Effects of probiotic supplementation on bone health in postmenopausal women: a systematic review and meta-analysis
What this study found
Probiotic supplementation was associated with better bone outcomes overall, especially increased lumbar spine and hip bone mineral density and lower bone resorption markers. The pooled effects favored probiotics for lumbar spine BMD (SMD = 0.60, 95% CI 0.14 to 1.05) and hip BMD (SMD = 0.74, 95% CI 0.15 to 1.33), with reductions in CTX (SMD = -1.51, 95% CI -1.88 to -0.41) and BALP (SMD = -1.80, 95% CI -2.78 to -0.81). P1NP was not clearly changed (SMD = 0.59, 95% CI -0.14 to 1.32), and OC, OPG, and RANKL were not significantly affected. Benefits appeared greater with higher probiotic doses…
- Study & population
- This was a systematic review and meta-analysis of 7 randomized controlled trials in postmenopausal women, including participants with osteopenia or osteoporosis.
- Intervention
- Probiotic supplementation was evaluated across seven randomized trials in postmenopausal women.
- Key limitation
- The evidence base was small and heterogeneous, with different probiotic strains, doses, co-supplements, and intervention durations across trials.
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Open PDFOriginal abstract
Context The beneficial effects of probiotic supplementation on bone health in postmenopausal women require further validation. Objective This study systematically reviewed and conducted a meta-analysis of randomized controlled trials (RCTs) to assess the relationship between probiotic supplementation and changes in bone mineral density (BMD) and bone turnover markers (BTMs) among postmenopausal women. Methods A systematic search was conducted across four databases to retrieve data on lumbar spine BMD, hip BMD, collagen type 1 cross-linked C-telopeptide (CTX), receptor activator of nuclear factor-κB ligand (RANKL), osteocalcin (OC), osteoprotegerin (OPG), N-terminal propeptide of type 1 procollagen (P1NP), and bone-specific alkaline phosphatase (BALP) in postmenopausal women. Eligible RCTs were quantitatively analyzed using random-effects meta-analyses. Additional analyses, including subgroup, sensitivity, and meta-regression analyses, were performed. Results Twelve RCTs involving 1183 postmenopausal women were included. Compared with the control group, postmenopausal women who received probiotic supplementation showed significantly greater BMD in both the lumbar spine (standardized mean difference [SMD] = 0.60, 95% confidence interval [CI] 0.14 to 1.05) and the hip (SMD = 0.74, 95%CI 0.15 to 1.33). Additionally, probiotic supplementation was associated with reduced levels of CTX (SMD = -1.51, 95%CI -1.88 to -0.41) and BALP (SMD = -1.80, 95%CI -2.78 to -0.81). No significant differences were found between the probiotic and control groups in terms of other BTMs. Subgroup analyses revealed that the increase in BMD due to probiotic supplementation was more significant in postmenopausal women with osteopenia than in those with osteoporosis. The meta-analysis results for both lumbar spine and hip BMD remained robust after conducting sensitivity analyses and meta-regressions. Conclusion Supplementation with probiotics may increase BMD among postmenopausal women, with stronger evidence in women with osteopenia than osteoporosis. Further RCTs are suggested to confirm and refine these findings. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42024576764.