Background: Osteopenia is a very common problem in postmenopausal women, with significant risk of fracture and progression to osteoporosis, yet despite the variety of treatment options, hormone-related bone loss is difficult to treat effectively while minimizing side effects. The composition of the gut microbiota is strongly associated with bone health, and probiotics are a promising adjunct therapy to the standard of care for osteopenia.
Methods: An exhaustive search of the literature was performed using the search terms probiotics, synbiotics, osteoporosis, bone mineral density, low bone mass, age-related bone changes, postmenopausal, fracture healing, fracture, and spontaneous fracture. Studies were assessed for quality using GRADE.
Results: The initial search generated 75 articles excluding duplicates. Two randomized clinical trials met eligibility criteria, with a study duration of at least 6 months and enrolled osteopenic postmenopausal women. One study found that supplementation of a mixed probiotic supplement seemed to induce a more positive profile of osteometabolic biomarkers, and the other study combined probiotics and isoflavones which significantly diminished bone loss over 12 months.
Conclusion: Probiotics are a promising option for the treatment of osteopenia, especially in combination with plant-derived isoflavones. Further studies will likely provide more support for probiotic administration in postmenopausal women, but in the meantime it would be safe and probably beneficial for clinicians to recommend probiotics to patients as an osteoprotective effort.
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