Multispecies Probiotic Significantly Reduces Serum Bone Resorption Marker CTX in Postmenopausal Women with Osteopenia

by | Apr 11, 2024 | 2024, Bone Health, Probiotics, Recent Articles, Women's Health - Bone Health

Written by Taylor Woosley, Science Writer. 12-week supplementation with a multispecies probiotic resulted in a significant decrease in the serum bone resorption marker CTX versus baseline (p-value < 0.001) compared to placebo. 

probioticsWomen generally experience natural menopause due to loss of ovarian follicle activity between the ages of 45 and 55, and surgical menopause is also accompanied by loss of estradiol1. In additional to psychosocial effects, the early postmenopausal decline of estradiol frequently initiates clinical changes including accelerated bone loss and changes in body composition2. Skeletal disorders, such as osteoporosis and osteopenia, affect about 24.8% and 39.4% of women, with a higher prevalence noted in postmenopausal women due to the hypoestrogenism characteristic of menopause3.

The gut microbiome is a key regulator of bone health and alterations in the microbiota composition contribute to pathological bone loss4. Furthermore, the intestinal microflora influences osteoclasts’ activity by regulating the serum levels of IGF-1, while also acting on the intestinal absorption of calcium5. Previous research on supplementation with Bacillus subtilis, lactobacillus, and multispecies probiotic administration have shown beneficial effects on markers of bone turnover and short-term prevention of lumbar spine bone loss6.

Vanitchanont et al. conducted a double-blind, randomized, placebo-controlled trial to investigate the changes in the standard serum bone resorption marker C-terminal telopeptide of type 1 collagen (CTX) and bone formation marker N-terminal propeptide of type 1 procollagen (P1NP) in postmenopausal women with osteopenia after supplementation with multispecies probiotics. Subject inclusion consisted of postmenopausal women (amenorrhea for at least 12 consecutive months) with osteopenia aged 45 to 70 years who had undergone bilateral oophorectomy or have a measurement of serum follicle-stimulating hormone (FSH) > 40 IU per liter. Osteopenia was diagnosed by having a bone mineral density measured by Dual-energy X-ray Absorptiometry T-score of between -1 and -2.5 at the lumbar spine, femoral neck, or total hip.

40 participants were randomized to either the multispecies probiotic group (n=20) or to the placebo (n=20) for a 12-week intervention. Those in the probiotic group were instructed to consume one sachet of multispecies probiotics per day before any meal. The sachet contained Lactobacillus reuteri GL-104 1.5 Billion CFU, Lactobacillus paracasei MP-137 0.6 Billion CFU, Lactobacillus rhamnosus MP108 0.6 Billion CFU, Lactobacillus rhamnosus F-1 0.3 Billion CFU, Lactobacillus rhamnosus BV77 0.6 Billion CFU, Bifidobacterium animalis ssp. lactis CP-9 2.4 Billion CFU, Bifidobacterium longum ssp. longum OLP-01 1 Billion CFU, Bacillus coagulans 1 Billion CFU, and 270 milligrams of inulin (prebiotics). The placebo group received a sachet containing 270 milligrams of inulin. Subjects in both groups were instructed to take at least 1200 milligrams of calcium daily and 20,000 IU vitamin D2 per week.

At the beginning of the intervention, baseline characteristics were collected from all subjects including age, menopausal age and type, parity, history of smoking and alcohol consumption, medical history, and exercise status. Participants underwent a physical examination, including body weight, height, body mass index, and blood pressure. Additionally, bone mineral density at the lumbar spine, femoral neck, and total hip were recorded at baseline. Fasted blood samples were collected at baseline and at the end of 12-week intervention to analyze CTX and P1NP levels. A paired t-test and the Mann-Whitney U test for normal and non-normal distribution data were utilized to assess any within-group differences when comparing baseline and end of intervention serum bone turnover markers. No significant differences in baseline characteristics were noted between groups, besides a significant difference in serum CTX between the two groups at baseline, with a higher serum CTX noted in the intervention group (p-value: 0.004). Significant findings of the study are as follows:

  • A significant difference in the serum bone resorption marker CTX was noted at baseline versus 12 weeks between the multispecies probiotic and placebo groups (p-value < 0.001).
  • The intervention group experienced a significant decrease in serum CTX at 12 weeks compared to baseline (p-value: 0.026). No significant change was observed in the placebo group.

Results of the double-blind, randomized, placebo-controlled trial including 40 postmenopausal women with osteopenia show that supplementation with a multispecies probiotic significantly decreased the serum bone resorption marker CTX compared to placebo. Findings suggest that administration of multispecies probiotics may be beneficial for postmenopausal women with skeletal disorders. Study limitations include the significant difference in CTX levels between groups at baseline, the short follow up duration, and small sample size of participants.

Source: Vanitchanont, Marut, Sakda Arj-Ong Vallibhakara, Areepan Sophonsritsuk, and Orawin Vallibhakara. “Effects of Multispecies Probiotic Supplementation on Serum Bone Turnover Markers in Postmenopausal Women with Osteopenia: A Randomized, Double-Blind, Placebo-Controlled Trial.” Nutrients 16, no. 3 (2024): 461.

© 2024 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/
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Posted April 11, 2024.

Taylor Woosley studied biology at Purdue University before becoming a 2016 graduate of Columbia College Chicago with a major in Writing. She currently resides in Glen Ellyn, IL.

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