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Bone and Joint Natural Health: A Moving Market

K2VITAL®
 
Albion Minerals®
Bone and Joint Health Bone and Joint Health

The panel:

Gene Bruno, MS, MHS, RH(AHG), Vice President of Scientific & Regulatory Affairs, NutraScience Labs, Farmingdale, NY, www.nutrasciencelabs.com

Eric Ciappio, Strategic Development Manager, Nutrition Science, Balchem, Montvale, NJ, https://balchem.com

Ohad Cohen, CEO, Gadot Biochemical Industries, Haifa Bay, Israel, www.gadotbio.com

Nena Dockery, Scientific Affairs Manager, Stratum Nutrition, Carthage, MO, www.stratumnutrition.com

Isabel Elias-Castro, President, Maypro Global Nutrition Group, Purchase, NY, www.maypro.com

Annie Eng, CEO, HP Ingredients, Bradenton, FL, https://hpingredients.com

Algin Guingao, Product Development Supervisor, Lief Labs, Valencia, CA, https://lieflabs.com

Jeff Lind, National Director of B2B Sales, Novozymes OneHealth, Glenview, IL, https://novozymesonehealth.com

Kalyanam Nagabhushanam, PhD, President R&D, Sabinsa Corporation, East Windsor, NJ, https://sabinsa.com

Emily Navarro, MS, RD, Global Marketing Manager, Lonza Capsules & Health Ingredients, www.lonza.com

Angie Rimel, Marketing Communications Manager, North America, GELITA, Sioux City, IA, www.gelita.com

Jim Roza, Chief Scientific Officer, Layn Natural Ingredients, Irvine, CA, https://layncorp.com

The global bone and joint health supplements market is expected to grow at a CAGR of between 7 and 8.5 percent until the end of the decade, with some projections forecasting an international market size of as much as $17.6 billion by 2027.

That being said, the relatively low number of new product launches with bone-health claims suggests a need for innovation.

Growth in the meta-category is driven by various forces, with factors such as an aging world population and the growing popularity of science-backed “more bang for your buck” ingredients, such as vitamin D and collagen.

To take a look at the bone-and-joint health market today—and to see where it might be headed—we enlisted the aid of a panel of industry experts.

NIE: What is the current state of the market for bone health and joint health, globally and in the U.S.?

Cohen: In the U.S. and globally, the market for bone and joint health products is expected to grow steadily, driven by similar factors, such as the aging population and the increasing prevalence of conditions like osteoporosis and arthritis.

[Yet, looking at] the significant overall health impact of bone diseases and low product launches with bone health claims, food and drink brands need to respond. There is room for product innovation targeting bone and joint health in food supplements, food fortification and functional foods.

Dockery: Diet, genetics, exercise-induced stress and strain or lack of exercise, excessive body weight and aging are all significant causes of diminished bone strength and integrity as well as joint stiffness and discomfort. For this reason, the demand for bone and joint health nutraceuticals will remain strong and continue to grow. The U.S. makes up most of the bone and joint supplement users, accounting for about 35 percent of total global market by revenue share.

Navarro: The U.S. joint health market grew by an impressive 5 percent in 2021, to $2.1 billion. In fact, sports nutrition products marketed with a joint health benefit are among the strongest-growing parts of the joint health market.

Lind: The market has become more sophisticated as the body of science on bone health has grown. For example, calcium has always been the “go-to” supplement for strong bones. Eventually we learned about the importance of adding vitamin D3 for calcium absorption. Today, we know about the crucial role of vitamin K2 for proper utilization of calcium, guiding the calcium away from the heart and soft tissue, where it may cause problems, to the bones where it belongs.

NIE: Discuss the different consumer targets for bone-and-joint health ingredients and supplements.

Lind: For generations consumers have known about the need for building strong bones. Many products are enriched with calcium for this purpose. While bone loss is generally related to aging, it must be addressed in childhood and among younger adults. Building a sturdy “bone bank” early on lays the foundation for better bone health, no matter how long someone lives. Women especially need higher calcium intake starting in their teens to help offset bone loss in their post-menopausal years.

Guingao: Bone and joint health ingredients and supplement brands have typically targeted the consumer in need of repair, but now we’re seeing a greater need for these ingredients in recovery supplements.

Nagabhushanam: Dietary supplement use among younger people tends to be high, so bone health messaging accompanying sports nutrition and recovery products could well help them have stronger bones in later life.

Dockery: Middle-aged and older consumers continue to make up the largest demographic for bone and joint health products. However, that is changing as increasingly younger and more active individuals are purchasing sports nutrition supplements that include ingredients which support skeletal health.

Navarro: Over the last few years, we have seen an increase in younger, active consumers who now understand the role that joint health plays in maintaining healthy, active lifestyles. Brands have now placed renewed focus on delivering joint health support to diverse consumer groups, from Millennials to Boomers, whatever their activity level.

Bruno: Not surprisingly, the growth in the elderly population is driving the bone and joint supplement market. In addition, insufficient exercise, low vitamin D levels and inadequate calcium intake has become, in various age groups, more widely recognized and collectively are contributing factors to the surge in bone and joint health supplement popularity.

Other sources indicate bone and joint health supplements are also attracting a younger audience to meet the physical demands of their active lifestyles.

A benefit of the sports nutrition crowd utilizing supplements to help with joint health is that it is easier for a brand to discuss claims for relief of pain and inflammation when discussing a non-diseased population.

Cohen: Demand is driven by the elderly, the largest revenue share, and adults. If we dig into the adult category, we see changes in consumer behavior. Millennials are concerned about their health and purchase supplements for joint recovery and prevention. Both Millennials and Baby Boomers are stimulating the growth in this category, which comes from active nutrition and prevention. Sports nutrition and functional nutrition are no longer niches, and they offer a window of opportunity for innovation and new product development.

NIE: Is bone and joint health today more of a multi-functional category with ingredients that support very benefits, such as skin health?

Roza: Many of the compounds that provide protection against oxidation, inflammation and glycation/crosslinking that support bone and joint integrity are also beneficial for skin health. As consumers continue to connect the dots, I expect to see even more category overlap in the future.

Elias-Castro: While it is still very much a category, it is also true that other structure-function benefits are a bonus, including skin health. For example, Juvecol is both a bone-and-joint-health ingredient with randomized, placebo-controlled, double-blind human clinical research behind it. The study found that Juvecol’s salmon cartilage proteoglycans (sPG) didn’t just promote collagen growth in joints—it improved multiple indices of skin condition after just two weeks, including elasticity, moisture and appearance—reducing blotchiness, wrinkles, pore size.

Rimel: While the bone and joint category has been a mainstay in the nutritional supplement market for decades, it is experiencing heightened consumer expectations for more. Savvy and educated consumers demand multiple benefits from a single nutritional supplement. Guingao: Adding bone and joint complexes or proprietary blends into a product has diversified the sub-categories. Previously, we would see sub-categories that focus toward osteoporosis or osteoarthritis and now we can see bone and joint branching into areas of beauty from within, fruit and vegetable products, or even menopause products.

Ciappio: True. There is an overlap in the bone health category, specifically those categories associated with longevity and healthy aging. Discoveries and growing awareness of the multifunctional ingredient properties are certainly driving growth.

Bruno: At least to some extent, I think that this is true. If you’re working out or otherwise physically active, you might be using these products to help with muscle pain as well as joint discomfort. But the multi-functional nature of the category is more associated with the choice of nutraceutical being used.

For example, there are various collagen peptides which have been shown to have value for joints, skin and sports recovery. Likewise, there are turmeric/curcumin materials shown to effectively address knee pain, as well as delayed onset of muscle soreness (DOMS) associated with an exercise routine. Another example is resveratrol, which has been shown to reduce UVB-induced photoaging, while also stimulating collagen production and reducing the production of inflammatory factors.

Eng: I feel that bone and joint health are definitely so closely related, that it would gain much more traction in the consumer marketplace if they are marketed toward “mobility.” This will then expand relevance for sports and fitness.

That said, there’s still a market for each on its own. Postmenopausal women who are in relatively good shape and nutrition minded would be more apt to prioritize bone fortification/nutrition than joint support. Middle-aged healthy and fit adults who are experiencing the signs of joint degradation will prioritize joint-support products over bone health.

NIE: Talk about staple ingredients with staying power, such as calcium, magnesium, vitamin D (from fish oil), glucosamine and MSM.

Cohen: If I had to pick one staple ingredient for bone health, it would definitively be Gadot´s Cal2Mag, a unique mineral blend that combines calcium and magnesium citrate, which is produced with a unique granulation process and has an effective ratio for calcium absorption. Among the different mineral sources, citrates have an added value because they are highly absorbable. Citrates are the only form of mineral salts that support the reduction of kidney stones, and absorption is independent of the timing (before or after a meal.)

Balancing calcium with the right amount of magnesium is vital. Cal2Mag is a highly bioavailable composition of calcium and magnesium citrates. One Cal2Mag gram equals 100 mg of calcium citrate and 50 mg of magnesium citrate.

Bruno: These nutraceuticals can certainly be effective for bone and joint health, but only if they are used consistently and at a clinically relevant dose. A good way to make this happen is to formulate the product so that the serving size is two capsules or less. When the number of capsules required goes above that, consumer compliance decreases. Unfortunately, with most of these nutraceuticals it isn’t possible to get a clinically relevant dose in two capsules. Luckily we can get some of our calcium and magnesium from our diet, so a lesser dose in supplements is acceptable. Not so with glucosamine and MSM. That’s why I seldom formulate with glucosamine and chondroitin anymore, since there are a number of other options that work so well without the need for multiple capsules.

Elias-Castro: Magnesium is a great one to point out. It is critical to human health and yet increasingly difficult to obtain through food in adequate amounts. Even then, only 30 percent of conventional magnesium (magnesium oxide) is absorbed by the small intestine. We are seeing forward-thinking suppliers take these “staple” ingredients and create ways to improve their bioavailability and efficacy.

Sucrosomial Magnesium for example, is a highly bioavailable sucrosomial complex of magnesium oxide providing 32 percent elemental magnesium. Because the magnesium is surrounded by a matrix of phospholipids and sucrose esters of fatty acids, its absorption is not impacted by the presence of other nutrients, unlike conventional forms of magnesium.

A head-to-head test demonstrated that Sucrosomial Magnesium had faster absorption and 20 percent higher bioavailability than magnesium citrate, one of the most bioavailable forms of magnesium on the market.

NIE: What advances — in extraction, processing for formulating—are powering innovation in this broad category today?

Elias-Castro: Maypro is excited about the upcycled ingredients in our portfolio that are meeting the call for greater sustainability in end products. The first is Juvecol, a naturally sourced proteoglycan derived from the cartilage of wild caught salmon ideal for healthy aging formulations for both joint health and skin beauty.

We also offer AppleActiv-DAPP, which is an organic dried apple peel powder upcycled from discarded peels. It’s the only apple peel powder on the market, and a 12-week pilot human clinical study found that AppleActiv-DAPP supports joint comfort,* encourages healthy range of motion* and promotes healthy joint function.

Another unique ingredient is MBP, a component of whey consisting of several different biologically active proteins purified by cation exchange resin. Six human clinical studies (including four double-blind placebo-controlled trials) have shown that MBP increases bone mineral density in both young and elderly adults by balancing osteoblastic bone formation and osteoclastic bone resorption.

Bruno: Self-Nanoemulsifying Dietary Delivery System (SNEDDS) is a technology with a demonstrated ability to vastly improve the bioavailability of bone and joint health ingredients such as curcumin, thymoquinone, resveratrol and cannabinoids. For my money, SNEDDS is the best option for improving bioavailability and powering innovation in this category.

Roza: Some supplements that support joint health are also poorly absorbed and have low bioavailability. For example, the bioavailability of quercetin is known to be low. Because Bio+ Quercitrin from Layn Natural Ingredients has a ribose molecule attached to it, absorption is faster as it shuttles quercetin into the body more efficiently.

Navarro: Lonza’s Capsugel DUOCAP capsule-in-capsule technology, which consists of a smaller, prefilled capsule inside of a larger filled capsule, opens up a range of formulation opportunities, enabling supplement brands to create innovative multi-benefit products that support joint health along with other related health goals.

Another area of innovation is in functional foods and beverages with joint health benefits. At Lonza, we’re proud to be leading the way on this with an ongoing pipeline of research to support our UC-II undenatured type II collagen—watch this space!

Dockery: Some of the best overall innovation in the dietary supplement realm has been in developing ingredients and products that are both good for the consumer and good for the environment. For example, eggshells that would be destined for landfills are excellent sources for high-quality calcium that isn’t susceptible to heavy metal contamination.

NIE: Joint health includes ligaments, tendons, muscles and bone—what ingredients are the most comprehensive and wide-ranging in their benefits?

Nagabhushanam: Bone health is intimately connected with joint and ligament health, requiring a multitude of ingredients, with each bringing in its own benefits to enhance bone density, and healthy function plus maintenance of joints. Sabinsa’s R&D scientists recognized that a carefully designed medley of herbal products, specifically, boswellia, curcumin and ginger, along with the natural bioavailability enhancer, Bioperine, would be a good solution. This formula, Nilitis, combines all the four mentioned ingredients showing efficacy in a clinical trial.

Bruno: From my perspective, hydrolyzed collagen peptides is the best bet since collagen is required in the structure of ligaments, tendons, muscles and bone, as well as joints.

NIE: Briefly, what new bone-health/joint-health research is the most exciting?

Nagabhushanam: Sabinsa recently introduced Sabroxy, primarily targeting brain health, but it was exciting to see new research published on Oroxylin A, a main constituent in Sabroxy, on its benefits in mitigating bone loss.

Eng: One new study that I believe the industry can get behind—and work in marketing with their joint/mobility support products—is one appearing in Arthritis & Rheumatology, showing that walking for exercise can reduce new frequent knee pain among people aged 50 and older who have knee osteoarthritis. Findings from this study suggest that walking regularly as exercise may be an effective way to slow down progression of the damage incurred by OA (osteoarthritis). By promoting this activity for the active adult market, consumers will be primed to support the positive effects of walking with quality and effective supplements.

Ciappio: In the diet, sulfur can be found in amino acids, but as a dietary supplement ingredient methylsulfonylmethane (MSM) is critical as it is involved in multiple aspects of exercise recovery. It’s important to remember that our gains aren’t made in the gym, they’re made during recovery.

Regarding vitamin K2, by the end of this year we expect the first results from a new sports health study with K2VITAL vs placebo in collaboration with the University of Glasgow with endpoints on performance, muscle recovery and reduction of inflammation after strenuous exercise in 80 healthy participants over 12 weeks.

Bruno: A six-month randomized, double-blind, parallel-group clinical trial was carried out to evaluate the efficacy of a water extract of cucumber fruit (Q-Actin) against glucosamine-chondroitin (GC) to promote joint comfort in 122 patients (56 males and 66 females) aged between 40 and 75 years. The GC group received 2,700 mg of GC daily and the Q-Actin group received 20 mg daily of the cucumber extract. The results were that, in the Q-Actin group, joint comfort improved by 70.39 percent, compared to only 33.7 percent in the GC group. A subsequent study using Q-Actin in comparison to placebo showed similar beneficial results.

Navarro: UC-II is the only undenatured type II collagen that is clinically proven to improve joint flexibility 15 times better than placebo, help active consumers of all ages hit their daily step count, and decrease joint discomfort by over 30 minutes following physical activity.

NIE: What botanical or plant-derived ingredient is attracting the most interest now, and why? What about mineral-plant combinations?

Roza: Consumers are often looking for convenience, and combination products that include multiple ingredients for bone and joint health in a single supplement can be appealing, for example a supplement that combines magnesium and green tea—each providing multiple benefits. Innovation is also taking place in combining several plant-derived ingredients together to deliver broader health benefits.

Mineral-plant combinations, such as calcium and vitamin D from plant sources like algae, are becoming increasingly popular in the bone and joint health market. These combinations may offer better absorption and bioavailability than synthetic versions of these nutrients.

Cohen: Boswellia, turmeric and curcumin are herbs traditionally used to treat joint pain and inflammation. Mineral-plant combinations are also gaining popularity as they offer a synergistic effect, providing comprehensive support for bone and joint health.

Calcium, magnesium, potassium and zinc are effective minerals for bone health and have claims recognized by FDA (U.S. Food and Drug Administration) and EFSA (European Food Safety Authority). Formulators can use these ingredients in an economical way to upgrade and develop new formulas.

Elias-Castro: Published research suggests that astaxanthin can support cartilage homeostasis through modulation of nuclear factor erythroid 2–related factor 2 (Nrf2) signaling. Astaxanthin is also believed to exert anti-arthritic effects by inhibiting inflammation, oxidative stress and apoptosis in pre-clinical studies. Some studies indicate that astaxanthin can fend off cartilage degradation by activating Nrf2.

I would point to our MicroActive Astaxanthin, which offers uniformly enhanced absorption in all users, higher continued absorption over time, 3.6-times higher uptake than regular astaxanthin, and 24-hour sustained release for convenient once-a-day dosing.

Nagabhushanam: Wherever possible one should consider calcium and vitamin D along with herbal ingredients. Sabinsa’s Boswellin range of products admirably address bone and joint health together. A recently published clinical trial results firmly established Boswellin as an important ingredient for bone and joint health. The study also pointed out the synergy between the constituents present in the extract.

NIE: Collagen seems to be a category on its own, it’s so big; speak to what’s most interesting in this monster sub-category right now?

Elias-Castro: Collagen is the body’s most abundant building block and the key structural protein that ensures cohesion, elasticity and regeneration of our connective tissues, including skin, tendons, ligaments, cartilage and bone. While we offer high-quality collagen, collagen peptides and collagen tripeptides, we’re particularly excited about Juvecol and MBP—two ingredients that promote collagen growth and repair by addressing underlying physiological causes.

Navarro: While it’s a large sub-category within joint health, it’s important to note that not all collagen is created equal. In fact, there are up to 16 different types of collagen in the body. The preserved structure in undenatured type II collagen—including Lonza’s UC-II undenatured type II collagen—enables a unique mechanism of action that delivers science-backed joint health benefits in a small daily dose of just 40 mg.

NIE: What should manufacturers consider when selecting ingredients with which to formulate new bone-and-joint-health products?

Roza: According to a report by Innova Market Insights, clean label claims such as “no additives/preservatives” and “natural” were among the top five claims made on new supplement launches in the U.S. in 2020. Consumers are demanding transparency from brands and make purchase decisions based on ingredients they trust.

Dockery: The main thing for any manufacturer or formulator to consider in selecting ingredients for a bone and joint product is how well the ingredients work together in the formula. Some ingredients metabolize and are absorbed along the same pathway, which can result in interference if the ingredients are in the same formulation.

The other main factor to consider is using the correct dosage for each ingredient in a formula. Just because two ingredients both work to support bone or joint health doesn’t mean that it would be appropriate to add both in a formulation but at less than the researched dosage. Synergy between ingredients cannot be assumed. A product containing multiple joint/bone support ingredients is not better if the individual ingredients are in less than efficacious amounts.

Eng: Effective synergy. If a manufacturer is seeking to blend several researched-supported proprietary ingredients and ingredient blends, they need to ensure that the combination of ingredients do not cancel one another out, do not compete with one another but instead synergize and provide efficacy. Although an expense (investment), the multi-ingredient product should be tested on a group of participants for a significant amount of time, perhaps three to six months. This will ensure the combination works, and also provide proprietary marketing.

Guingao: There are many choices for raw materials to enable manufacturers to develop something unique for each of their clients if they have the right amount of information. For example, when formulating for pets, a key ingredient to consider would be green lipped mussel powder. I would be more inclined to use mussel powder for a pet vs. human consumers. For human consumption, I am more inclined to choose MSM.

Ciappio: Despite their well-documented importance in bone health, we know that many consumers simply don’t get enough calcium and magnesium in their diets; this is important to keep in mind.

Elias-Castro: Manufacturers should select at least one branded flagship ingredient that has serious science supporting it, ensure it has a high absorption rate and formulate with the dosage found to be most effective in human clinical studies.

Cohen: Offer science-based preventive and maintenance solutions for bone and joint health in convenient and enjoyable delivery formats, keeping the cost at a reasonable price point for the final product, also take into account the bioavailability and synergistic effects of the ingredients and that the dosage is adequate.

NIE: Briefly spotlight—in a couple of paragraphs—your top bone/joint-health ingredient.

Dockery: Stratum Nutrition’s primary joint health ingredient is NEM eggshell membrane. NEM is a proprietary partially hydrolyzed eggshell membrane ingredient that is safely and gently processed to retain all of the active components within the fibrous matrix of the membrane. NEM stands out among other joint health ingredients and among other eggshell membrane joint health ingredients in the breadth and depth of the research supporting the ingredient.

Lind: MenaquinGold Natural Vitamin K2-7 is a fermented, natural vitamin K2 in its most bioactive form, Menaquinone-7 (MK-7). With GRAS (generally recognized as safe) status for children, MenaquinGold has been studied extensively in children and has been shown to effectively build the body’s bone bank.

Plus, in a 2013 double-blind, randomized clinical trial in 244 healthy post-menopausal women, after three years, both bone mineral content and bone mineral density, as well as bone strength, were statistically significantly better for the MK-7 group compared to the placebo group.

Roza: SophorOx is a natural antioxidant extract ingredient scientifically supported by research that demonstrates its ability to inhibit oxidative stress and support a healthy inflammation response.

A recent in-vivo study headed by internationally renowned Vedic Lifesciences demonstrated that SophorOx is a significant potent antioxidant. The research showed that daily oral administration of SophorOx, at an equivalency of 500 mg per day for an average adult, significantly reduced oxidative stress and inflammation markers associated with high intensity exercise.

SophorOx was shown to inhibit pro-inflammatory compounds and reactive molecules that cause oxidative stress.

Elias-Castro: Proteoglycans are a component of connective tissues such as bone, cartilage and skin. Made from proteoglycans extracted from the cartilage of salmon, Juvecol is a NEXTY Award winning ingredient clinically documented to support joint health and skin beauty.

Navarro: The UC-II ingredient and its benefits for joint health are supported by a body of evidence that spans more than two decades and over 20 studies—including 11 human clinical studies. This extensive scientific research explores the ingredient’s effects on a wide variety of subjects, including animals, healthy individuals and individuals with osteoarthritis.

Eng: ParActin Andrographis paniculata is applicable for formulas intended for bone health, joint health, muscle health, cartilage protection and inflammation management. LJ100 Tongkat Ali (Eurycoma longifolia) has several published studies also demonstrating value in preserving bone structure.

Nagabhushanam: Sabinsa offers numerous products for bone health. ActiCissus is a standardized extract of Cissus quadrangularis. Sabinsa offers another well-known isoflavone, Ipriflavone, whose efficacy for bone health has been demonstrated in several clinical trials. Sabinsa’s C3 Complex contains 95 percent curcuminoids; these curcuminoids have been shown to exert their protective influence on bone density; the complex also improved vitamin D status in a clinical trial.

NIE: Where do you believe the bone-and-joint health market is headed over the next one to two years?

Eng: According to Mintel, poor bone health affects approximately 200 million people globally and there has been a paucity of product launches in this niche. So, that just shows the extraordinary opportunity for [re-energizing] it with fresh products. Mintel notes that “Bridging nutritional gaps through nutrient fortification while providing bone health needs in plant-based drinks can create brand differentiation.”

Guingao: In one to two years, I see the bone and joint health market heading toward finding more natural sources to add into supplements. The use of prune powder will probably be more common in bone and joint health. Turmeric and ginger are natural ingredients that are common in the inflammation world and will most likely be promoted more heavily in the bone and joint category as a natural alternative. We already see products that occasionally target this, but I anticipate that companies with trademarks on turmeric or ginger products will move forward with more studies to support bone and joint health. NIE

*These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure or prevent any disease.

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