Article Text

Original research
Probiotic supplements and bone health in postmenopausal women: a meta-analysis of randomised controlled trials
  1. Jiawei Yu1,
  2. Gaoyang Cao2,
  3. Shuohui Yuan1,
  4. Cong Luo1,
  5. Jiafeng Yu1,
  6. Ming Cai1
  1. 1Department of Orthopedic Surgery, Zhuji Affiliated Hospital of Wenzhou Medical University, Shaoxing, China
  2. 2Department of Colorectal Surgery, Zhejiang University School of Medicine Sir Run Run Shaw Hospital, Hangzhou, China
  1. Correspondence to Dr Ming Cai; caiming1208{at}


Objective Osteoporosis is a common disease in postmenopausal women. Several studies have analysed the associations between dietary supplementation with probiotics and bone health in postmenopausal women, but the results are still controversial. We conducted this meta-analysis to assess the effects of probiotics supplement on bone mineral density (BMD) and bone turnover markers for postmenopausal women.

Design Systematic review and meta-analysis.

Methods We systematically searched PubMed, EMBASE and the Cochrane Library from their inception to November 2020 for randomised controlled trials (RCTs) assessing probiotic supplements and osteoporosis in postmenopausal women. Study-specific risk estimates were combined using random-effect models.

Results Five RCTs (n=497) were included. Probiotic supplements were associated with a significantly higher BMD in the lumbar spine (standardised mean difference, SMD=0.27, 95% CI 0.09 to 0.44) than in control. There was no difference between probiotic supplements and BMD in hips (SMD=0.22, 95% CI −0.07 to 0.52). Collagen type 1 cross-linked C-telopeptide levels in the treatment groups were significantly lower than those of the placebo group (SMD=−0.34, 95% CI −0.60 to −0.09). In subgroup meta-analysis, levels of bone-specific alkaline phosphatase, osteoprotegerin, osteocalcin and tumour necrosis factor did not differ between the probiotic and placebo groups.

Conclusions We conclude cautiously that supplementation with probiotics could increase lumbar BMD. More RCTs are recommended to validate or update these results.

  • bone diseases
  • hip
  • spine
  • nutrition & dietetics

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Supplementary materials


  • JY and GC contributed equally.

  • Contributors MC and JY conceived and designed the meta-analysis; GC, SY and CL searched the literature; JY, GC and SY analysed the data; JY contributed analysis tools; JY and GC wrote the paper; JY and MC revised the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article or uploaded as online supplemental information. No additional data available.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.