It’s no industry secret that the bone and joint health category was once solely aimed at the retirement crowd. But, like many other condition-specific categories, it has grown more inclusive to feature wider ranges of ingredients and formulation possibilities.

Gencor product development executive Mariko Hill observed that joint health used to predominantly be associated with older people. However, times have changed, and so-called “active lifestylers” are more inclined to support joint health in their mid-20s.

“Active adults are increasingly taking a proactive approach to health and wellness, as they start to become more aware of the impact of exercise and nutrition on their well-being,” she said. “As the demographic starts to change and the number of people aged 60+ is expected to double by 2050, generation X and baby boomers of today are more inclined to consume supplements that support joint/bone health for their later years. From what once used to be an age that not many people live past, we now see individuals at the age of 65 competing in ultra-endurance events. As sports nutrition goes more into the mainstream, we start to see how trends have an impact on this category.” 

According to GELITA marketing coordinator Angie Rimel, as the population continues to have increased longevity and particularly an increase in the baby-boomer demographic, organizations such as the CDC and WHO are implementing programs to help meet the need for healthy aging. As a result, seniors in 2020 are better educated and more proactive with their health than at 2000, or any prior generation.

“Boomers and gen Xers typically start taking joint health products after they exhibit joint health problems,” said Francesca de Rensis, marketing director, Indena SpA. “In contrast, millennials have a better understanding of lifelong maintenance and health. They comprehend that the choices made now have an impact on their health later. Therefore, millennials start making healthier choices earlier in life. This is an important insight to recognize when formulating joint health products for this audience.” 

Stephanie Lynch, vice president of sales, marketing and technology for IDF (International Dehydrated Foods) agreed. “Joint health isn’t typically something people worry about until and unless they begin to experience joint discomfort and stiffness. However, people are beginning to focus more on overall wellness and how nutrition, exercise, and lifestyle changes can help them reach and maintain their wellness goals. Taking preventive measures for the future, consumers have increasingly begun to embrace bone broth. Bone broth has long been touted by athletes and nutrition experts, and collagen has come to be recognized as the missing protein for joint benefits and more.”

Market research from the Natural Marketing Institute that was commissioned by Lonza showed joint health is one of the top five health concerns for U.S. consumers of all ages, with 36% of respondents saying it is a concern, reported Juliana Erickson, senior marketing manager, consumer health & nutrition. “Our research also showed that 44% of individuals today are likely to purchase solutions, like supplements, to support and manage their joint health—a 32% increase over a 10-year period.”

Since 2000, views have drastically evolved about the importance of staying active and the role bone/joint health plays in affording that ability, noted Kate Quackenbush, communications director, NattoPharma USA.

She cited a 2004 Surgeon General report that noted, “The bone health status of Americans appears to be in jeopardy, and left unchecked it is only going to get worse as the population ages. Each year an estimated 1.5 million individuals suffer an osteoporotic-related fracture.”

The numbers, Quackenbush said, have not improved. According to the National Osteoporosis Foundation, approximately 2 million Medicare beneficiaries sustained 2.3 million osteoporotic fractures in 2015. “Essentially, it has become more recognized that quality of life is integrally linked to one’s ability to remain active,” she said. “And that ability to remain active is also linked to nutrient supplementation to eliminate deficiencies and provide a strong foundation for bone and joint health. That strategy has to include calcium, vitamins K2, and vitamin D3.”

The increasing prominence of K2 in bone (and heart) health, wasn’t part of the bone/joint category in 2004, when glucosamine and chondroitin and calcium were the dominant players.

According to Annie Eng, CEO and founder, HP Ingredients, the bone-joint support market has catered to the mass perception that glucosamine and chondroitin shows an effect on bone, joint, and muscle pain. This was largely due to seniors who were influenced by the 1997 book The Arthritis Cure by Jason Theodosakis, MD, who expounded upon the joint-support abilities of glucosamine and chondroitin, resulting in a surge of sales.

“It gave consumers hope for the efficacy of natural ingredients with no drug side-effects,” she said, “and opened the door for other natural ingredients to be considered, even though The National Institutes of Health Glucosamine/Chondroitin Arthritis Intervention Trial (GAIT) showed mixed results: ‘for participants in the mild pain subset, glucosamine and chondroitin sulfate together or alone did not provide statistically significant pain relief,’” she explained.

Active Lifestyler Impact
Relief of discomfort is also highly sought after by anyone engaging in a regular fitness program and/or sports. These millions of aforementioned “active lifestylers” are primed for bone and joint support products. For example, Jenn Rodriguez, marketing manager, Ashland Inc., said she is seeing a wider set of the population engaged in regular exercise, including more women and seniors aged 65 to 74, according to Statista (U.S. Census Bureau, 2010 to 2018).

“People are engaged in a variety of activities such as sports, running, weightlifting, yoga, and cycling, to remain fit,” she said. “All these activities take a toll on joints. Certain sports put a considerable amount of pressure on single or even multiple joints which, over time, can cause the cartilage to wear down and cause joint pain. Exercise, important when we were young to build strong bones, remains crucial as we get older for maintaining bone health.”

Hill observed multiple target groups that are starting to emerge in the sports nutrition landscape, such as “active moms, CrossFit cult, hardcore endurance athletes, active elders, and the casual selfie girl,” she said. “Most of these groups participate in some form of sport that impacts joint health status (e.g., a lot of demand on the joints among CrossFit athletes). People participating in sports, which include heavy loading or stress by repetitive bouts of movement, are a great target demographic for joint and bone-related supplements,” she commented.

Additionally, said Hill, seniors who exercise regularly may have stronger needs for joint and bone health supplementation due to the added stress on top of the changes that come naturally with age (e.g., loss of bone, strength, etc.).

Rimel agreed, characterizing the global wellness and fitness industry as “booming.” According to The Global Wellness Institute, the industry is now triple the size of the pharmaceutical industry. “From Barbell classes, to CrossFit to High-Intensity Interval Training, to running to cycling, intense and regular physical activity can take a toll on bone/joint health status,” she asserted.

But Rimel said there is a caveat: what is good for the bones isn’t necessarily good for the joints. For example, weight-bearing exercises are known to be excellent for maintaining bone health but also may contribute to wearing out joints.

Joints can be affected by the free radicals generated by regular intense exercise, explained Marcos Lopez, regional director of business development-USA, Monteloeder. “Physical activity causes joint cells to create free radicals (reactive oxygen species, ROS) as byproducts from making energy to promote movement. These free radicals damage cells and cause inflammation, pain, muscle soreness, joint pain, fatigue and overall discomfort, which can last for several days.”

Bone Support
Typical consumers who think about skeletal health may immediately contemplate calcium and its sidekick vitamin D3.

Not just any form of calcium will be effectively absorbed and utilized in the body, so form is key when selecting this mineral for product formulation, according to Tom Druke, marketing director of Balchem. For example, he explained, “Calcium bisglycinate chelate is one of the most bioavailable forms of calcium. Each calcium molecule is bound to two glycine molecules through Albion’s patented chelation process, transforming it into an amino acid chelate that has nearly twice the absorption rate of calcium citrate or calcium carbonate. The amino acid chelating agents promote the assimilation of the calcium into the cells, which helps facilitate the Krebs energy cycle.

Balchem’s Calci-K (a blend of calcium potassium and phosphorus) is suitable for calcium fortification of liquid foods and beverages, many of which can reduce the absorbability of added calcium. Research, said Druke, showed that Calci-K’s absorption rate is not reduced when taken with milk.

As Quackenbush explained, while calcium is very important for building strong bones,  if it is not paired with vitamin K2 menaquinone-7 (MK-7) and D3, then the calcium is not being utilized properly by the body for bone health.

Vitamin K2 has been shown through multiple studies to essentially improve functional equilibrium of both the cardiovascular and skeletal systems; this is achieved via MK-7’s interaction with calcium, which on its own can create an undesirable seesaw effect. In the case of bone health, MK-7 activates osteocalcin, which binds calcium to the bone mineral matrix, leading to stronger, denser bones.

NattoPharma’s patented MenaQ7 is the only MK-7 clinically validated for bone and cardiovascular health, according to Quackenbush, and it is offered in several varieties for a wide scope of applications. Of its 19 published trials, Quackenbush highlighted three compelling studies for bone health applications.

One trial showed that 3-year daily dose of 180 mcg MenaQ7 improved bone mineral content, bone mineral density, and bone strength (Osteoposisis International, 2013). Another showed that healthy prepubertal children taking 45 mcg MenaQ7 daily improved activation of osteocalcin, resulting in more osteocalcin working to grow bone and improving bone mineral density (British Journal of Nutrition, 2009). A third established the optimal, safe dose of MK-7 for the activation of K-dependent proteins osteocalcin (bone health) and matrix Gla protein (heart health) (British Journal of Nutrition, 2012).

Bone is primarily a mixture of mineral crystals held in an organic collagen matrix; collagen comprises approximately 95% of the bone matrix and is essential for bone health, according to Rimel. “Adults of all ages are adding collagen to their arsenal of supplements to battle effects of aging,” she observed.

GELITA’s FORTIBONE, she added, has been developed to increase bone density, promote bone health and reduce the degradation process, thereby making bones more elastic and stable and helping to reduce bone loss and bone fragility. “A 2018 study confirmed a pronounced increase in bone mineral density after GELITA’s FORTIBONE supplementation,” she said (Nutrients, 2018 and Nutrafoods, 2018).

Joint Support 
Strong healthy bones are not as obvious to someone whose joints are degraded via accelerated wear and tear. For companies looking to develop bone support products, considering a companion joint support formula could make sense. And there are numerous ingredients that can create compellingly unique joint health products that address specific components of the articular system.

For example, according to Erickson, Lonza’s UC-II undenatured type II collagen has been proposed to maintain collagen structure for significant and long-term joint health benefits, and has a unique proposed mode of action. She explained that it is believed to initiate immune cascades that use the body’s natural repair mechanisms in the joints; it may play a role in supporting the rebuilding of cartilage. When taken orally, it is hypothesized that undenatured type II collagen reaches specialized lymphoid follicles called Peyer’s Patches found in portions of the small intestine that form a part of the gut-associated lymphoid tissue. It has been proposed that, once the UC-II undenatured collagen contacts the Peyer’s Patches, it commences interaction with the immune system. The interaction leads to the stimulation of the regulatory T-cell, which produces several cytokines that are transported to the knee joint where they induce the chondrocytes to produce more type II collagen and other constituents comprising the knee joint’s structural matrix.

Also rich in type II collagen is IDF’s chicken bone broth ingredients, said Lynch. IDF offers chicken bone broth ingredients in multiple formats (concentrated, liquid, and dry) and flavor profiles for use in savory beverages, functional foods, and supplements, and more. “Our chicken bone broth ingredients are soy-, dairy-, and gluten-free; Certified Paleo by the Paleo Foundation; keto-friendly; and all-natural, as well as low in sodium and fat, and contain valuable protein,” she described.

Similarly, said Rimel, GELITA’s FORTIGEL stimulates the cartilage cells to increase the production of both collagen and proteoglycans, the two major components comprising nearly 90% of cartilage dry mass. And, according to published research, when ingested orally, FORTIGEL is absorbed in the intestines and accumulates in cartilage (Osteoarthritis Cartilage, 2007). “By addressing the actual causes, FORTIGEL considerably improves joint mobility, and produces a lasting quality of life,” she claimed. “The effectiveness of FORTIGEL in joint cartilage recovery has been scientifically proven by GELITA in several studies,” (Osteoarthritis Cartilage, 2011; Current Medical Research and Opinion, 2008; Applied Physiology, Nutrition, and Metabolism, 2016).

Xsto Solutions offers Cuvitus, a botanical extract from a special cultivar of Cucumis sativus, commonly known as cucumber, according to Andrew Downey, marketing manager. “Cuvitus’ applications as a dietary supplement are patent-protected and clinically supported,” he said. “Cuvitus can be formulated in either a water-soluble or capsule delivery system and marketed for temporary relief of muscle pain/soreness, joint support, and increase performance.”

Levagen+ is Gencor’s branded palmitoylethanolamide (PEA), an endogenous fatty acid amide produced in the body in response to pain, inflammation, and stress, Hill explained. PEA also helps stimulate the production of endocannabinoids in the body’s endocannabinoid system, which helps regulate sleep, immune-system responses, relaxation, pain, and more.

Levagen+ acts on a different mechanism of action for its anti-inflammatory actions via PPAR-a receptors. Results of one human clinical study showed Levagen+ to significantly improve symptoms across all three domains of the WOMAC (stiffness, pain, and function) in four weeks, according to Hill (Inflammopharmacology, 2019).

She added that HydroCurc is Pharmako Biotechnologies’ curcumin standardized to 95% curcuminoids and is highly bioavailable to safely address inflammatory cascades indicated in joint conditions.

“Because both ingredients have a difficult time dispersing in watery environments such as the stomach, HydroCurc and Levagen+ utilize LipiSperse delivery technology that enhances bioavailability and functionality of lipophilic compounds,” Hill explained. “LipiSperse allows formulators to use such ingredients in a wider variety of formats, such as effervescents and RTD shots, which can be appealing to consumers who have pill-fatigue. HydroCurc and Levagen+ also provide a vegan alternative to many bone/joint health ingredients, such as glucosamine, chondroitin, fish oil, and collagen.”

Indena’s biomimetic curcumin ingredient MERIVA is said to contain all three curcuminoids as found in the same “proportions expected in nature, and it is the formulation with the highest plasmatic levels of DMC [the most potent curcuminoid].”

The dose of curcuminoids per 1g of MERIVA is 200 mg, which the company said represents the clinically validated dose and which has been repeatedly proven effective in over 30 human trials.

Also shown to improve joint discomfort parameters is ParActin, from HP Ingredients. This patented extract of Andrographis paniculata, said Eng, can carry the following claims as shown via several studies: Promotes healthy NFkB activity, helps reduce pro-inflammatory cytokines and enzymes such as XOX-2, reduces C-reactive protein (CRP, helps reduce rheumatoid factor TNF-a and supports healthy joint function (Clinical Rheumatology, 2008).

A recent 84-day human clinical trial evaluated two doses of ParActin (300 and 600 mg) against placebo on WOMAC scores in 103 participants with knee osteoarthritis.

Among the study findings, Eng reported, the WOMAC pain scores showed a significant and progressive reduction in both ParActin groups starting at day 28 compared to placebo. The reduction in pain scores from baseline to day 84 within the groups was also highly statistically significant in both ParActin groups but not in the placebo group. Additionally, the stiffness score was significantly reduced in the ParActin group by day 84 compared to no improvement in the placebo group. In the quality of life scores, ParActin groups showed highly significant improvements in physical function score, bodily pain score, and social function score. In addition, markers of fatigue improved in the ParActin group (Phytotherapy Research, 2019).

“These results are encouraging for the millions of active adults of all ages who are concerned about knee joint degradation that may occur as a result of exercise and athletic activity performed for the long-term,” Eng commented.

Monteloeder’s MOVE!PLX lemon verbena extract was the subject of a pilot study looking at pain and stiffness models in humans. When combined with omega-3 fish oils, it was shown to reduce WOMAC score (53%) and Lequesne’s score (78%) after nine weeks of daily supplementation. Onset of the effects was noted at the third and fourth weeks into the study when, according to the study authors, statistically significant differences were detected compared to placebo (Journal of Alternative and Complementary Medicine, 2011).

Ashland’s Perluxan is a proprietary extract of hops cones standardized to contain a minimum 30% of alpha- and iso-alpha acids, humulone and co-humulone, said Rodriguez. “Perluxan has been shown to be a COX-2 inhibitor for up to nine hours (Journal of Clinical Nutrition, 2004) and also has a fast-acting effect on relieving joint discomfort,” she said.

Celadrin, also sold through Ashland, is an esterified fatty acid complex of acetylated fatty acid esters and other active synergistic compounds. According to Rodriguez, it offers formulation flexibility and two options for route of administration. When applied topically, Celadrin has been shown to reduce discomfort within 30 minutes (Journal of Strength and Conditioning Research, 2004 and 2005) and effectively reduce neck discomfort when combined with physical therapy (Journal of Bodywork and Movement Therapies, 2011). When taken as a supplement, Celadrin has been shown to improve knee range of motion and overall function (Journal of Rheumatology, 2002) and to provide significant improvements in functional self-efficacy as well as significant reduction in knee discomfort (Journal of Strength & Conditioning Research, 2004 and 2005).

Market research firm Mordor Intelligence, in its report “Bone and Joint Health Supplements Market, Growth, Trend and Forecast 2020-2025,” noted that the market may still thrive on use by the aging populations worldwide, but increasing strong demand will come from the millennial population who participate regularly in sports and fitness. This demographic segment, according to the report, “is anticipated to scale the demand for bone and joint supplements.”

Promoting bone and joint health earlier in adulthood can also promote future quality of life as healthy, discomfort-free mobility also staves off moodiness and weight gain. Bone and joint supplements can then be a cornerstone to healthy aging.