Joint Health for Pets: Nutrition, Weight Management, and Joint Support Supplements

Osteoarthritis is a common issue for joint health for pets that can be derived from weight management issues, genetic predispositions, or a combination of the two. Using a multi-modal approach with early attention to nutrition, ongoing weight management, and joint supplements, a veterinary practitioner can learn to prevent and successfully manage the osteoarthritic canine patient.

Osteoarthritis in Pets

Osteoarthritis (OA) is a common problem for pets, particularly in older dogs, but there are some misconceptions about osteoarthritis in dogs. Owners often think of OA as an old dog problem, in part because OA is most often diagnosed in middle-aged and older humans. In contrast to humans, though, in dogs the majority of OA cases are caused by genetically driven developmental problems during the puppy years; this is called developmental orthopedic disease (DOD).

Developmental orthopedic disease (DOD) refers to a genetic tendency for skeletal abnormalities that affect primarily large- and giant-breed dogs as well as dog breeds with chondrodysplasia or “short-leggedness” i.e. Basset Hound, Pembroke Welsh Corgi, and Dachshunds. DOD in the young, growing dog may result in:

• Hip dysplasia
• Elbow dysplasia
• Osteochondritis dissecans (OCD) of the humeral head, femoral condyles, and ridges of the talus, cranial, and cruciate ligament (CCL) disease and injuries
• Intervertebral disc disease
• Patellar luxation (1-5)

The role of nutrition in development of musculoskeletal disease in growing dogs has been recognized for decades. Nutrient excesses of calcium from diet or supplements as well as high calorie intake are risk factors for the DOD-prone breeds. Calorie-dense pet foods and overfeeding should also be avoided. Currently practitioners should be recommending feeding at-risk puppies pet foods that are labelled with the following Association of American Feed Control Officials (AAFCO) statement:

“[Pet Food Name] is formulated to meet the nutritional levels established by the AAFCO Dog Food Nutrient Profiles for growth/all life stages including growth of large-size dogs (70 lbs or more as an adult). (1-6)

Weight Management for Osteoarthritis in Pets

Overweight/obesity not only results in excess forces on joints and articular cartilage, but adipose tissue is also metabolically active and pro-inflammatory. Mechanical “wear and tear” and inflammation in an overweight canine patient may have a negative impact on joint health for pets, causing pain and inactivity, which results in further weight gain; therefore, a vicious cycle ensues. (7-12) Practitioners need to identify the patient who is “at risk” for osteoarthritis, i.e. one who is becoming overweight. Using body weight and assigning a body condition score, a measurement of body fat, is essential for managing these patients to prevent the comorbidities associated with obesity and osteoarthritis.

Practitioners should educate clients about keeping young, at-risk dogs at an ideal body condition score to extend lifespan and delay the development of osteoarthritis. A long-term study was performed with 48 Labrador Retriever puppies genetically at risk for hip dysplasia. They were divided into two dietary groups:

1. Group 1 fed an adult maintenance dog food at 0.2700 kJ of metabolizable energy per kilogram of body weight per day
2. Group 2 fed an adult maintenance dog food at 0.2025 kJ of metabolizable energy per kilogram of body weight per day (75 percent of the amount fed to Group 1)

Restricted fed dogs (Group 2) compared to non-restricted fed dogs (Group 1) lived an average of 1.8 years longer, weighed less, had better body condition scores, and had longer delays to development of chronic disease, including osteoarthritis. Maintaining optimal or slightly lean body condition in the canine patients can be challenging, but as this study demonstrates it can decrease the development of osteoarthritis and/or delay of onset of clinical signs of osteoarthritis. (13-16)

If an osteoarthritic dog is already overweight or obese, studies support the idea that weight reduction can improve quality of life and osteoarthritis management. (17-19) In a study of 14 client-owned dogs with clinical and radiographic signs of osteoarthritis, body weight reduction of at least 6.1 percent resulted in a significant decrease in lameness, and a loss of at least 8.9 percent body weight resulted in improvement in kinetic gait analysis.₂₀

These results confirm that weight loss is an important treatment modality of obese dogs with osteoarthritis and that noticeable improvement may be seen after modest weight loss of at least 6 percent. (20) Practitioners should educate owners about the pain and debilitating effects of obesity in a dog with osteoarthritis followed by recommending a safe and effective weight loss program.

Common Supplements for Osteoarthritis in Dogs

Besides nutrition and weight management, specific joint support supplements can be used to manage joint health for pets, specifically osteoarthritis in dogs. Understanding the ingredients found in joint support supplements will enable the practitioner to utilize these to manage osteoarthritic patients.

Omega-3 fatty acids

Fish oil supplements that contain omega 3 fatty acids such as eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) have been shown to help resolve inflammation in disease states such as osteoarthritis. (21-25) Other lipid components like pro-resolving lipid mediators, bioactive peptides, and other fatty acids may also play a role in some of the beneficial effects that have been demonstrated in the literature.

Glucosamine and chondroitin sulfate

Other common ingredients found in joint support supplements include glucosamine and chondroitin sulfate, which are purported to slow or alter the progression of osteoarthritis. Glucosamine and chondroitin are precursors for glycosaminoglycans, which are a major component of joint cartilage; therefore, supplemental glucosamine and chondroitin may help to maintain or rebuild cartilage. (26-31)

Green-lipped mussel

Perhaps a less familiar ingredient used in supplements for joint support is the New Zealand green-lipped mussel (Perna canaliculus; GLM). How did the GLM become an “active ingredient” in both human and animal joint supplements? The GLM is endemic in the coastal waters of New Zealand and has been a part of the staple diet of the indigenous Maori people for hundreds of years. Interestingly, the benefits of the GLM stemmed from the observation that these coastal communities consuming GLM had a lower incidence of arthritis than their European or inland counterparts. (32-34) The GLM is not only a rich source of glycosaminoglycans, but it also has anti-inflammatory effects most likely derived from omega-3 polyunsaturated fatty acid content.

Early studies of GLM found no significant benefits of GLM, but at the time, the extracts were not well preserved. In 1986, dried mussel extracts became available that were stabilized with a preservative. These stabilized lipid extracts used in more recent studies have been shown to be more effective than a non-stabilized extract at inhibiting inflammation. Today there are over 150 publications on the benefits of GSM with many in vitro and in vivo trials using GLM extracts to evaluate its effectiveness in alleviating the symptoms of inflammation and osteoarthritis in rodents, humans, dogs, cats, and horses. (32-34)

Several studies indicate that GLM extracts are a safe, logical supplement for the veterinary patient with osteoarthritis:

In a randomized controlled clinical study of 31 dogs with arthritis, GLM powder was added to a test diet. When compared to control groups, dogs on the GLM test diet had significant improvement in subjective arthritis scores, joint swelling, and joint pain. (35) Another randomized-controlled study of 45 dogs with osteoarthritis reported dogs receiving GLM had improvement in mobility when compared with placebo.(36)  A study of 81 dogs with presumptive osteoarthritis reported improved clinical signs on day 56 of the study in dogs receiving GLM. (37) An uncontrolled study of 85 dogs fed a GLM supplemented diet for 50 days showed reduction of a composite arthritic score when compared with baseline scores on various diets dogs were consuming.(38)

Boswellia serrata

Another ingredient that has found its way into joint supplements are extracts from Boswellia serrata, a medicinal plant found in the mountainous regions of India, Northern Africa and the Middle East. B. serrata is also commonly known as guggul, Indian olibanum, loban, or kundru. Since ancient times, Boswellia has been an important traditional medicinal plant used for the treatment of various ailments. More recent in vitro and in vivo studies have demonstrated the immense therapeutic potential against several conditions especially those involving inflammation. (39-40)

Extracts of the gum resins of Boswellia contain numerous pentacyclic triterpenic acids, with acetyl-11-keto–boswellic acid (AKBA) and 11-keto-β-boswellic acid (KBA) being primarily responsible for its anti-inflammatory effects. Studies in vitro and in vivo suggest these active components in Boswellia extracts (BSE) may inhibit the 5-lipoxygenase pathways as well as microsomal prostaglandin E2 synthase to reduce inflammation in body tissues. (39-40) Studies in humans with osteoarthritis in the knee have reported some beneficial effects in mobility and pain management. (41-42) A non-placebo-controlled study demonstrated a reduction in clinical signs of naturally occurring osteoarthritis in dogs supplemented with an oral BSE formulation.(43) Another study evaluated two BSE containing supplements compared to placebo in a random, controlled clinical study of 32 client owned dogs with osteoarthritis. This study demonstrated an improvement in clinical signs.(44) These studies in osteoarthritis as well as other studies in other chronic disease states demonstrate BSE can have some efficacy,  seems safe, and well tolerated. (44-47)

Practitioners should be recommending appropriate diets for puppies at risk of developmental orthopedic disease, ensuring they grow slowly and maintain an appropriate body condition score. For joint health for pets, especially overweight dogs with osteoarthritis, even a small amount of weight loss can make an impact on quality of life. Joint support supplements with common ingredients such as EPA, DHA, glucosamine, chondroitin, and newer ingredients such as the New Zealand green lipped mussel (Perna canaliculus) and Boswellia serrata extracts may also benefit dogs with osteoarthritis.

References

1. Hazewinkel HAW. Skeletal disease In: Wills JM,Simpson KW, eds. The Waltham Book of Clinical Nutrition. Tarrytown, NY: Pergamon, 1994;395-423.
2. Hazewinkel HAW, Goedegebriure S, Poubs P, et al. Influences of chronic calcium excess on the skeletal development of growing great danes. J Am Anim Hosp Assoc 1985;21:377-391.
3. Lauten SD. Nutritional risks to large-breed dogs: from weaning to the geriatric years. Vet Clin North Am Small Anim Pract 2006;36:1345-1359, viii.
4. Smith GK, Paster ER, Powers MY, et al. Lifelong diet restriction and radiographic evidence of osteoarthritis of the hip joint in dogs. J Am Vet Med Assoc 2006;229:690-693.
5. Nap RC, Hazewinkel HA, Voorhout G, et al. Growth and skeletal development in Great Dane pups fed different levels of protein intake. J Nutr 1991;121:S107-113.
6. Alexander JE, Wood LLH. Growth studies of Labrador Retrievers fed a caloric dense diet: Time-restricted versus free choice feeding. Canine Practice 1987;14:41-47.
7. Greenberg AS, Obin MS. Obesity and the role of adipose tissue in inflammation and metabolism. Am J Clin Nutr 2006;83:461S-465S.
8. Pang SS, Le YY. Role of resistin in inflammation and inflammation-related diseases. Cell Mol Immunol 2006;3:29-34.
9. Otero M, Lago R, Gomez R, et al. Leptin: a metabolic hormone that functions like a proinflammatory adipokine. Drug News Perspect 2006;19:21-26.
10. Zoran DL. Obesity in dogs and cats: a metabolic and endocrine disorder. Vet Clin North Am Small Anim Pract 2010;40:221-239.
11. Marshall W, Bockstahler B, Hulse D, et al. A review of osteoarthritis and obesity: current understanding of the relationship and benefit of obesity treatment and prevention in the dog. Vet Comp Orthop Traumatol 2009;22:339-345.
12. Edney ATB, Smith PM. Study of obesity in dogs visiting veterinary practices in the United Kingdom. Vet Rec 1986;118:391-396.
13. Alexander JE, Wood LLH. Growth studies of Labrador Retrievers fed a caloric dense diet: Time-restricted versus free choice feeding. Canine Practice 1987;14:41-47.
14. Kealy RD, Lawler DF, Ballam JM, et al. Effects of diet restriction on life span and age-related changes in dogs. J Am Vet Med Assoc 2002;220:1315-1320.
15. Larson BT, Lawler DF, Spitznagel EL, Jr., et al. Improved glucose tolerance with lifetime diet restriction favorably affects disease and survival in dogs. J Nutr 2003;133:2887-2892.
16. Kealy RD, Lawler DF, Ballam JM, et al. Evaluation of the effect of limited food consumption on radiographic evidence of osteoarthritis in dogs. J Am Vet Med Assoc 2000;217:1678-1680.
17. Impellizeri JA, Tetrick MA, Muir P. Effect of weight reduction on clinical signs of lameness in dogs with hip osteoarthritis. J Am Vet Med Assoc 2000;216:1089-1091.
18. Burkholder WJ, Taylor L, Hulse DA. Weight loss to optimal body condition increases ground reactive force in dogs with osteoarthritis. Compen Cotin Educ Pract Vet 2000;23:74.
19. Mlacnik E, Bockstahler BA, Muller M, et al. Effects of caloric restriction and a moderate or intense physiotherapy program for treatment of lameness in overweight dogs with osteoarthritis. J Am Vet Med Assoc 2006;229:1756-1760.
20. Marshall WG, Hazewinkel HA, Mullen D. et al. The effect of weight loss on lameness in obese dogs with osteoarthritis. Vet Res Commun. 2010 Mar;34(3):241-53.
21. Serhan CN, Arita M, Hong S, et al. Resolvins, docosatrienes, and neuroprotectins, novel omega-3-derived mediators, and their endogenous aspirin-triggered epimers. Lipids 2004;39:1125-1132.
22. Hong S, Gronert K, Devchand PR, et al. Novel docosatrienes and 17S-resolvins generated from docosahexaenoic acid in murine brain, human blood, and glial cells. Autacoids in anti-inflammation. J Biol Chem 2003;278:14677-14687.
23. Xu ZZ, Zhang L, Liu T, et al. Resolvins RvE1 and RvD1 attenuate inflammatory pain via central and peripheral actions. Nat Med 2010;16:592-597, 591p following 597.
24. James M, Proudman S, Cleland L. Fish oil and rheumatoid arthritis: past, present and future. Proc Nutr Soc 2010;69:316-323.
25. Calder PC. n-3 polyunsaturated fatty acids, inflammation, and inflammatory diseases. Am J Clin Nutr 2006;83:1505S-1519S.
26. Chan PS, Caron JP, Orth MW. Effects of glucosamine and chondroitin sulfate on bovine cartilage explants under long-term culture conditions. Am J Vet Res 2007;68:709-715.
27. Lippiello L, Han MS, Henderson T. Protective effect of the chondroprotective agent Cosequin DS on bovine articular cartilage exposed in vitro to nonsteroidal antiinflammatory agents. Vet Ther 2002;3:128-135.
28. Gouze JN, Bordji K, Gulberti S, et al. Interleukin-1beta down-regulates the expression of glucuronosyltransferase I, a key enzyme priming glycosaminoglycan biosynthesis: influence of glucosamine on interleukin-1beta-mediated effects in rat chondrocytes. Arthritis Rheum 2001;44:351-360.
29. Dodge GR, Jimenez SA. Glucosamine sulfate modulates the levels of aggrecan and matrix metalloproteinase-3 synthesized by cultured human osteoarthritis articular chondrocytes. Osteoarthritis Cartilage 2003;11:424-432.
30. Phitak T, Pothacharoen P, Kongtawelert P. Comparison of glucose derivatives effects on cartilage degradation. BMC Musculoskelet Disord 2010;11:162.
31. Silbert JE. Dietary glucosamine under question. Glycobiology 2009;19:564-567
32. Eason CT, Adams SL, Puddick J, et al. Greenshell Mussels: A Review of Veterinary Trials and Future Research Directions. Vet Sci 2018;5
33. Gibson RG, Gibson SL, Conway V, et al. Perna canaliculus in the treatment of arthritis. Practitioner 1980;224:955-960.
34. Butters DE, Whitehouse MW. Treating inflammation: some (needless) difficulties for gaining acceptance of effective natural products and traditional medicines. Inflammopharmacology 2003;11:97-110.
35. Bui LM, Bierer TL. Influence of green lipped mussels (Perna canaliculus) in alleviating signs of arthritis in dogs. Vet Ther 2003;4:397-407.
36. Hielm-Bjorkman A, Tulamo RM, Salonen H, et al. Evaluating Complementary Therapies for Canine Osteoarthritis Part I: Green-lipped Mussel (Perna canaliculus). Evid Based Complement Alternat Med 2009;6:365-373.
37. Pollard B, Guilford WG, Ankenbauer-Perkins KL, et al. Clinical efficacy and tolerance of an extract of green-lipped mussel (Perna canaliculus) in dogs presumptively diagnosed with degenerative joint disease. N Z Vet J 2006;54:114-118.
38. Servet E, Biourge V, Marniquet P. Dietary intervention can improve clinical signs in osteoarthritic dogs. J Nutr 2006;136:1995S-1997S.
39. Kunnumakkara AB, et al. Googling the guggul (Commiphora and Boswellia) for prevention of chronic disease. Front Pharm 9 (2018) Article 686.
40. Lalithakumari K, et al. Safety and toxicological evaluation of a novel, standardized, 3-O-acetyl-11-keto-beta-boswellic acid (AKBA)- enriched Boswellia serrata extract (5-1 Loxin®). Toxicol Mech Methods 16 (2006) 199–226.
41. Sengupta K, et al. Comparative efficacy and tolerability of 5-Loxin and Aflapin against osteoarthritis of the knee: a double blind, randomized, placebo controlled clinical study. Int J Med Sci 7 (2010) 366–377.
42. Vishal AA, et al. A double blind, randomized, placebo controlled clinical study evaluates the early efficacy of Aflapin in subjects with osteaoarthritis of the knee. Int J Med Sci 8 (2011) 615–622.
43. Reichling J, et al. Dietary support with Boswellia resin in canine inflammatory joint and spinal disease. Schweiz Arch Tierheilkd 146:2 (2004) 71-79.
44. Moreau M, et al. A medicinal herb-based natural health product improves the condition of a canine natural osteoarthritis model: A randomized placebo-controlled trial. Res Vet Sci 97 (2014) 574–581.
45. Meins J, et al. Survey on the quality of the top-selling European and American botanical dietary supplements containing Boswellic acids. Planta Med 82 (2016) 573–579.
46. Miscioscia E, Justin Shmalberg J, et al. Measurement of 3-acetyl-11-keto-beta-boswellic acid and 11-keto-beta-boswellic acid in Boswellia serrata supplements administered to dogs. BMC Vet Res 15 (2019) 270.
47. Haroyan, et al. Efficacy and safety of curcumin and its combination with boswellic acid in osteoarthritis: a comparative, randomized, double-blind, placebo-controlled study. BMC Complement Altern Med 18:7 (2018)