2026-02-02
Probiotics for stronger bones?
Rhumatology
By Ana Espino | Published on February 2, 2026 | 3 min read
Osteoporosis is a chronic skeletal disorder characterized by a progressive loss of bone mineral density (BMD) and deterioration of bone microarchitecture. This increased fragility exposes patients — particularly postmenopausal women — to a high risk of fractures, often occurring without prior symptoms. According to the WHO, over 200 million people worldwide are affected, with a major incidence after the age of 50.
Current management is primarily based on pharmacological treatments such as bisphosphonates, selective estrogen receptor modulators (SERMs), or hormone replacement therapy. Although effective, these treatments have significant limitations : side effects (gastrointestinal, cardiovascular), poor adherence, and heterogeneous response across patients. These constraints highlight the need for complementary strategies that are safer and better tolerated.
Among emerging approaches, probiotics are gaining increasing attention. Their ability to modulate the gut microbiota could positively impact bone health via the gut–bone axis, by enhancing calcium absorption, reducing systemic inflammation, and regulating osteoblastic and osteoclastic activity.
In this context, the present study aimed to assess the clinical effects of probiotic supplementation on bone formation and resorption markers in older adults with osteoporosis or osteopenia.
Fifteen randomized clinical trials including 1,432 participants over the age of 50 were selected. Intervention durations ranged from 8 weeks to 12 months. The probiotics studied included strains from Lactobacillus, Bifidobacterium, and Saccharomyces, administered individually or in combination, at doses ranging from 10⁸ to 10¹¹ CFU/day.
These studies enabled an in-depth analysis of key bone remodeling biomarkers. Markers of bone formation showed significant improvements, with an increase in P1NP of +8.4 mg/L and a modest but significant rise in osteocalcin. In terms of bone resorption, a significant reduction in CTX-I—a direct indicator of type I collagen breakdown—was observed. However, the effects on NTX and TRAP-5b remained variable and overall non-significant.
Multi-strain formulations proved more effective than single-strain ones, both in stimulating bone formation and reducing resorption. A clear dose–response effect was observed, particularly for P1NP. Furthermore, postmenopausal women experienced more marked benefits compared to mixed-gender groups.
Sensitivity analyses confirmed the robustness of the results, and no significant publication bias was detected for the main markers (P1NP, CTX-I).
Osteoporosis is a condition characterized by increased bone fragility and elevated fracture risk. Despite the availability of pharmacological treatments, management remains limited by side effects, low adherence, and inconsistent efficacy.
In light of these challenges, this study aimed to assess the potential of probiotics as an adjunctive strategy to modulate bone remodeling. The results confirm a favorable impact of supplementation, particularly through increased levels of bone formation markers (P1NP, osteocalcin) and reduced resorption (CTX-I), with enhanced benefits seen in multi-strain and long-duration interventions.
However, limitations remain and justify further research. These future studies should include long-term trials with improved control of methodological bias, standardization of probiotic strains, and broader representation of under-studied populations. A deeper investigation into strain-specific mechanisms, particularly through the gut–bone axis, will also be essential to refine clinical recommendations.
About the author – Ana Espino
PhD in Immunology, specialized in Virology
As a scientific writer, Ana is passionate about bridging the gap between research and real-world impact. With expertise in immunology, virology, oncology, and clinical studies, she makes complex science clear and accessible. Her mission: to accelerate knowledge sharing and empower evidence-based decisions through impactful communication.
Osteoporosis is a chronic skeletal disorder characterized by a progressive loss of bone mineral density (BMD) and deterioration of bone microarchitecture. This increased fragility exposes patients — particularly postmenopausal women — to a high risk of fractures, often occurring without prior symptoms. According to the WHO, over 200 million people worldwide are affected, with a major incidence after the age of 50.
Current management is primarily based on pharmacological treatments such as bisphosphonates, selective estrogen receptor modulators (SERMs), or hormone replacement therapy. Although effective, these treatments have significant limitations : side effects (gastrointestinal, cardiovascular), poor adherence, and heterogeneous response across patients. These constraints highlight the need for complementary strategies that are safer and better tolerated.
Among emerging approaches, probiotics are gaining increasing attention. Their ability to modulate the gut microbiota could positively impact bone health via the gut–bone axis, by enhancing calcium absorption, reducing systemic inflammation, and regulating osteoblastic and osteoclastic activity.
In this context, the present study aimed to assess the clinical effects of probiotic supplementation on bone formation and resorption markers in older adults with osteoporosis or osteopenia.
Could bacteria reshape our bones?
Fifteen randomized clinical trials including 1,432 participants over the age of 50 were selected. Intervention durations ranged from 8 weeks to 12 months. The probiotics studied included strains from Lactobacillus, Bifidobacterium, and Saccharomyces, administered individually or in combination, at doses ranging from 10⁸ to 10¹¹ CFU/day.
These studies enabled an in-depth analysis of key bone remodeling biomarkers. Markers of bone formation showed significant improvements, with an increase in P1NP of +8.4 mg/L and a modest but significant rise in osteocalcin. In terms of bone resorption, a significant reduction in CTX-I—a direct indicator of type I collagen breakdown—was observed. However, the effects on NTX and TRAP-5b remained variable and overall non-significant.
Multi-strain formulations proved more effective than single-strain ones, both in stimulating bone formation and reducing resorption. A clear dose–response effect was observed, particularly for P1NP. Furthermore, postmenopausal women experienced more marked benefits compared to mixed-gender groups.
Sensitivity analyses confirmed the robustness of the results, and no significant publication bias was detected for the main markers (P1NP, CTX-I).
A Microbial Cure to Strengthen the Future?
Osteoporosis is a condition characterized by increased bone fragility and elevated fracture risk. Despite the availability of pharmacological treatments, management remains limited by side effects, low adherence, and inconsistent efficacy.
In light of these challenges, this study aimed to assess the potential of probiotics as an adjunctive strategy to modulate bone remodeling. The results confirm a favorable impact of supplementation, particularly through increased levels of bone formation markers (P1NP, osteocalcin) and reduced resorption (CTX-I), with enhanced benefits seen in multi-strain and long-duration interventions.
However, limitations remain and justify further research. These future studies should include long-term trials with improved control of methodological bias, standardization of probiotic strains, and broader representation of under-studied populations. A deeper investigation into strain-specific mechanisms, particularly through the gut–bone axis, will also be essential to refine clinical recommendations.
Read next: Epigenetic regulation in osteoporosis
About the author – Ana Espino
PhD in Immunology, specialized in Virology
As a scientific writer, Ana is passionate about bridging the gap between research and real-world impact. With expertise in immunology, virology, oncology, and clinical studies, she makes complex science clear and accessible. Her mission: to accelerate knowledge sharing and empower evidence-based decisions through impactful communication.
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