Joint health category remains slugging despite consumer need
This article first appeared in the Nutrition Business Journal Changing Need States Issue.
Amid the COVID-19 pandemic and its aftermath, nearly every condition area tracked by NBJ saw sales spikes or drops. Many experienced both. Not joint health. This sleepy sector, which accounts for about 3.3% of the U.S. dietary supplement market, kept slugging along—not really up, not alarmingly down, just flat.
Registering $2.25 billion in sales in 2024, per NBJ estimates, the joint health category grew a yawn-inducing 1.1% over the prior year. NBJ expects growth to pick up only slightly, topping out at 2.4% in 2027, to make the joint health market worth $2.39 billion. Sure, any growth is good, but these predictions are less than thrilling, especially when the broader supplement industry’s growth is projected to stay north of 5% through 2027.
To many, joint health’s stagnancy is a bit puzzling. After all, the massive baby boomer generation, still some 72 million strong, is now 61 to 79 years old—prime time for joint problems, courtesy of osteoarthritis, excess body weight and accumulated damage from decades of wear and tear. Gen X is also getting up there, with the oldest members hitting 60 and the youngest turning 45 this year.
On top of the population aging, research shows consumers are more active today than ever before. “Active nutrition has been way up, from both a product and a demographic standpoint,” says Scott Dicker, senior director of market insights at SPINS. With more and more people hitting the gym, more and more are experiencing joint discomfort, Dicker reasons—or they will be very soon.
“Even baby boomers are getting more into active lifestyles—playing pickleball, getting overuse injuries, having falls,” says Adam Kreitenberg, rheumatologist and physician formulator for 1MD Nutrition. “So you’d think there would be better trends in the joint health supplement space.”
One possible contributor to the ho-hum sales: surgical techniques and replacement joints have improved dramatically, and procedure volumes are way up. Nearly 800,000 total knee replacements and 544,000 hip replacements are performed every year in the U.S., according to the American College of Rheumatology, and those numbers are rising fast.
“Right there, that’s part of the answer,” says Corey Hilmas, chief regulatory officer at contract research organization KGK Science. By replacing a bum knee or hip, “these people effectively take themselves out of the market. Now they don’t need something to help their joint discomfort.”
Kreitenberg doesn’t buy that theory. “If you ask most anybody, the last thing they’d want to do is replace a knee instead of taking supplements,” he says, “but sometimes a mechanical issue is so bad that there’s only one way to fix it.” Even then, though, most people who opt for a new knee or hip probably have trouble in other joints.
“It’s just that nothing else has reached the threshold where they are symptomatic,” Kreitenberg says. “These are still people who would benefit from a multipronged joint wellness approach, which involves physical therapy, an anti-inflammatory diet and supplements, which would hopefully help protect the joints in the long run.”
Interest intact
Despite minimal sales growth, research shows consumers are, in fact, interested in joint health and open to nutraceutical support. Last year, when NBJ asked 1,030 U.S. supplement users what concerns them most about aging, loss of mobility—intrinsically tied to joint health—topped the list, selected by 28% of respondents. That’s a full 5% more than chose the next most common concerns: Alzheimer’s, dementia and vision loss.
What’s more, 28% of NBJ’s respondents reported experiencing aging-related joint symptoms currently. That number rockets to 48% among baby boomers.
But are these people buying joint supplements? They say they are. When NBJ asked which health conditions consumers use supplements to manage as they age, 23%—and 30% of women—said joint health, second only to weight management.
Similarly, CRN’s 2024 Consumer Survey found that 19% of U.S. adults who take supplements—and 25% of those aged 55 and up—cite joint health as a reason why. And in Nextin Research’s 2024 survey of supplement users, 27% said joint pain motivated them to make changes to improve their health in the last year, and 21% purchased a joint supplement.
Datapoints like these would suggest stronger growth for the category, yet sales aren’t exactly soaring. This merits a deeper exploration into why—and what industry can do (or is already doing) to reverse this market’s fortunes.
“Joint health is one of those categories where there won’t be lack of interest—I am very confident in that,” Dicker says. “If you have a bad back or bad knees, you’re going to be willing to try [a supplement], so there is opportunity. It’s just about finding the right solutions.”
Numbers don’t lie—but they obscure
To be fair, the category’s woes might appear worse on paper; the numbers may not tell the whole story.
“I compare joint health to the weight management category, where people aren’t uninterested in weight loss—they are just going at it in a more holistic way,” Dicker says. “By that I mean weight-loss supplements are down, but protein shakes, for example, are up.” Applying that logic to joint health, the category at large may lack luster, but certain ingredients within it are outkicking their coverage.
The biggest drag on the sector is glucosamine/chondroitin. This old-news combo is still the most purchased single ingredient for joint health, accounting for 23.1% of sales in 2023, per NBJ’s latest hard data—and it’s bleeding money by the year. In 2023 alone, glucosamine/chondroitin sales dropped 4.1%, shedding $21.8 million. That was almost enough to pull the whole category into the negatives, but because every other ingredient group added sales that year, joint health stayed positive—barely.
Among the ingredients on fire, traditional sports nutrition solutions repositioned for joint health surged 8.5% in 2023, NBJ reports. This trajectory is expected to continue through 2027, at which point joint-focused sports nutrition sales should be 23.7% higher than in 2023. Omega-3s are another steady gainer in joint health, with growth predicted to reach 6% this year.
And then there is collagen, kind of a supplement Swiss Army knife. Though it doesn’t crack the joint-health top six based on market size, collagen is one of the fastest-growing specialty ingredients across the entire supplements industry, NBJ reports. That popularity pumps more life into the category—and that’s counting only those collagen products positioned explicitly for joint health. Collagen, like omega-3s, multivitamins and several botanicals, is used widely, but not exclusively, for joints.
“Some popular ingredients are often thought of as joint support, but because of their versatility, they might not be coded as such by either [SPINS] or NBJ,” Dicker says. “That has me thinking that there is more interest in joint health than the obvious data suggest.”
Peter Wojewnik, managing partner at CRO Dicentra, makes a similar observation. “We feel like today’s consumer is shifting toward a more holistic anti-inflammatory approach,” he says. “So, rather than just targeting joints, consumers seem to be tackling inflammation from many different angles. Brands really need to pay attention to this and modernize how they are positioning their product.”
Category aches and pains
Categorization and semantics can’t explain away all of the category’s tepidness. Kreitenberg sees several impediments at play, including a general lack of awareness of joint health products among consumers and conventional physicians alike.
“Not only do most healthcare practitioners not know enough about dietary supplements but they often pooh-pooh them,” he says. “That does a huge disservice to our patients because there is a whole world of nutraceuticals that is insufficiently tapped.”
Another hindrance may be misguided expectations of what joint supplements can do. In today’s on-demand society, consumers want solutions immediately, Kreitenberg says, “but with joint health, that doesn’t exist. It takes work. And whether it’s diet, exercise or supplements, it takes time, and I think that is one of the biggest issues.”
Dicker agrees: “There are still a lot of people who expect to feel something on that first dose. So any product not delivering on that—and not being very clear that you shouldn’t have those expectations—risks turning people off to a category.”
For many, glucosamine/chondroitin may have done exactly that. “When they work—studies are all over the map—these ingredients take six to eight weeks for improvement,” says Todd Runestad, chief marketing officer at ingredient supplier NXT USA. “That’s the end of the second bottle! A lot of consumers give up before they see results.” But even those who stick with it still might not benefit since glucosamine and chondroitin don’t work for everyone.
“The fact that these are still the best-selling ingredients is insane,” Kreitenberg says. “Because it’s not that there isn’t any innovation in joint health, there is just a lack of education.” He says most doctors and pharmacists, if asked about joint supplements, will point to glucosamine and chondroitin, or maybe MSM. “Whether or not they’ve actually seen valuable studies supporting their use, those are just what they know.”
But glucosamine/chondroitin shouldn’t shoulder all of the blame for souring shoppers on joint health supplements. Another product has overpromised and underdelivered more recently—and on a much grander scale.
“What is the last big ingredient that came through for joint discomfort? CBD,” Hilmas says. “That was a flash in the pan because we saw a lot of marketing that was cart before the horse, ahead of any studies.”
Millions of consumers tried CBD during its boom, many looking specifically for joint support. But after not experiencing the benefits brands touted, “consumers lost confidence in CBD and just abandoned it,” Hilmas says. “And by then, the time to do a clinical trial to create clarity for CBD was over.”
Slow spending on science
Some of joint health’s meager growth may track back to the lab. Unquestionably, glucosamine and chondroitin have been studied extensively, earning their wide recognition among consumers and healthcare practitioners, says Stéphanie-Anne Girard, director of scientific affairs at CRO SGS Nutrasource.
However, those studies are now old and thus, to many, uninspiring. “At Dicentra, we feel that consumers are looking for new science, and glucosamine and chondroitin don’t really justify the cost of new research because they are commonplace,” Wojewnik says. “But without fresh clinical data or innovative positioning, even great products can stagnate.”
Maybe those two have reached the end of their research runways, but are companies actively investigating other ingredients? Some are, but not a lot.
“Research is happening in joint health, but it’s definitely not at the pace we see in more popular categories like gut, cognitive, metabolic or immune health,” Wojewnik says. “The joint health market is very crowded, which makes it hard for any one brand or product to stand out. So there is reluctance to invest in research because of that.”
When companies do pursue research, their primary objective is often “to differentiate a product from well-established commodity ingredients,” Wojewnik adds. “We’ve seen some studies that are more exploratory in nature or attempt to reposition known anti-inflammatory ingredients, like curcumin or collagen, for joint health.”
Over at KGK Science, investment into joint health research has also “lagged a bit,” Hilmas says. “But we do have people coming to us wanting to do studies in the space, and with baby boomers aging, I don’t think it’s going anywhere.” Ingredients now being studied for joint health, he says, include collagen, omega-3s and Boswellia serrata.
Girard says SGS Nutrasource is currently in discussion with sponsors for several joint health studies, “some focused on traditional ingredients applied in innovative ways or paired with novel outcomes, and others centered around next-generation, cutting-edge ingredients. There’s a healthy mix of both approaches in the pipeline.”
Industry CROs are also fielding more multi-ingredient trials for joint health. “Brands are coming to us wanting to look at how blends of ingredients may have synergistic effects that outperform single ingredients,” Wojewnik says. “However, overall, the gold-standard placebo-controlled trial specific to joint health is rare from our perspective.”
Contributing to the dearth of high-quality clinicals are both the challenges and expense of recruiting, studying and demonstrating efficacy in healthy populations, a must for structure/function claims. “I think the tendency is ‘let’s just get osteoarthritis participants in here to do the trial,’” Hilmas says. “But if you focus on a diseased population, then you risk being flagged for making suggestions, either direct or indirect, that your product is intended to treat a disease state. We see that all the time.”
It’s also complex and costly to measure joint health objectively. “Pain and mobility are subjective, and they see slow-changing outcomes,” Wojewnik says. “Traditional metrics like WOMAC [Western Ontario and McMaster Universities Osteoarthritis Index] and self-reported pain assessments are still widely used, but questionnaires have limitations.” Self-reports do bring value, Hilmas concurs, but if the goal is to tie an endpoint to a specific mechanism of action, then biomarker testing usually yields stronger evidence—and more meat for structure/function claims.
Jolting joint health
Tepid growth, tired ingredients and research roadblocks aside, there is still plenty of opportunity—even excitement—within joint health. In fact, some believe the category is on the brink of breaking big (or at least bigger).
“I’ve been waiting for joint health to have a moment for a couple of years now,” Dicker says. “Bone and joint supplements are two segments that really haven’t had a moment since the pandemic boomed everything. We saw immune health boom, then stress and sleep, then gut health, then it’s been active, active, active [nutrition] ever since.”
Dicker reiterates his theory that, as consumers step up physical activity, they’ll need more joint support. And, thanks to numerous advances in the category, they’ll likely find more solutions that move the needle than were available not too long ago.
A few novel, science-backed branded ingredients have launched in recent years, while some existing offerings have padded their portfolios of published research. Both groups are giving formulators a broader menu of high-quality, scientifically substantiated ingredients to help differentiate their joint health supplements, deliver results and earn loyal customers.
“A savvy supplement maker will want to address problems on multiple mechanisms of action,” Runestad says. “So, with joints, sure, you want to hit the inflammation that causes pain, but you also want ingredients that support the pillows and hinges of your joints.”
This was Kreitenberg’s philosophy when formulating 1MD Nutrition’s comprehensive joint supplement MoveMD. Compelling clinical research informed his ingredient choices, including PLT Health Solutions’ branded boswellia extract AprèsFlex, Valensa’s Zanthin Natural Astaxanthin and several types of collagen, including data-rich undenatured type II.
Powerful clinical evidence is helping NXT USA plant a flag with TamaFlex, its branded turmeric-tamarind blend shown to address inflammation modulation, joint discomfort and joint integrity. TamaFlex now has three published human studies involving more than 300 participants and using a range of assessments, including physical tests and biomarkers.
“In every study, just 250 mg of TamaFlex has proven effective, with results starting in only five days,” Runestad says. “This five-day threshold to positive effect is the new benchmark for joint-support ingredients. Both efficacy and fast-acting effectiveness are no doubt why two major brands launched new products in April with TamaFlex as their hero ingredient.”
Schiff Move Free, the top-selling joint health brand globally, says Runestad, unveiled Move Free Advanced Joint Support with Glucosamine and TamaFlex. In an arguably bigger coup, Johnson & Johnson spinoff Kenvue debuted Proactive Support Muscle & Joint and Muscle & Joint + Stress, branding them “From the Makers of Tylenol.” The fact that Kenvue is leveraging the reputable Tylenol name to sell a dietary supplement is significant.
“This a big deal for the ingredient and for the industry,” Dicker says. “You’ll probably see a lot of catching on just because that deal exists.”
Runestad thinks TamaFlex’s two “grand slams,” plus product launches soon to come, can buoy the whole joint health market. “There is this new era of joint health ingredients—like eggshell membrane, like PLT’s AprèsFlex, like TamaFlex—that are much more fast-acting,” he says. Such rapid results, Runestad adds, “should improve the fortunes of the joint health category.”
In the meantime, Wojewnik encourages companies to keep investing in research around new and old ingredients alike. “At Dicentra, we see a lot of low-hanging fruit in opportunities,” he says, noting that botanical anti-inflammatories such as boswellia, turmeric and ginger, along with micronutrient combinations, all have promising early data. “But they need more data from well-powered trials to gain further clinical and regulatory acceptance, so it’s just a matter of putting more dollars into it.”
Wojewnik also sees big potential in the intersection of gut and joint health. “Emerging research shows that by modulating the gut microbiome, we can manage systemic inflammation, including in our joints,” he says. “I think this opens up an entirely new frontier for innovation in joint health research.”
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