Role of collagen hydrolysate in bone and joint disease.
OBJECTIVE
To review the current status of collagen hydrolysate in the treatment of osteoarthritis and osteoporosis.


METHODS
Review of past and current literature relative to collagen hydrolysate metabolism, and assessment of clinical investigations of therapeutic trials in osteoarthritis and osteoporosis.


RESULTS
Hydrolyzed gelatin products have long been used in pharmaceuticals and foods; these products are generally recognized as safe food products by regulatory agencies. Pharmaceutical-grade collagen hydrolysate (PCH) is obtained by hydrolysis of pharmaceutical gelatin. Clinical studies suggest that the ingestion of 10 g PCH daily reduces pain in patients with osteoarthritis of the knee or hip; blood concentration of hydroxyproline is increased. Clinical use is associated with minimal adverse effects, mainly gastrointestinal, characterized by fullness or unpleasant taste. In a multicenter, randomized, doubleblind, placebo-controlled trial performed in clinics in the United States, United Kingdom, and Germany, results showed no statistically significant differences for the total study group (all sites) for differences of mean pain score for pain. There was, however, a significant treatment advantage of PCH over placebo in German sites. In addition, increased efficacy for PCH as compared to placebo was observed in the overall study population amongst patients with more severe symptomatology at study onset. Preferential accumulation of 14C-labeled gelatin hydrolysate in cartilage as compared with administration of 14C-labeled proline has been reported. This preferential uptake by cartilage suggests that PCH may have a salutary effect on cartilage metabolism. Given the important role for collagen in bone structure, the effect of PCH on bone metabolism in osteoporotic persons has been evaluated. Studies of the effects of calcitonin with and without a collagen hydrolysate-rich diet suggested that calcitonin plus PCH had a greater effect in inhibiting bone collagen breakdown than calcitonin alone, as characterized by a fall in levels of urinary pyridinoline cross-links. PCH appeared to have an additive effect relative to use of calcitonin alone.


CONCLUSIONS
Collagen hydrolysate is of interest as a therapeutic agent of potential utility in the treatment of osteoarthritis and osteoporosis. Its high level of safety makes it attractive as an agent for long-term use in these chronic disorders.
Moskowitz
R W
RW
Case Western Reserve University, Division of Rheumatic Diseases, University Hospitals of Cleveland, OH, USA.
D000596:Amino Acids / Q000652:urine; D000818:Animals; D003094:Collagen / Q000493:pharmacokinetics / Q000627:therapeutic use*; D004311:Double-Blind Method; D006801:Humans; D007391:International Cooperation; D007596:Joints / Q000187:drug effects / Q000503:physiopathology; D015207:Osteoarthritis, Hip / Q000188:drug therapy* / Q000378:metabolism / Q000503:physiopathology; D020370:Osteoarthritis, Knee / Q000188:drug therapy* / Q000378:metabolism / Q000503:physiopathology; D010146:Pain / Q000188:drug therapy; D010147:Pain Measurement / Q000187:drug effects; D011492:Protein Hydrolysates / Q000493:pharmacokinetics / Q000627:therapeutic use; D012720:Severity of Illness Index; D016896:Treatment Outcome
D000596:Amino Acids; D011492:Protein Hydrolysates; C015484:pyridinoline; C036020:deoxypyridinoline; D003094:Collagen