prevalence of knee osteoarthritis to be 263 million, which accounts for 86.8% of osteoarthritis cases. The years lived with disability (YLD) due to knee osteoarthritis for the period 1990-2007 and 2007-2017 is about 63.7% and 30.8%, respectively3.

Osteoarthritis (OA) is a chronic joint disorder that is characterized by progressive breakdown of the articular cartilage and abnormal remodeling of joint tissues4. This leads to pain that aggravates with increased joint loading and physical activity along with morning stiffness, thus reducing the overall quality of life of the patient, especially in those who are aged 60 years and above. Although, various treatments exist including joint protection, exercise, heat/cold therapy, weight loss, physiotherapy and medications (such as paracetamol and NSAIDs), these therapies do not reverse the condition and might have additional side effects5.

The search for a healthy and functional food led to glucosamine (G) and chondroitin (C) supplements. However, they were found to have only mild to moderate effect on human osteoarthritis6.  Since fetal and adult articular cartilage matrix is made up of around 75% and 90% of type 2 collagen, respectively; undenatured type 2 collagen derived from chicken sternum cartilage is being extensively studied7.

Recently, Lugo and colleagues8 studied the efficacy and safety of undenatured type 2 collagen (UC-II) versus placebo and glucosamine and chondroitin (GC) in moderate to severe knee osteoarthritis subjects. The study was a randomized, double blind trial that involved 191 OA volunteers for 180 days. Individuals supplemented with UC-II (40 mg) demonstrated statistically significant improvement with regard to pain, stiffness and physical function as measured by WOMAC (Western Ontario McMaster Universities Osteoarthritis Index). Furthermore, the mean VAS (Visual Analog Scale) score determined by 7 pain-related questions and LFI (Lequesne Functional Index) score determined by assessing pain, walking distance and activities of daily living, also showed statistically significant improvement in UC-II supplemented volunteers against both placebo and GC (1500 mg G and 1200 mg C) supplemented groups.

There was no significant improvement noted when comparing the placebo and GC supplemented groups. No significant difference was noted on knee flexion in any groups. The need for rescue medication was also low in UC-II supplemented volunteers versus GC or placebo groups. No adverse effects were noted with UC-II supplementation, while 62% of adverse effects were seen in GC supplemented group.

The results of the study by Lugo et al.8 are comparable to a previous study done by Crowley et al.5 in OA volunteers, which showed reduction in WOMAC score by 33%, VAS score by 40% and LFI score by 20% in UC-II group against 14%, 15.4% and 6%, respectively in GC group after a 90-day supplementation period.

UC-II is not only found efficacious and safe in OA patients, but also in healthy individuals. A previous study done on healthy individuals showed statistically significant improvements in knee extension after 120 days of UC-II (40 mg) supplementation along with reduced knee joint pain and longer pain free exhaustion period after strenuous activities9.

These studies not only indicate the effectiveness of UC-II in reducing pain and stiffness that will increase the quality of life of people with knee OA, UC-II also benefits healthy and active individuals without any side effects.


  1. Ashe MC, Miller WC, Eng JJ, Noreau L; Physical Activity and Chronic Conditions Research Team. Older adults, chronic disease and leisure-time physical activity. Gerontology. 2009;55(1):64–72.
  2. Satariano WA, Guralnik JM, Jackson RJ, Marottoli RA, Phelan EA, Prohaska TR. Mobility and aging: new directions for public health action. American Journal of Public Health. 2012;102(8):1508–1515.
  3. James S, Abate D, Abate K, Abay S, Abbafati C, Abbasi N et al. Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. The Lancet. 2018;392(10159):1789-1858.
  4. Loeser RF, Goldring SR, Scanzello CR, Goldring MB. Osteoarthritis: a disease of the joint as an organ. Arthritis and amp; Rheumatism. 2012;64(6):1697–1707.
  5. Crowley DC, Lau FC, Sharma P, Evans M, Guthrie N, Bagchi M, Bagchi D, Dey DK, Raychaudhuri SP. Safety and efficacy of undenatured type II collagen in the treatment of osteoarthritis of the knee: a clinical trial. International journal of medical sciences. 2009;6(6):312–321.
  6. Bruyere O, Reginster JY. Glucosamine and chondroitin sulfate as therapeutic agents for knee and hip osteoarthritis. Drugs Aging. 2007; 24(7):573-80.
  7. Prabhoo R, Billa G. Undenatured collagen type II for the treatment of osteoarthritis: a review. International Journal of Research in Orthopedics. 2018;4(5):684-689.
  8. Lugo JP, Saiyed ZM, Lane NE. Efficacy and tolerability of an undenatured type II collagen supplement in modulating knee osteoarthritis symptoms: a multicenter randomized, double-blind, placebo-controlled study. Nutrition Journal. 2016;15:14.
  9. Lugo JP, Saiyed ZM, Lau FC, Molina JP, Pakdaman MN, Shamie AN, Udani JK. Undenatured type II collagen (UC-II®) for joint support: a randomized, double-blind, placebo-controlled study in healthy volunteers. Journal of the International Society of Sports Nutrition. 2013;10(1):48.