Arthritis Osteoarthritis Treatment Before You Take Osteo Bi-Flex for Osteoarthritis What to know about the ingredients in this supplement By Carol Eustice Carol Eustice LinkedIn Twitter Carol Eustice is a writer who covers arthritis and chronic illness. She is the author of "The Everything Health Guide to Arthritis." Learn about our editorial process Updated on January 19, 2023 Medically reviewed by Anita C. Chandrasekaran, MD, MPH Medically reviewed by Anita C. Chandrasekaran, MD, MPH LinkedIn Anita Chandrasekaran, MD, MPH, is board-certified in internal medicine and rheumatology and currently works as a rheumatologist at Hartford Healthcare Medical Group in Connecticut. Learn about our Medical Expert Board Print Osteo Bi-Flex is a dietary supplement that helps maintain joint health. It's often recommended as an over-the-counter treatment for people with knee osteoarthritis and is one of the best-known supplements in this category. As with any supplement, you should speak with your healthcare provider before taking Osteo Bi-Flex. Your medical history may indicate that it's not right for you, and it may interact with other medications. It's also good to know what's inside this supplement and what scientific research says about the effectiveness of its ingredients. Because Osteo Bi-Flex is a supplement, it is not approved by the Food and Drug Administration. However, the components of the drug have been studied. ljubaphoto / Getty Images Osteo Bi-Flex Ingredients Osteo Bi-Flex offers a variety of formulations that contain multiple ingredients; each is a little different. However, the brand promotes a few compounds as the key ingredients. Among these are:"Joint Shield"GlucosamineChondroitin sulfateUC-II collagenMethylsulfonylmethane (MSM) Joint Shield Osteo Bi-Flex promotes "Joint Shield" as its main ingredient, a proprietary blend of compounds that includes 5-Loxin Advanced—Boswellia serrata extract enriched with a compound known as 3-O-acetyl-11-keto-beta-boswellic acid (AKBA). 5-Loxin is reported to be beneficial for treating osteoarthritis of the knee. In one study, it reduced pain and improved physical function in osteoarthritis patients by controlling inflammation. Though researchers say it is safe, they err on the side of caution, saying that it may improve joint health. "Joint Shield" is found in most Osteo Bi-Flex products, though they differ slightly in the secondary ingredients. Each of these also has been reported to have some positive effects on osteoarthritis symptoms to varying degrees. Glucosamine Along with chondroitin, glucosamine has long been recommended as a treatment for osteoarthritis. Its actual effectiveness is under debate and can vary from one supplement manufacturer to another. Glucosamine is a natural compound found in human cartilage that is responsible for fluid surrounding the joints. In supplements, glucosamine is either lab-generated or derived from shellfish shells. For people who have shellfish allergies, glucosamine could be problematic. It's important to read labels carefully if this is a concern for you. Chondroitin Another natural compound found in the cartilage, chondroitin, helps retain water in joints. In supplements, the most common source of chondroitin is animal cartilage. Guidelines for Glucosamine and Chondroitin Note that the American College of Rheumatology recommends against the use of glucosamine and chondroitin, given varying interpretations of the scientific evidence and lack of proven benefit. Discuss these guidelines with your healthcare provider before considering either supplement. UC-II Collagen This is undenatured type II collagen that has been known to support joint health. It is included in several Osteo Bi-Flex products. In supplements, it is most often derived from chicken sternum cartilage. UC-II collagen has shown positive results in independent studies of osteoarthritis treatment. A study tested the effects of UC-II collagen in patients with moderate-to-severe osteoarthritis of the knee and found that patients who took UC-II collagen reported a significant improvement in physical function, stiffness, and pain compared with patients who were given a placebo or a combination of glucosamine hydrochloride and chondroitin sulfate. Do Collagen Supplements Benefit Arthritis? MSM Methylsulfonylmethane (MSM) is often sold alone as a dietary supplement for different health conditions, including osteoarthritis. Some Osteo Bi-Flex products contain it and typically say "with MSM" on the package. MSM is a compound that contains sulfur, which is required by the body's connective tissues. It is thought to fight inflammation, though one study found the benefits to be minimal. It also notes that the clinical significance of MSM and osteoarthritis is unknown. Supplements that are composed of only MSM have been known to have side effects, including upset stomach and diarrhea. Also, it should not be taken with blood thinners. Discuss this with your healthcare provider as the amount of MSM found in a particular Osteo Bi-Flex product might not be right for you. Warnings and Interactions Just because a dietary supplement is sold over the counter does not necessarily mean it's safe for you. Talk to your healthcare provider before taking Osteo Bi-Flex. There may be an ingredient in one of the various formulations that may be problematic given your medical history or medications and supplements you're taking. Some potential concerns to be aware of: Allergies: Shellfish allergies are a concern with some Osteo Bi-Flex products. Also, some people have allergic reactions to glucosamine (which can be derived from shellfish) or chondroitin. Pregnant or nursing: It is recommended that people who are pregnant or nursing should consult their healthcare provider before taking any Osteo Bi-Flex products. Drug interactions: The anticoagulants Coumadin (warfarin) and Mirador (anisindione) can interact with this product. If you take any medications, check with your healthcare provider before taking Osteo Bi-Flex. Glaucoma: Glucosamine may increase eye pressure. If you have glaucoma, talk to your doctor before using Osteo Bi-Flex. Overdose: Do not take other products that contain glucosamine or chondroitin while taking Osteo Bi-Flex. Doing so can result in an overdose. Signs of glucosamine toxicity include vomiting, diarrhea, jaundice, and lack of appetite. Blood sugar: Glucosamine can alter glucose metabolism. People with diabetes, prediabetes, or hypoglycemia should monitor their blood sugar more closely while taking products containing glucosamine. Liver disease: People who have chronic liver disease should speak to their healthcare provider before taking products containing glucosamine. Research suggests glucosamine may be associated with elevated liver enzymes in people with pre-existing liver disease. A Word From Verywell Many people dealing with osteoarthritis have found some relief through the regular use of Osteo Bi-Flex. It is available in a variety of formulas, and most require just one or two caplets to be taken daily. The American College of Rheumatology notes that these products might not work for everyone and emphasizes that since these products are not checked by the FDA, they might have serious side effects. While there are studies that back up the benefits of some ingredients found in Osteo Bi-Flex, the supplements themselves have not been tested. Now that you know what's inside this supplement, you can have an informed conversation with your healthcare provider about whether they're right for you. Frequently Asked Questions What are the side effects of Osteo Bi-Flex? Potential side effects of Osteo Bi-Flex include bloating, constipation, diarrhea, gas, hair loss, nausea, puffy eyelids, and stomach pain. Rarer, but more serious side effects include irregular heartbeats, swelling in the legs, and allergic reactions. Does Osteo Bi-Flex repair joint damage? Possibly, but not likely. There's some evidence the individual ingredients of Osteo Bi-Flex may benefit joint health, improve mobility, and reduce pain. However, there's no before-and-after research involving imaging that confirms the reversal of joint damage. Does Osteo Bi-Flex affect the kidneys? Possibly. Research in animals suggests that moderate to large doses of glucosamine, one of the main ingredients in Osteo Bi-Flex, may cause kidney damage. However, it is unclear whether or not it has the same effect in humans. Does glucosamine cause weight gain? It's unclear. In animal studies, glucosamine caused weight gain in rodents fed a standard diet but not in those on a high-fat diet. Glucosamine may promote insulin resistance, which is linked to weight gain. Research in humans is needed. 15 Sources Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Majeed M, Majeed S, Narayanan NK, et al. A pilot, randomized, double-blind, placebo-controlled trial to assess the safety and efficacy of a novel Boswellia serrata extract in the management of osteoarthritis of the knee. Phytother Res. 2019;33(5):1457-1468. doi:10.1002/ptr.6338 Sengupta K, Alluri KV, Satish AR, et al. A double blind, randomized, placebo controlled study of the efficacy and safety of 5-Loxin for treatment of osteoarthritis of the knee. Arthritis Res Ther. 2008;10(4):R85. doi:10.1186/ar2461 Al-Saadi HM, Pang K-L, Ima-Nirwana S, et al. Multifaceted protective role of glucosamine against osteoarthritis: Review of its molecular mechanisms. Scientia Pharmaceutica. 2019; 87(4):34. doi:10.3390/scipharm87040034 Kolasinski SL, Neogi T, Hochberg MC, et al. 2019 american college of rheumatology/arthritis foundation guideline for the management of osteoarthritis of the hand, hip, and knee. Arthritis Rheumatol. 2020;72(2):220-233. doi:10.1002/art.41142 Lugo JP, Saiyed ZM, Lau FC, et al. Undenatured type II collagen (UC-II®) for joint support: A randomized, double-blind, placebo-controlled study in healthy volunteers. J Int Soc Sports Nutr. 2013;10(1):48. doi:10.1186/1550-2783-10-48 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. Nutr J. 2016;15:14. doi:10.1186/s12937-016-0130-8 van der Merwe M, Bloomer RJ. The influence of methylsulfonylmethane on inflammation-associated cytokine release before and following strenuous exercise. J Sports Med (Hindawi Publ Corp). 2016;2016:7498359. doi:10.1155/2016/7498359 Pedrosa M, Boyano-martínez T, García-ara C, Quirce S. Shellfish allergy: A comprehensive review. Clin Rev Allergy Immunol. 2015;49(2):203-16. doi:10.1007/s12016-014-8429-8 Arthritis Foundation. Glucosamine and chondroitin for osteoarthritis pain. Cerda C, Bruguera M, Parés A. Hepatotoxicity associated with glucosamine and chondroitin sulfate in patients with chronic liver disease. World J Gastroenterol. 2013;19(32):5381–4. doi:10.3748/wjg.v19.i32.5381 National Center for Complementary and Integrative Health. Glucosamine and chondroitin for osteoarthritis. Correia CS. Herbal remedies, supplements & acupuncture for arthritis. American College of Rheumatology. June 2018. Gueye S, Saint-Cricq M, Coulibaly M, et al. Chronic tubulointerstitial nephropathy induced by glucosamine: a case report and literature review. Clin Nephrol. 2016;86(2):106–10. doi:10.5414/cn108781 Dostrovsky NR, Towheed TE, Hudson RW, Anastassiades TP. The effect of glucosamine on glucose metabolism in humans: a systematic review of the literature. Osteoarthritis Cartilage. 2011;19(4):375–80. doi:10.1016/j.joca.2011.01.007 Hwang JS, Park JW, Nam MS, Cho H, Han IO. Glucosamine enhances body weight gain and reduces insulin response in mice fed chow diet but mitigates obesity, insulin resistance and impaired glucose tolerance in mice high-fat diet. Metabolism. 2015;64(3):368-79. doi:10.1016/j.metabol.2014.11.005 Additional Reading Debbi EM, Agar G, Fichman G, et al. Efficacy of methylsulfonylmethane supplementation on osteoarthritis of the knee: A randomized controlled study. BMC Complement Altern Med. 2011;11:50. doi:10.1186/1472-6882-11-50 Henrotin Y, Mathy M, Sanchez C, et al. Chondroitin sulfate in the treatment of osteoarthritis: From in vitro studies to clinical recommendations. Ther Adv Musculoskelet Dis. 2010;2(6):335–348. doi:10.1177/1759720X10383076 Hess A. Chondroitin sulfate and glucosamine supplements in osteoarthritis. Arthritis Foundation. Zhu X, Sang L, Wu D, et al. Effectiveness and safety of glucosamine and chondroitin for the treatment of osteoarthritis: A meta-analysis of randomized controlled trials. J Orthop Surg Res. 2018;13(1):170. doi:10.1186/s13018-018-0871-5 By Carol Eustice Carol Eustice is a writer who covers arthritis and chronic illness. 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