The role that nutrition plays in supporting the musculoskeletal system—bones, joints, muscles, and connective tissue—is becoming a lifelong focus among proactive-minded wellness consumers. Today’s market of muscle, bone, and joint health nutraceuticals has matured to offer products tailored to all walks of life, regardless of age, fitness level, or overall health status.

Pain Points

Over the past few years, immune health was the dominating health factor, but activity on the musculoskeletal front has begun ramping up again, said Eric Anderson, managing director at NXT-USA. “It’s wonderful to see innovative thinking turned in other directions again.”

Mike Hughes, head of research and insights at FMCG Gurus, said the most cited issues in this area of health typically relate to inactivity and poor posture. A large portion of consumers’ aches and pains are attributed to modern living, and people are concerned that minor issues will get worse years down the line.

“Compared to other areas of wellbeing, consumers tend to be less proactive when it comes to their bone, muscle, and joint health, despite these problems often being self-inflicted,” Hughes said. “Consumers tend to associate aches and pains as an inevitable part of modern-day life, especially as they get older.”

“As Americans, we don’t address problems until we are aware of them,” Anderson concurred. “We are heavily influenced by Western medicine and advertising; if you have a problem, take a pill.”

Overweight/obesity is an extremely common cause of joint pains, and breaking out of a sedentary pattern can cause enough physical stress to serve as a barrier to entry, said Rajat Shah, co-founder and executive director of Nutriventia.

A subset of consumers today are turning a corner with a more proactive mindset, observers noted. For example, young people are more motivated to preserve mobility and strength to enter their golden years gracefully.

Emily Navarro, global marketing manager at Lonza Capsules & Health Ingredients, noted the company’s research indicates that “improved overall health and wellness is the top motivation for maintaining long-term joint health and mobility. We’re seeing a societal shift in consumer purchase drivers in this market.”

In fact, 29% of people over 55 reported that they’ve started exercising more, Navarro said.

For now, there’s plenty of consumers in both the reactive and preventive camps, and both immediate relief and daily support products are in demand, said Maggie McNamara, marketing director at Gencor.

Muscle health complaints warrant more immediate solutions, with issues like dwindling performance at the gym, perceived weakness during routine activities, prolonged soreness and recovery, or persistent fatigue. On the other end, bone health is rooted in prevention, as bone loss rarely comes with any symptoms, and is irreversible after a certain age.

Buyers of joint health products tend to occupy a middle ground, motivated both in a proactive and reactive sense. They want solutions to discomfort, but are well aware of the prevalence of osteoarthritis (OA), the most common degenerative joint disease caused by “wear and tear.” Research reported in The Lancet estimated OA afflicts 10-18% of people over 60, noted Sébastien Bornet, vice president of global sales and marketing at Horphag Research.

Muscle complaints tend to be more minor in nature, while bone, tendon, ligament, cartilage, joint, and skin injuries account for more than 70% of time spent away from exercise regimens, said Angie Rimel, marketing communications manager, North America, at Gelita. “This indicates a real need for nutritional strategies to strengthen white connective tissue.”

Shah noted the fitness industry is looking at the bigger picture. Nearly 30% of consumers use exercise to live long and healthy lives, with over a third specifically mentioning that they strength train for longevity, according to a survey by Mindbody. Main goals are to preserve muscle tissue, bone density, and a high metabolic rate well into life, strengthening the appeal of nutraceuticals that can aid in these efforts.

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“Compared to other areas of wellbeing, consumers tend to be less proactive when it comes to their bone, muscle, and joint health, despite these problems often being self-inflicted. Consumers tend to associate aches and pains as an inevitable part of modern-day life, especially as they get older.”
—Mike Hughes, FMCG Gurus

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Growth Drivers

Bone, muscle, and joint supplement markets are competitive and crowded with many well-established ingredients.

Technologies to improve absorption and bioavailability, dispersibility, and solubility of ingredients help to make products stand out. Specialized versions of ingredients like hyaluronic acid, collagen, and palmitoylethanolamide (PEA), are particularly noteworthy in the joint health arena, said McNamara.

David Foreman, known as the Herbal Pharmacist, and partner with Gencor, concurred that novel ingredient breakthroughs are few and far between. Technologies such as Gencor’s LipiSperse delivery technology (which enables full liquid dispersion and efficacy at lower dose), can help to achieve what Foreman considers to be the biggest success factor in this market: a rapid onset of perceptible, experiential change.

Separating ingredients through specialized technologies, such as through Lonza’s DUOCAP capsule-in-capsule technology, can help to open up a new range of combinations, Navarro noted.

It’s important not to bring a product to market before establishing both objective biomarkers of improvement and measured experiential improvements, Anderson noted. Beyond inflammatory markers, users’ physical experience of reduced inflammation and increased mobility are key, he added.

Clean label is another major attribute in the musculoskeletal market. “Consumers are increasingly opting for natural and ‘free from’ ingredients and look for this to be conveyed in product information,” noted Xavier Berger, global market manager of mobility and joint health at Gnosis by Lesaffre.

Multi-ingredient products with several modes of action are sought-after, but it’s important that ingredients don’t interfere with absorption or metabolism of other constituents, said Julianne Gardner, marketing and communications coordinator at Stratum Nutrition. Ingredients like hyaluronic acid, botanical extracts, eggshell membrane, and peptides “showcase potent anti-inflammatory properties crucial for managing conditions like arthritis. Additionally, there is a focus on cartilage protection and regeneration, essential for maintaining joint function. Collagen support is also emphasized, acknowledging the pivotal role of collagen in joint structure.”

No ingredients are cure-alls for bone, joint, and muscle health, noted Anderson. “The way our industry lumps musculoskeletal health together can be misleading. While it’s certainly true that they’re literally connected, the requirements for good bone health are not the same as those for good joint or muscle health,” he said. “With different mechanisms and treatment modalities for each of these unique functions, it is important to note that while the systems may be complementary, the therapies and supplements are not the same.”

Combination formulas can help companies aspire to more impressive, substantiated health claims than what’s possible with single-ingredient products.

“Joint support ingredients have expanded beyond just glucosamine to include a much broader variety of ingredients, including collagen, curcumin, and eggshell membrane, all of which Stratum Nutrition offers,” said Gardner. “In some cases, these ingredients are combined with other active ingredients like calcium or vitamin D for products targeting overall skeletal health.”

Joint Health

According to SPINS, overall sales for the joint health supplements it tracks were down 6.1% to reach $243 million, and most top-selling ingredients were down in sales in 2023. The top-selling supplements featured glucosamine/chondroitin ($145 million, -10.2%), glucosamine ($22 million, -25.6%), turmeric ($6.1 million, -1%), vitamin D ($4.7 million, +53.6%), and collagen products ($3.9 million, +9.7%).

Innovative collagen products have been front-of-mind for joint health consumers for years. Navarro said that 60% of young adults reported in a survey that they associate collagen with overall joint health maintenance, improved joint flexibility, and increased mobility.

Each collagen type functions differently, and how collagen is hydrolyzed can further enhance its activity.

Lonza has compiled evidence for the unique joint benefits of UC-II, the company’s undenatured type II collagen, which is manufactured to maintain a triple helix structure and binding regions that trigger an immune response to aid in cartilage building.

The company most recently completed a trial on 96 healthy, active men and women between the ages of 20 and 55, who took 40 mg of UC-II daily for 24 weeks. “UC-II improved joint flexibility by 3 degrees, 15 times more effectively than placebo. This correlates to joints feeling 10 years younger,” said Navarro.^1-2

Gelita’s Fortigel, unlike other collagen ingredients, has been shown to accumulate directly in cartilage.

“It stimulates cartilage cells to increase the production of both collagen and proteoglycans—the two major components that make up almost 90% of cartilage dry mass,” Rimel said. “By treating the actual causes rather than symptoms, Fortigel considerably improves joint mobility, [including in cases of knee osteoarthritis]and produces a lasting quality of life.^3-6

For a wider net of health claims, finished product manufacturers often work with a “full spectrum” arrangement of collagen peptides.

Ancient Nutrition’s Joint + Mobility supplement, for instance, features a multi-collagen complex from bovine hide, chicken bone broth, fermented eggshell membrane, and fish sources. Notably, this supplement also contains ginger root, turmeric root, and skullcap aerial parts, all of which are organic and fermented, alongside apple cider vinegar.

Stratum has spent the past several years investing in both in vitro and human clinical trials to demonstrate how its flagship ingredient, NEM, can support joint health. The partially-hydrolyzed eggshell membrane is rich in hyaluronic acid, collagen, glycosaminoglycans, and other proteins, which are naturally in a food matrix.

“The studies range from in vitro studies that provide insight into how NEM is absorbed into circulation and how it functions systemically, to randomized controlled trial studies that reveal NEM’s benefits in humans, and how it can protect against cartilage breakdown,” said Gardner.

Another ingredient to watch in the joint health space is sulfur, usually found in the form of methylsulfonylmethane (MSM) in supplements, said Jessica Arnaly, senior marketing and business development manager at Balchem. This essential building block of joints and connective tissue plays a role in the synthesis of amino acids needed to produce glutathione, thereby making it crucial to overall joint health.

“Providing cartilage with much-needed nutrients, supplementation with OptiMSM has been shown to support joint and physical function.” MSM doesn’t interfere with the absorption or activity of other key joint health ingredients like glucosamine or collagen, making it suitable for co-formulation, she said.

In recent years, botanicals have been garnering plenty of attention for their applications in joint health. A range of botanical ingredients have become a fresh face of the category.

Nutriventia has been showcasing its delivery technology in TurmXTRA 60N against standard curcumin extracts, in studies such as a 2022 clinical trial which found that treatment resulted in significantly greater reductions in muscle ache intensity 12 hours post-exercise, compared to standard turmeric extracts, at a comparatively low dose of 250 mg.⁷

Similarly, TurmXTRA was shown to significantly improve self-reported joint pain in a 106-participant clinical trial published one year prior. Those who took the supplement had a 2.5-times greater reduction in self-reported joint complaint scores than the placebo group after 90 days. They also performed significantly better in physical tests, and had reduced inflammatory markers.⁸

The water-dispersible turmeric has consistently achieved efficacy at a once-daily dose of 250 mg, per a review published last year. “It is important for formulators to understand that most of the turmeric extract formulations used in the studies reviewed contained approximately 20-40% curcuminoids, but TurmXTRA contains 60% natural curcuminoids.”⁹

NXT-USA has been compiling evidence for TamaFlex, a pairing of curcumin with an extract of tamarind. While most formulas take weeks for results, clinical studies in 2023 and 2022 found that treatment led to significant improvements in self-reported joint issues in as little as 5 days. “[These results are] impressive on their own, but even more so when contrasted with longtime joint health headliners glucosamine and chondroitin which have lost popularity, perhaps because it’s hard for consumers to feel immediate results from these products,” Anderson said.^10-11

TamaFlex has two mechanisms of action, targeting the COX-2 and LOX pathways, which the body uses to metabolize fatty acids and regulate inflammatory responses, respectively. “TamaFlex has also been shown to reduce the production of Matrix MMP-3,” Anderson said. To date, the ingredient has been tested with positive results in three clinical studies with over 300 participants.

Certain classes of antioxidants can target reactive oxygen species within joints. Cartilage has very limited blood supply, so antioxidants that get delivered to joint tissue stand out.

One type is plant polyphenols, such as those present in Pycnogenol French maritime pine bark extract, which have been linked to significant reductions in pro-inflammatory and cartilage degradation markers, as well as subjective complaints and physical function in people with osteoarthritis, Bornet said.

“Metabolites of Pycnogenol could be detected in the fluid around the knee cartilage, which explains the observed beneficial effects,” he noted. “Pycnogenol turns to the root of the problem, inhibiting the production of the pro-inflammatory enzymes 5-LOX and COX-2.”

In addition to a 2017 study that found oral supplementation led to the presence of polyphenols in knee synovial fluid, a trial two years later also found that topical patch treatment was effective in reducing inflammation, discomfort, and oxidative stress in osteoarthritis patients.^12-13

Many trending joint health supplements today have claims focused on rapid onset of relief.

For instance, Life Extension markets its Fast Acting Joint Formula as able to achieve efficacy in a matter of days, thanks to a blend of three branded ingredients: Hyal-Joint collagen-hyaluronic acid complex; Decursinol-50, an Angelica gigas extract; and Cynatine, a solubilized keratin ingredient.

Meanwhile, supplement brand 1st Phorm claimed that its Joint Mobility supplement can improve discomfort in as little as 30 minutes. The formula contains Cissus quadrangularis, more commonly known as veld grape, which is claimed to be among the fastest-acting botanicals for joint health, along with ParActin, an Andrographis paniculata extract from HP Ingredients developed to promote a healthy inflammatory response in the joints.

Several prominent products feature long ingredient lists. GNC’s Select Joint Support Complex, for instance, features a combination of glucosamine, chondroitin, and MSM, combined with vitamins C and D, manganese, hydrolyzed gelatin, Boswellia serrata, boron, and hyaluronic acid.

The trend appears to be global. Bioiberica, for instance, announced strategic partnerships in Mexico and Spain to develop advanced joint health formulas featuring Collavant n2, an undenatured type II collagen with a distinct mechanism of action, and Mobilee, a hyaluronic acid matrix containing polysaccharides and collagen. In Mexico, these two ingredients were combined to form a finished joint health complex marketed as Hialoflex. Meanwhile, Collavant n2 is combined with eggshell membrane, hyaluronic acid, magnesium, and vitamins C, K2, and D3, in a complex marketed as Vitanatur Multicollagen in Spain.

Bone Health

According to a survey of over 600 U.S. supplement shoppers conducted by MarketPlace, 33% of supplement consumers bought a product for bone health, and 23% bought a product for joint health in the year prior. Forty-four percent bought calcium supplements in the past 12 months, including 57% of all female supplement users over 55 years old, noted Jon Copeland, research manager at MarketPlace.

SPINS valued the 2023 market for bone health supplements at $637 million, down -0.5% from the year prior. Within the calcium and bone health supplements market, products which use calcium as a standalone ingredient were the top sellers at $206 million (+5.6%), followed by calcium-magnesium combos ($65 million, +0.8%), magnesium ($16 million, +4.7%), multi-minerals ($1.9 million, +191.4%), and vitamin D ($1.7 million, -19.6%).

Supporting bone mineral density into the late stages of life entails a complex interplay of several nutrients and other lifestyle factors. 

“More than calcium, magnesium and vitamin D are needed to have strong bones. Other ingredients like resveratrol and vitamin K2 are perfect examples,” said Foreman. “Bone building naturally slows and ends in our late teens to early 20s … Osteopenia and osteoporosis don’t ‘just happen’ in our later years, but develop over the early decades of life and are only noticed when we are older.”

The more calcium one can “bank” during early life, the better the trajectory for strong bones later in life, said Berger. “Peak bone mass is reached around 30 years of age, and from there on out a steady loss of bone density and strength takes place until menopause, when this loss only accelerates.”

Modest improvements in bone mineral density are proving to have an even greater impact on health outlook than originally thought. A study published in late 2023 in the Journal of Bone and Mineral Research, for instance, found that even a modest 3% improvement in bone mineral density resulted in a 45% reduction of bone fracture risk in a population of 3,000 people over the age of 60.¹⁴

Until around the turn of the century, vitamin K2 was a key missing link in the known essential nutrients that contribute to heart and bone health. By activating a dependent protein, vitamin K2 diverts calcium away from depositing on the walls of arteries, increasing its uptake in bone tissue.

“Our 3-year study in healthy postmenopausal women showed that a 180 mcg daily dose significantly decreased circulating inactive osteocalcin,” said Berger. “Both bone mineral content and bone mineral density, as well as bone strength, were significantly better for the MenaQ7 group compared to the placebo.”¹⁵

MenaQ7 was also tested in a population of 55 healthy children, and researchers determined that treatment with a low daily dose of 45 mcg for 8 weeks significantly improved measures of bone strength and density compared to placebo, Berger noted.¹⁶

Balchem has made its vitamin K2 ingredient, K2Vital Delta, more suitable for combination with other bone health ingredients. The ingredient is “the first vitamin K2 to be micro-encapsulated in special double-coated beadlets for complete stability in most environments,” said Arnaly. This includes combinations with calcium, magnesium, and other dietary minerals, and in new application formats such as powders, liquids, and functional foods and beverages.

As the science allows, personalization for specific need states can help draw people to a specific bone health product, Gardner noted. “Targeting athletes or osteoporosis risks, embracing new scientific ingredients, and offering personalized testing or innovative delivery methods could turn heads.”

Adjacent health states, and life stages, are a big consideration for bone health products.

“The gut microbiome is emerging as a hidden hero, influencing nutrient absorption and potentially paving the way for personalized probiotics to boost bone health in children,” Gardner noted. “And thanks to gene sleuthing, we’re now identifying genetic variations that affect bone density in childhood, allowing for targeted dietary recommendations to get ahead of potential problems.”

Adolescents experience peak bone mass growth rates, and vitamin K2’s role in calcium metabolism may have a stronger impact at this time than any other. And as young adults engage in athletics, specific ingredients like vitamin D, omega-3s, and collagen peptides are top candidates being investigated for their potential to reduce injury risk among athletes, Gardner said. Precision nutrition specific to menopause is another area hot with activity, she added.

“We’re also moving beyond isolated supplements and recognizing the power of whole-food dietary patterns,” Gardner continued. “Novel bioactive compounds and plant-based extracts are being investigated for their bone-building potential, and we’re acknowledging the interconnectedness of bone health with gut health, inflammation, and overall metabolic wellbeing.” 

On the topic of hormonal support, human clinical evidence suggests a role for ADM’s soy isoflavones ingredient, Novasoy, in helping to reduce postmenopausal bone loss. Isoflavones’ mechanism of binding to estrogen receptors may mitigate certain conditions associated with drop-offs in hormone production, noted Vaughn DuBow, global director of marketing, microbiome solutions, at ADM.¹⁷

A specific blend of collagen peptides present in Gelita’s Fortibone improved bone density measures in several clinical studies, Rimel noted. In 2018, a randomized, double-blind, controlled trial linked 12 months of treatment with Fortibone to significantly greater bone mineral density in spine and femoral neck in 31 postmenopausal women with low bone density at baseline (by 4.2% and 7.7%, respectively). Meanwhile, in the placebo group, bone mineral density decreased.

A 2021 follow-up study tracked the 31 subjects from the 2018 study for an additional 3 years, with all subjects taking the supplement. A long-term increase in bone density was observed, with the strongest effect in the placebo group from 2018. Thickness in the spine increased 5.79-8.16%, and increased in the femoral neck 1.23-4.21%.^18-19

“Initial research into the mode of action of Fortibone indicates a suppressive effect on bone catabolism but, more importantly, a distinct stimulating impact on osteoblasts, the bone-building cells. This anabolic effect can increase collagen synthesis and support the development of a stable bone structure,” Rimel said.

Muscle Health and Proteins

The muscle health supplements market continues to innovate with personalized options.

“Examples would be joint health ingredients to improve flexibility and decrease pain,” said Foreman. “If an individual is in pain or discomfort due to joint issues, this will preclude them from doing the needed activity to help stimulate muscle formation. Adaptogens, especially those known to support physical stress, can have an indirect impact, and rhodiola is a perfect example. Even antioxidants such as curcumin and astaxanthin can positively decrease discomfort and increase stamina.”

While there’s been plenty of research and product development for protein in relation to strength, endurance is an untapped opportunity, said Rimel.

“Twice as many people ran marathons in 2022 compared to 2021,” she said. “Sports nutrition hasn’t quite caught up. The market is dominated by protein solutions for body shaping and muscle building, with nutritional support for endurance athletes limited to carbohydrate-based options that provide a quick energy fix.”

On that note, Gelita recently launched PeptEndure, a proprietary collagen blend which has been evaluated in two studies on women and men. In each study, following 4 months of treatment, the ingredient improved time trial performance as well as cardiometabolic parameters including aerobic metabolism. “That means PeptEndure promotes adaptive changes rather than delivering a short-term energy boost. Therefore, optimal results are achieved when it is taken consistently over several months,” Rimel noted.^20-21

Recent studies continue to confirm that Gelita’s Bodybalance collagen peptides can support strength, body mass, and fat-free mass alongside resistance training, Rimel noted. “A total of six randomized, controlled trials—performed in nearly 500 participants across a broad target consumer group of men and women of all ages and fitness levels—consistently demonstrate the benefits of Bodybalance.”

On a broad level, “a new understanding of collagen peptide activity is emerging, taking protein nutrition to the functional level, where the role of protein has become more than just providing the amino acid building blocks,” Rimel said. Specific peptides stimulate collagen-producing cells of different types of tissues, which is how Gelita formulates its ingredients.

While products for bone and joint health have been fixtures in the healthy aging consumer market, forward-thinking brands are developing muscle health products more tailored toward older crowds. Recovery has been the key word across muscle health products geared toward older adults.

Nuritas’ PeptiStrong, a fava bean ingredient standardized to specific cell-signaling peptides, has been featured in several muscle health products geared toward the healthy aging consumer base. The peptides within PeptiStrong upregulate and downregulate certain genes to improve recovery and retention of muscle strength, according to clinical and in vitro findings. The ingredient was included in a line of nutritional bars recently launched by PEP, the brand’s first longevity-positioned product.

Healthgevity also launched a product called Longevity featuring PeptiStrong, along with NuLivScience’s Senactiv, and AstraGin, which are included to strengthen muscle cell tissue to speed up recovery, and improve the bioavailability of amino acids via improvements to gut wall integrity, respectively.

Thorne’s RecoveryPro is another example of this trend. The supplement combines whey protein with tryptophan, magnesium bisglycinate, and PharmaGABA in a chocolate powder format formulated with restful post-workout sleep in mind. 

Up to this point, the gut-muscle axis has been relatively under-examined, especially in athletes, noted Vicky Davies, global marketing director of performance, active, and medical nutrition at FrieslandCampina Ingredients. The duration, frequency, and type of exercise can change the balance of bacterial composition and potentially lead to gut health complaints. FrieslandCampina has been invested in fine-tuning ingredients that can help to overcome muscle issues downstream of the gut, like nutrient absorption, protein metabolism, and overall muscle function.²²

“There’s an opportunity to develop protein solutions for athletes and sports enthusiasts which go beyond just supporting muscle health,” said Davies, for example, “enhancing sports performance by addressing potential interferences from gastrointestinal issues.”

FrieslandCampina’s Biotis Fermentis taps into the gut-muscle axis as an ingredient with co-fermented whey protein, prebiotic galacto-oligosaccharides (Biotis GOS), and probiotic cultures.

“Research by FrieslandCampina showed that after taking Biotis Fermentis daily for 3 weeks, consumers not only self-reported improved gastrointestinal health such as reduced bloating, but also improved overall physical wellbeing, including a better mood and feeling more active and energetic,” Davies said.²³

ADM has been investigating probiotics for muscle health, DuBow noted. The company’s spore-forming probiotic DE111 was recently shown to improve measures of body composition in female athletes during off-season training, suggesting the role of probiotics in muscle/metabolic health in both athletes and perhaps a wider active nutrition consumer group.²⁴

Approaching metabolism from a holistic standpoint often translates to overall body composition improvements, including the preservation/growth of lean body mass. For this reason, the muscle health market shouldn’t rule out pro- and postbiotics like BPL1 which target metabolic health factors with other ingredients like Novasoy, acerola extract, vitamin E, vitamin C, and more, DuBow said.²⁵

Gut health support is also proving to be useful in exercise recovery, DuBow said. “Our new active lifestyle blend is one such solution helping move the needle in this space. It incorporates our award-winning ES1 (Bifidobacterium longum CECT7347) alongside our BPL4 (Lactobacillus casei CECT9104) and BPL15 (Lactobacillus rhamnosus CECT8361), with clinical research showing that the blend supports certain biomarkers related to post-exercise oxidative stress.”²⁶

The use of enzymes in protein products, in addition to other digestive support ingredients, is another area ADM is investigating in the context of muscle health and sports nutrition, DuBow noted.

While vitamin K2 is well-established for its role in improving calcium uptake and other measures of bone health, emerging in vitro evidence indicates that it might also play a role in muscle function. Berger pointed to a 2022 study which found that MenaQ7 increased adenosine triphosphate (ATP) production, which is the fuel source for muscle contraction. It also lowered oxidative stress.²⁷

^References

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