Boswellia Research
43 peer-reviewed studies · Evidence score: 8.5/10
Comparative Effectiveness of Nutritional Supplements in the Treatment of Knee Osteoarthritis: A Network Meta-Analysis
Zhang Y et al. • Nutrients (2025)
However, further large-scale, well-designed randomized controlled trials (RCTs) are needed to confirm these findings, particularly those that include more standardized dosages and formulations, as well as to evaluate their long-term efficacy.
- Bayesian rankings indicated Boswellia had the highest probability of being most effective for pain and stiffness, with krill oil and curcumin showing potential for function improvement.
- Conclusions: Nutritional supplements, particularly Boswellia, appear to be effective and well-tolerated for improving KOA symptoms and function.
- These results suggest that certain supplements may be useful as part of non-pharmacological KOA management.
Efficacy evaluation of standardized Boswellia serrata extract (Aflapin(Ⓡ)) in osteoarthritis: A systematic review and sub-group meta-analysis study
Dubey V et al. • Explore (New York, N.Y.) (2024)
BS supplementation is effective OA symptomatic management.
- BS supplementation significantly reduced VAS (MD: -10.71; p<0.00001), LFI (MD: -2.99; p<0.00001), WOMAC-pain (MD: -10.69; p<0.0001), WOMAC-stiffness (MD: -5.49; p<0.00001), and WOMAC-function (MD: -10.69; p<0.00001) scores compared to control therapy.
- BS supplementation is effective OA symptomatic management.
- Sub-group analysis revealed that AflapinⓇ supplementation may be better in improving the symptoms of OA which needs to be confirmed by more comparative clinical studies.
Oral herbal medicines marketed in Brazil for the treatment of osteoarthritis: A systematic review and meta-analysis
Del Grossi Moura M et al. • Phytotherapy research : PTR (2017)
Copyright © 2017 John Wiley & Sons, Ltd.Copyright © 2017 John Wiley & Sons, Ltd.
- Z. officinale showed improvement of pain over placebo.
- The evidence was insufficient to support the effective and safe use of these herbal medicines, because the quality of evidence of studies was low.
- This study guides managers of the Brazilian public health system and prescribers in decision-making regarding the use of these herbal medicines for OA.
Oral herbal therapies for treating osteoarthritis
Cameron M et al. • The Cochrane database of systematic reviews (2014)
Evidence for the proprietary ASU product Piasclidine® in the treatment of osteoarthritis symptoms seems moderate to high for short term use, but studies over a longer term and against an apparently active control are less convincing.
- Seventeen studies of confirmatory design (sample and effect sizes pre-specified) were mostly at moderate risk of bias.
- Physical function was 33 points on the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) 0 to 100 point subscale (0 is no loss of function) with placebo, enriched Boswellia serrata improved function by 8 points (95% CI 2 to 14); NNTB 4.
- Moderate-quality evidence (one study, 96 participants) indicated that adverse events were probably reduced with enriched Boswellia serrata (18/48 events versus 30/48 events with placebo; relative risk (RR) 0.60, 95% CI 0.39 to 0.92).
Ayurvedic interventions for osteoarthritis: a systematic review and meta-analysis
Kessler CS et al. • Rheumatology international (2015)
Well-planned, well-conducted and well-published trials are warranted to improve the evidence for Ayurvedic interventions.
- For the compound preparation, Rumalaya, large and apparently unbiased effects beyond placebo were found for pain (standardized mean difference [SMD] -3.73; 95 % confidence interval [CI] -4.97, -2.50; P < 0.01) and global improvement (risk ratio 12.20; 95 % CI 5.83, 25.54; P < 0.01).
- There is also some evidence that effects of the herbal compound preparation Shunti-Guduchi are comparable to those of glucosamine for pain (SMD 0.08; 95 % CI -0.20, 0.36; P = 0.56) and function (SMD 0.15; 95 % CI -0.12, 0.36; P = 0.41).
- No severe adverse events were observed in all trials.
Boswellia serrata for osteoarthritis: A systematic review and meta-analysis
Yu G et al. • BMC Complementary Medicine and Therapies (2020)
Boswellia significantly improved pain and function in knee OA.
- Significant pain reduction vs placebo
- Improved physical function
- Effects seen by 4 weeks
Interventions for treating collagenous colitis
Kafil TS et al. • The Cochrane database of systematic reviews (2017)
Low quality evidence suggests that budesonide may be effective for inducing and maintaining clinical and histological response in patients with collagenous colitis.
- Clinical response occurred in 100% (4/4) of patients who received bismuth subsalicylate (nine 262 mg tablets daily for 8 weeks) compared to 0% (0/5) of patients who received placebo (1 study; 9 participants; RR 10.80, 95% CI 0.75 to 155.93; GRADE = very low).
- Clinical response occurred in 44% (7/16) of patients who received Boswellia serrata extract (three 400 mg/day capsules for 8 weeks) compared to 27% (4/15) of patients who received placebo (1 study; 31 participants; RR 1.64, 95% CI 0.60 to 4.49; GRADE = low).
- Clinical response occurred in 80% (24/30) of budesonide patients compared to 44% (11/25) of mesalamine patients (1 study; 55 participants; RR 1.82, 95% CI 1.13 to 2.93; GRADE = low).
Chemical Constituents and Pharmacological Properties of Frankincense: Implications for Anticancer Therapy
Wu YR et al. • Chinese journal of integrative medicine (2024)
The Chinese Journal of Integrated Traditional and Western Medicine Press and Springer-Verlag GmbH Germany, part of Springer Nature.
- They also have comprehensive effects on regulating flora.
- Frankincense and its principal chemical constituents have demonstrated promising chemoprophylactic and therapeutic abilities against tumors.
- This review provides a systematic summary of the mechanism of action underlying the antitumor effects of frankincense and its major constituents, thus laying the foundations for developing effective tumor-combating targets.© 2024.
Efficacy of curcumin and Boswellia for knee osteoarthritis: Systematic review and meta-analysis
Bannuru RR et al. • Seminars in arthritis and rheumatism (2018)
The results of our study suggest that curcuminoid and boswellia formulations could be a valuable addition to the knee OA treatment regimens by relieving symptoms while reducing safety risks.
- Both curcuminoid and boswellia formulations were statistically significantly more effective than placebo for pain relief and functional improvement.
- Curcuminoids showed no statistically significant differences in efficacy outcomes compared to NSAIDs; patients receiving curcuminoids were significantly less likely to experience gastrointestinal adverse events.
- The results of our study suggest that curcuminoid and boswellia formulations could be a valuable addition to the knee OA treatment regimens by relieving symptoms while reducing safety risks.
Efficacy of Extracts of Oleogum Resin of Boswellia in the Treatment of Knee Osteoarthritis: A Systematic Review and Meta-Analysis
Dalmonte T et al. • Phytotherapy research : PTR (2024)
Phytotherapy Research published by John Wiley & Sons Ltd.
- More than 40% of patients use complementary and alternative medicine including supplements containing phytoextracts with anti-inflammatory properties as those from the Boswellia genus.
- This was also confirmed in the meta-regression applied to the WOMAC scores.
- This is an important finding as people exposed to NSAID-related adverse effects could benefit from the use of Boswellia extracts.
Anti-inflammatory and anti-cancer activities of frankincense: Targets, treatments and toxicities
Efferth T et al. • Seminars in cancer biology (2022)
All rights reserved.
- The therapeutic potential against other tumor types is still speculative.
- Experimental toxicology and clinical trials revealed only mild adverse side effects.
- More randomized clinical trials are required to estimate the full clinical potential of frankincense for cancer therapy.Copyright © 2020 Elsevier Ltd.
Reducing Biofilm Infections in Burn Patients' Wounds and Biofilms on Surfaces in Hospitals, Medical Facilities and Medical Equipment to Improve Burn Care: A Systematic Review
Thomas RE et al. • International journal of environmental research and public health (2021)
Cleaning and disinfecting needs to include identifying biofilms on keyboards, tablets, cell phones, medical equipment (especially endoscopes), sinks, drains, and kitchens.
- Biofilms in burns are major problems: bacterial communities rapidly develop antibiotic resistance, and 60% of burn mortality is attributed to biofilms.
- Most interventions aimed to penetrate cell membranes and reported significant reductions in biofilms in cfu/mL or biofilm mass or antibiotic minimal inhibitory concentrations or bacterial expression of virulence or quorum sensing genes.
- Scanning electron microscopy identified important changes in bacterial surfaces.
Chemoprevention Agents to Reduce Mammographic Breast Density in Premenopausal Women: A Systematic Review of Clinical Trials
Salazar AS et al. • JNCI cancer spectrum (2021)
A limited number of chemoprevention agents have been shown to reduce MBD in premenopausal women.
- Hormonal interventions were associated with net reductions in percent density (tamoxifen [13.4%], leuprolide acetate [8.9%], and goserelin [2.7%]), whereas nonhormonal (vitamin D and isoflavone) interventions were not.
- A limited number of chemoprevention agents have been shown to reduce MBD in premenopausal women.
- Identification of new and well-tolerated chemoprevention agents targeting MBD and larger studies to confirm agents that have been studied in small trials are urgent priorities for primary breast cancer prevention in premenopausal women with dense breasts.
The role of dietary supplements in inflammatory bowel disease: a systematic review
Rossi RE et al. • European journal of gastroenterology & hepatology (2016)
In summary, attention to dietary factors such as curcumin, green tea and vitamins, including vitamins D and B12, appears to be beneficial and, if necessary, supplementation may be appropriate.
- Zinc and iron should be supplemented in selected cases.
- Probiotics (VSL#3) may reduce disease activity in IBD patients with pouchitis.
- Complementary and alternative medicines are used by IBD patients and some studies have shown promising results.
Systematic review of complementary and alternative medicine treatments in inflammatory bowel diseases
Langhorst J et al. • Journal of Crohn's & colitis (2015)
Complementary and alternative therapies might be effective for the treatment of inflammatory bowel diseases; however, given the low number of trials and the heterogeneous methodological quality of trials, further in-depth research is necessary.
- Complementary and alternative therapies might be effective for the treatment of inflammatory bowel diseases; however, given the low number of trials and the heterogeneous methodological quality of trials, further in-depth research is necessary.
- Published in Journal of Crohn's & colitis (2015)
- Further research warranted to confirm findings
Dietary Ingredients as an Alternative Approach for Mitigating Chronic Musculoskeletal Pain: Evidence-Based Recommendations for Practice and Research in the Military
Crawford C et al. • Pain medicine (Malden, Mass.) (2019)
Currently the scientific evidence is insufficiently robust to establish definitive clinical practice guidelines, but processes could be established to track the impact of these ingredients.
- Currently the scientific evidence is insufficiently robust to establish definitive clinical practice guidelines, but processes could be established to track the impact of these ingredients.
- Until then, providers have the evidence needed to make informed decisions about the safe use of these dietary ingredients, and future research can address existing gaps.
- Further research warranted to confirm findings
Dietary supplements for treating osteoarthritis: a systematic review and meta-analysis
Liu X et al. • British journal of sports medicine (2018)
The overall analysis including all trials showed that supplements provided moderate and clinically meaningful treatment effects on pain and function in patients with hand, hip or knee osteoarthritis at short term, although the quality of evidence was very low.
- Another six (undenatured type II collagen, avocado soybean unsaponifiables, methylsulfonylmethane, diacerein, glucosamine and chondroitin) revealed statistically significant improvements on pain, but were of unclear clinical importance.
- Chondroitin demonstrated statistically significant, but not clinically important structural improvement (effect size -0.30, -0.42 to -0.17).
- The overall analysis including all trials showed that supplements provided moderate and clinically meaningful treatment effects on pain and function in patients with hand, hip or knee osteoarthritis at short term, although the quality of evidence was very low.
Evidence for the efficacy of complementary and alternative medicines in the management of osteoarthritis: a systematic review
De Silva V et al. • Rheumatology (Oxford, England) (2011)
The major limitation in reviewing the evidence is the paucity of randomized controlled trials in the area: widening the evidence base, particularly for those compounds for which there is promising evidence, should be a priority for both researchers and funders.
- For other substances with promising evidence, the evidence base was either insufficiently large or the evidence base was inconsistent.
- Most of the CAM compounds studied were free of major adverse effects.
- The major limitation in reviewing the evidence is the paucity of randomized controlled trials in the area: widening the evidence base, particularly for those compounds for which there is promising evidence, should be a priority for both researchers and funders.
Reframing Nutraceuticals in Knee Osteoarthritis with Sarcopenia: A Muscle-Joint-Centered Narrative Review
Park D, Koh HS, Choi YH, Moon JW, Park I. • Nutrients (2026)
Nutraceuticals should be interpreted as optional, time-limited adjuncts within exercise-centered KOA management.
- Across glucosamine/chondroitin, collagen peptides, omega-3 fatty acids, curcumin, and Boswellia, symptomatic benefits were modest, heterogeneous, and formulation-dependent, with no consistent evidence of structural disease modification.
- Direct evidence that nutraceuticals improve exercise adherence or long-term physical activity remains limited; however, selected exercise-integrated or function-oriented studies show participation-relevant signals in gait speed, activity volume, and performance-based outcomes.
- Conclusions Nutraceuticals should be interpreted as optional, time-limited adjuncts within exercise-centered KOA management.
Advances in Drug Delivery Systems for Boswellic Acids from Boswellia serrata: Enhancing Oral Bioavailability and Therapeutic Efficacy
Rutkowska M, Olszewska MA. • International journal of molecular sciences (2026)
By comparing the advantages and limitations of conventional preparations with modern drug delivery systems, this review outlines the most effective strategies to enhance the bioavailability of BAs and highlights future research directions for their translational development.
- Results indicate that emerging formulation technologies significantly increase the oral absorption, systemic exposure, and biological effectiveness of BAs.
- Available in vivo and cellular studies are critically evaluated, with a focus on disease-specific outcomes.
- However, despite promising preclinical data, challenges remain regarding the standardization of Boswellia extracts, the stability of novel formulations, their safety, and limited clinical evaluation.