Association between gut microbiota and osteoporosis in adults: a systematic review and meta-analysis
4 affiliations
- 1Key Laboratory of Tropical Translational Medicine of Ministry of Education, School of Public Health, Hainan Medical University, Haikou, China
- 2UWE College of Hainan Medical University, Hainan Medical University, Haikou, China
- 3Research Unit for General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- 4Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
Abstract
ObjectivesTo systematically review and quantitatively synthesize observational evidence on gut microbiota alterations in adults with osteoporosis, osteopenia or low bone mineral density, with particular emphasis on α-diversity, β-diversity and taxonomic composition.MethodsA systematic search of PubMed, Embase, Web of Science, the Cochrane Library and EBSCO were conducted for studies published between 1 June 2012 and 31 December 2025. Observational studies comparing adults with osteoporosis, osteopenia or low bone mineral density against controls and using fecal microbiome sequencing were eligible. Standardized mean differences (SMDs) with 95% confidence intervals (CIs) were pooled for extractable α-diversity outcomes. β-diversity findings and taxonomic differences were synthesized descriptively. Methodological quality was assessed using a modified Newcastle–Ottawa Scale.ResultsEighteen studies were included in the systematic review and 15 contributed to the quantitative synthesis, representing 2,851 participants (1,094 cases/abnormal bone mass and 1,757 controls). Meta-analysis showed no significant overall differences in the Shannon index (SMD = 0.27, 95% CI: −0.03 to 0.57; I2 = 81.8%) or the Chao1 index (SMD = −0.13, 95% CI: −0.82 to 0.55; I2 = 85.4%). Descriptive synthesis of β-diversity more often suggested structural differences in gut microbial communities between case groups and controls. At the taxonomic level, Bacteroides was more frequently enriched in case groups, whereas evidence for several other genera, including Blautia, was less consistent. Direction-of-effect synthesis further indicated recurrent enrichment of Bacteroides and Lactobacillus in case groups and more frequent enrichment of Roseburia in controls. Overall study quality was moderate to high.ConclusionsThis review reveals that osteoporosis and abnormal bone mass present no significant differences in gut microbial alpha-diversity, but exhibit distinct β-diversity and consistent taxonomic alterations. Gut dysbiosis is potentially associated with compromised bone health; nevertheless, marked heterogeneity persists, necessitating further standardized studies to validate clinically valuable microbial signatures.Systematic review registrationhttps://www.crd.york.ac.uk/PROSPERO/view/CRD420261382643, identifier CRD420261382643.
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BibTeX
@article{cao2026association,
title = {{Association between gut microbiota and osteoporosis in adults: a systematic review and meta-analysis}},
author = {Wenting Cao and Yujia Liu and Shiqi Yin and Hanxiang Zhang and Rui Li and Ping Zhang and Jindong Ding Petersen and Jindong Ding Petersen and Jindong Ding Petersen},
journal = {Frontiers in Nutrition},
year = {2026},
month = nov,
doi = {10.3389/fnut.2026.1940274},
url = {https://doi.org/10.3389/fnut.2026.1940274},
note = {CC BY},
}
RIS
TY - JOUR
TI - Association between gut microbiota and osteoporosis in adults: a systematic review and meta-analysis
AU - Wenting Cao
AU - Yujia Liu
AU - Shiqi Yin
AU - Hanxiang Zhang
AU - Rui Li
AU - Ping Zhang
AU - Jindong Ding Petersen
AU - Jindong Ding Petersen
AU - Jindong Ding Petersen
PY - 2026
DA - 2026/11/05
JO - Frontiers in Nutrition
DO - 10.3389/fnut.2026.1940274
UR - https://doi.org/10.3389/fnut.2026.1940274
AB - ObjectivesTo systematically review and quantitatively synthesize observational evidence on gut microbiota alterations in adults with osteoporosis, osteopenia or low bone mineral density, with particular emphasis on α-diversity, β-diversity and taxonomic composition.MethodsA systematic search of PubMed, Embase, Web of Science, the Cochrane Library and EBSCO were conducted for studies published between 1 June 2012 and 31 December 2025. Observational studies comparing adults with osteoporosis, osteopenia or low bone mineral density against controls and using fecal microbiome sequencing were eligible. Standardized mean differences (SMDs) with 95% confidence intervals (CIs) were pooled for extractable α-diversity outcomes. β-diversity findings and taxonomic differences were synthesized descriptively. Methodological quality was assessed using a modified Newcastle–Ottawa Scale.ResultsEighteen studies were included in the systematic review and 15 contributed to the quantitative synthesis, representing 2,851 participants (1,094 cases/abnormal bone mass and 1,757 controls). Meta-analysis showed no significant overall differences in the Shannon index (SMD = 0.27, 95% CI: −0.03 to 0.57; I2 = 81.8%) or the Chao1 index (SMD = −0.13, 95% CI: −0.82 to 0.55; I2 = 85.4%). Descriptive synthesis of β-diversity more often suggested structural differences in gut microbial communities between case groups and controls. At the taxonomic level, Bacteroides was more frequently enriched in case groups, whereas evidence for several other genera, including Blautia, was less consistent. Direction-of-effect synthesis further indicated recurrent enrichment of Bacteroides and Lactobacillus in case groups and more frequent enrichment of Roseburia in controls. Overall study quality was moderate to high.ConclusionsThis review reveals that osteoporosis and abnormal bone mass present no significant differences in gut microbial alpha-diversity, but exhibit distinct β-diversity and consistent taxonomic alterations. Gut dysbiosis is potentially associated with compromised bone health; nevertheless, marked heterogeneity persists, necessitating further standardized studies to validate clinically valuable microbial signatures.Systematic review registrationhttps://www.crd.york.ac.uk/PROSPERO/view/CRD420261382643, identifier CRD420261382643.
SN - 2296-861X
ER -