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Collagen Supplementation As a Complementary Therapy for the Prevention and Treatment of Osteoporosis and Osteoarthritis

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Collagen Supplementation As a Complementary Therapy for the Prevention and Treatment of Osteoporosis and Osteoarthritis http://dx.doi.org/10.1590/1809-9823.2016.14145 153 Collagen supplementation as a complementary therapy for the prevention and treatment of osteoporosis and osteoarthritis: a TICLE R systematic review A EVIEW R Elisângela Porfírio1 Gustavo Bernardes Fanaro1 Abstract Introduction: Collagen hydrolysate is recognized as a safe nutraceutical, whose combination of amino acids stimulates the synthesis of collagen in the extracellular matrix of cartilage and other tissues. Objective: to conduct a systematic review of literature on the action of collagen hydrolysate in bone and cartilaginous tissue and its therapeutic use against osteoporosis and osteoarthritis. Method: a study of the PubMed, MEDLINE, LILACS, and SciELO databases was performed. Articles published in English and Portuguese Key word: Collagen; in the period of 1994 to 2014 were considered. Results: the sample comprised nine Osteoarthritis; Osteoporosis; experimental articles with in vivo (animals and humans) and in vitro (human cells) models, Elderly. which found that the use of different doses of collagen hydrolysate were associated with the maintenance of bone composition and strength, and the proliferation and cell growth of cartilage. Conclusion: hydrolyzed collagen has a positive therapeutic effect on osteoporosis and osteoarthritis with a potential increase in bone mineral density, a protective effect on articular cartilage, and especially in the symptomatic relief of pain. 1 Universidade Estácio de Sá, Programa de Pós-graduação em Nutrição Clínica: metabolismo, prática e terapia nutricional. São José dos Campos, SP, Brasil. Correspondence Elisângela Porfírio E-mail: [email protected] 154 REV. BRAS. GERIATR. GERONTOL., RIO DE JANEIRO, 2016; 19(1):153-164 INTRODUCTION with minimal adverse effects, whose amino acid composition provides elevated levels of glycine The human body goes through several stages: and proline, which accumulate when properly childhood, puberty, maturity or stabilization and digested, preferentially in cartilage.4 then aging. Aging occurs through several changes, and begins as early as the second decade of life. At Both aging and a poor diet can affect the level first, these changes are barely noticeable, but by the of collagen in the body. These changes are not end of the third decade many important functional noticeable in the early stages of life, but become and/or structural changes have taken place1. evident in the mature phase, in which food intake does not meet the recommended requirements Evidence indicates that many chronic diseases as effectively, in terms of energy and macro and result from the interaction of various factors, micronutrients.6 Also at this stage the chances including genetic, environmental and lifestyle. of developing bone and joint disorders are Those that are classified as modifiable include: higher. Balanced nutrition is essential not only smoking, alcohol intake, eating habits, a sedentary for preventing chronic diseases, but also for lifestyle, stress, while those classified as not maintaining a healthy body and ensuring its proper modifiable are heredity, gender and age.2 functioning.7 Osteoporosis (OP) constitutes a disease of the Thus, the aim of this study was to perform a skeleton of multifactorial cause that is characterized systematic review of literature on the action of by reduced bone mass and deterioration of the collagen hydrolysate in bone and cartilage tissue, anatomical and structural integrity of the bones, and its therapeutic effects on osteoporosis and leading to increased bone fragility and susceptibility osteoarthritis. to fracture. The group most affected by OP are older women whose decreased estrogen production after menopause accelerates bone loss.3 METHOD Among joint diseases, osteoarthritis (OA) A systematic review of literature was carried is the most prevalent and evolves slowly over out, focusing on scientific articles that studied decades, manifesting itself in episodes of pain the action of collagen hydrolysate on cartilage and culminating in the loss of joint function. and bone, as well as their possible therapeutic Inconclusive studies indicate that bone changes support in cases of osteoarthritis and osteoporosis. can initiate or influence the degradation of The PubMed, MEDLINE, LILACS and SciELO cartilage. Despite many efforts, there is so far no databases were consulted, and the descriptors used cure for OA, and the treatments available, both for research were collagen hydrolysate, combined with pharmacological and non-pharmacological, only osteoporosis, osteoarthritis, bone, cartilage, aging, ingestion act in reducing the symptoms, especially pain, and supplement. The search period was from January inflammation and immobility.4,5 1994 to May 2014. The review was conducted from January to May 2014. Nutraceuticals are substances which can act as adjuvants in the prevention and treatment of The inclusion criteria were: experimental chronic diseases, in particular OA. The term articles, in English and Portuguese, published nutraceutical comes from the combination of between January 1994 and May 2014, with the the words "nutrition" and "pharmaceutical". It object of study the action of collagen hydrolysate in corresponds to foods or products that not only bone and cartilage tissue as well as its therapeutic provide health benefits, but are also, by definition effects in osteoporosis and osteoarthritis. Excluded and regulation, devoid of adverse effects. Collagen from the search were meta-analyses, notes, case hydrolysate (CH) is recognized as a safe food reports, theses; articles involving other causes of Collagen supplementation on osteoporosis and osteoarthritis 155 bone and/or joint disease; articles that combined selection of work that would likely be of interest, drugs with oral supplementation of collagen; and 62 articles were excluded, leaving 68 studies, 47 duplicated items indexed in more than one of the in PubMed and 21 in MEDLINE, LILACS and selected databases. SciELO. Articles that met the eligibility criteria were retrieved so the full text could be read, with The process for inclusion of articles in the study a view to further evaluation. At this stage 59 involved the reading the titles and abstracts by two publications were excluded that did not meet the independent reviewers, who applied the inclusion purpose of this research. and exclusion criteria. In case of disagreement, the study was selected for evaluation of the full text. Nine experimental articles were identified as the basis for discussion in this review. The nine included: five research articles with human RESULTS models, three with animal models, and one that evaluated, respectively, in vitro models (human The initial search, based on a combination of cells) and animal models. terms, identified 187 articles. After verification of the existence of duplicity, 57 were excluded. Table 1 presents the experimental data of the Considering the titles and abstracts based on a wide articles included in this systematic review. Table 1. Distribution of articles according to author, sample, method, results and conclusion. May, 2014. Author Sample Method Results Conclusion Whey protein group: Whey protein (0.85 Lower weight; Humans: g/kg/weight/day) higher excretion of nine elderly Maintaining 15 days nitrogen Hays et al.24 women of weight and CH (0,81 g/kg/ CH group: (between 65-85 muscle mass weight/day) Maintaining of weight; years of age) 15 days Lower excretion of nitrogen Higher growth and CH 10 or 25 g/kg/ differentiation of weight/day Guillerminet et In vivo osteoblasts; Osteoprotective 4-12 weeks al.26 Mice higher growth and action Bone mineral differentiation of density osteoclasts Supported weight four- CH 50 mg; 100 mg, Greater times heavier; control (gelatin) conservation of Higher percentage of bone Jackix et al.27 Rats, six groups Sample of femur the composition protein; and vertebral and bone Higher bone column. strength mineralization 156 REV. BRAS. GERIATR. GERONTOL., RIO DE JANEIRO, 2016; 19(1):153-164 Author Sample Method Results Conclusion Increased osteoblast In vitro Gene COL1A1 differentiation by gene Human cells expression Osteoprotective Kim et al.28 CH 150; 500 mg/ action In vivo kg/weight/day Increase of bone mineral Rats 12 weeks density Vertebrae, lumbars CH 10 g placebo (xanthan Significant improvement Reduction of Humans: gum) Clark et al.34 in pain pain, protection 147 athletes Inflammation, (knee arthralgia) of cartilage mobility and joint pain Proliferation CH 8 g Increase of AA, di- and and cell growth, Humans: Blood samples 0,5; Sugihara et al.37 tripeptides in peripheral as well as five individuals 1; 2; 4 hours blood protection of Pro-Hyp; Hyp-Gly cartilage CH 12,5; 25; 50 mg Three consecutive Higher concentration Potential days of glycine in plasma; reduction in Hartog et al.38 Rats Induced swelling reduction; pain (hip and inflammation in proinflammatory knee) the ear cytokines Blood sample Different doses of CH/kg/weight Increase of (30,8; 153,8; 384,6 Dose-dependent increase Humans: Hp in plasma mg/kg/weight of 6.43; 20.17; 32.84 Healthy and potential Shigemura et al.39 Blood sample nmol/mL in the plasma volunteers of increase in before, 15, 30, concentration of Hyp, n= 4 amino acid 60, 120, 240, 360 respectively. absorption minutes after ingestion Humans: 6 month treatment, CH 12 g Efficacy and 200 patients improvement in symptoms Bruyère et al.40 Placebo (gel safety of older than 50 according to EVA-D scale; capsules) supplementation years of age tolerability
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