Chromium
| Evidence Level: L5 | Predicted Indications: 10 |
Table of Contents
Chromium: From a Marketed Trace-Element Infusion to Osteoarthritis
One-Sentence Summary
Chromium is registered in Singapore as a trace-element infusion concentrate, but the registration record does not state an approved indication. The TxGNN model predicts it may be effective for osteoarthritis, but the 2 related trials are implant studies and the literature is about joint-replacement hardware, not chromium as a treatment. This prediction is not supported by therapeutic evidence.
Quick Overview
| Item | Content |
|---|---|
| Original Indication | Not stated in the Singapore registration record |
| Predicted New Indication | Osteoarthritis |
| TxGNN Prediction Score | 98.68% |
| Evidence Level | L5 |
| Singapore Market Status | ✓ Marketed |
| Number of Registrations | 1 |
| Recommended Decision | Hold |
Why is This Prediction Reasonable?
Currently, detailed mechanism of action data is not available. The only registered product is an infusion concentrate (Nutritrace) containing chromium, and no approved indication text was recorded for it. No mechanism linking chromium to osteoarthritis can be established from the data compiled for this report.
The high score most likely reflects chromium's frequent co-occurrence with osteoarthritis in the literature, because cobalt-chromium alloys are widely used in hip and knee replacements for osteoarthritis. That is an association with implant hardware, not evidence that chromium treats the disease. The retrieved papers mostly describe metal wear debris, metallosis, elevated blood metal ions and immune reactions to metal, all of which are potential harms.
Clinical Trial Evidence
| Trial Number | Phase | Status | Enrollment | Key Findings |
|---|---|---|---|---|
| NCT00120952 | N/A | Withdrawn | 0 | Titanium vs cobalt-chromium femoral stem in cemented hip arthroplasty. It tests an implant material, not chromium as a drug. |
| NCT03681639 | N/A | Completed | 45 | Post-market follow-up of the Zimmer hip resurfacing system (metal-on-metal). It is a device study, not a test of chromium as a therapeutic. |
Neither trial tests chromium as a treatment for osteoarthritis.
Literature Evidence
| PMID | Year | Type | Journal | Key Findings |
|---|---|---|---|---|
| 41231919 | 2025 | RCT (implant bearing) | J Bone Joint Surg Am | Serum metal levels after hip replacement with conventional vs modular dual-mobility bearings. It concerns implant metal exposure, not treatment. |
| 41379985 | 2025 | Systematic review / meta-analysis | JBJS Reviews | Hip resurfacing is associated with lower metal ion levels and revision risk than large-head metal-on-metal total hip replacement. |
| 39881936 | 2024 | Review | Cureus | Mechanical causes and clinical consequences of metallosis after joint replacement. |
| 35601891 | 2022 | Review | Materials Today Bio | Wear-resistant coatings for implants. Metal ions and particles can cause hypersensitivity and tissue necrosis. |
| 29270560 | 2017 | Review | Joints | Ceramic knee replacement as an alternative, driven by metal hypersensitivity concerns. |
| 38821495 | 2024 | Cohort | Bone Joint J | 25-year survival of the Birmingham metal-on-metal hip resurfacing. |
| 37652450 | 2023 | Cohort | Bone Joint J | 20-year results of 234 Birmingham hip resurfacings. |
| 34628351 | 2021 | Observational | EBioMedicine | Synovial fibroblast subsets at painful vs non-painful sites in knee osteoarthritis. It does not involve chromium treatment. |
| 26231914 | 2015 | In vitro | Biomaterials | Effects of cobalt-chromium-molybdenum wear debris on cytokines and T cells. |
| 34724103 | 2023 | Observational | Arch Orthop Trauma Surg | Whether cobalt and chromium blood levels normalise after revision of failed metal-on-metal hips. |
None of these studies shows a therapeutic benefit of chromium in osteoarthritis.
Singapore Market Information
| Authorization Number | Product Name | Dosage Form | Approved Indication |
|---|---|---|---|
| SIN14341P | Nutritrace Concentrate for solution for infusion (B. Braun Melsungen AG) | Infusion, solution concentrate | Not stated in the registration record |
Safety Considerations
Please refer to the package insert for safety information.
The literature does show that chromium released from metal implants (as ions and wear debris) is associated with metallosis, adverse local tissue reactions and metal hypersensitivity. These findings concern implant-derived exposure, not infusion dosing, but they argue for caution before proposing any new systemic use.
Conclusion and Next Steps
Decision: Hold
Rationale: The osteoarthritis prediction rests on the model's association between chromium and joint-replacement alloys. No trial or publication shows that chromium treats osteoarthritis, and the literature mainly documents harms from metal exposure.
To proceed, the following is needed:
- Mechanism of action data for chromium, to assess any biological link to osteoarthritis
- The Singapore package insert, including approved indication, warnings and contraindications
- At least one well-designed study testing chromium itself, not an implant, in osteoarthritis
- A separate evaluation of rheumatoid arthritis, the model's third-ranked prediction. It has a completed Phase 2/3 randomised trial of trivalent chromium vs baricitinib (NCT05545020, n=60) and supporting animal data. That trial is small, single-study and active-comparator based, so independent replication would still be needed.
Disclaimer
This content is for research purposes only and does not constitute medical advice. Clinical validation is required before any clinical application.