Effectiveness of Boswellia and Boswellia extract for osteoarthritis patients: a systematic review and meta-analysis

Yu G, Xiang W, Zhang T, et al. · BMC Complementary Medicine and Therapies

Seven trials and 545 patients. Against control, pooled boswellia improved VAS pain (WMD -8.33; 95% CI -11.19 to -5.46), WOMAC pain (-14.22; -22.34 to -6.09), WOMAC stiffness (-10.04; -15.86 to -4.22), WOMAC function (-10.75; -15.06 to -6.43) and the Lequesne index (-2.27; -3.08 to -1.45), and the authors recommend at least four weeks of use. Four of the seven trials gave boswellia in combination rather than alone — with curcuminoids, with Elaeagnus, or with methylsulfonylmethane at 5,000 and 10,000 mg beside 7.5 and 15 mg of boswellic acid — and two of those four used ibuprofen or glucosamine sulfate as the comparator rather than placebo. Heterogeneity ran 93% to 99% on every pooled measure but the Lequesne index.

Population

7 randomized trials of Boswellia preparations in osteoarthritis

Intervention

Boswellia serrata or its extracts, typically 100-1000 mg/day for 4-24 weeks

Comparator

Placebo or control

Limitations

Trial base is small and dominated by manufacturer-funded studies from a few groups; heterogeneous extracts and doses limit generalization. The review rates its own material harshly: four of the seven trials carry a high risk of bias for declaring three primary outcomes without correcting the significance threshold, and three for leaving the outcome statistician unblinded. The two trials with two active arms had their single control group split to match, and the pooled VAS combines trials scoring pain 0 to 10 with trials scoring it 0 to 100.