Strain-specific and dose-dependent clinical efficacy of probiotics on bone mineral density improvement in postmenopausal women: a meta-analysis based on RCT studies
- 1Department of Endocrinology, Seventh People’s Hospital of Shanghai University of Traditional Chinese Medicine
- 2Clinical Medicine College, Shandong Second Medical University
Abstract
Background Probiotics may provide a safe and feasible alternative or adjuvant strategy for osteoporosis. However, there is no consensus on its strain specificity, dose threshold, and site differences. This meta-analysis quantitatively evaluates the strain-specific and dose-dependent clinical efficacy of probiotics on bone mineral density (BMD) in postmenopausal women. Methods Systematically search PubMed, Embase, Web of Science Core Collection, Scopus, Cochrane, and ClinicalTrials.gov up to December 24, 2025. Randomized controlled trials (RCTs) of probiotic/synbiotic interventions in postmenopausal women were included. A fixed-effects model was used to pool the standardized mean differences (SMD). Subgroup analyses were conducted based on probiotic genus (with Lactobacillus vs. without Lactobacillus), strain number (single vs. multi-strain), dose (≥ 1 × 10¹⁰ vs. <1 × 10¹⁰ CFU/d), and intervention duration. Results A total of 11 RCTs (12 reports, n = 1388) were entered into the analysis. Overall change in BMD was not significant (SMD = 0.01, 95% CI = -0.06, 0.08, I² = 0%). Lumber spine BMD was significantly higher in Lactobacillus subgroup (SMD = 0.19, 95% CI = 0.01, 0.37). Lactobacillus showed negative trends in hip (SMD = -0.07) and femur (SMD = -0.08) BMD. Exploratory analyses suggested a potential dose–response plateau at 1 × 10⁹-7.5 × 10⁹ CFU/d. Prolonged interventions (> 6 months) or higher dose did not increase lumbar gains and conversely turned the hip/femur effect negative. Safety profile did not differ from placebo. Based on the GRADE framework, evidence was moderate for lumbar spine BMD and adverse events but low for hip and femur BMD. This means research is needed to refine these estimates. Conclusions Effect of probiotics on BMD in postmenopausal women is site-genus-dose dependent. A single Lactobacillus strain at 1 × 10⁹-7.5 × 10⁹ CFU/d for 3–6 months is recommended for lumbar spine protection. Clinical trial number Not applicable.
Related
- Modulation of hormones in perimenopausal women by probiotics associated by specific gut bacteria: a pilot study
- Repeated Specific Health Guidance and improvement of metabolic syndrome in middle-aged working men: a longitudinal observational study using modified Poisson regression
- Effect of Probiotics on Stress Scores, Cortisol Levels, and Immune Functions in Moderately Stressed Adolescents and Young Adults: Results of a Feasibility Clinical Study
- Probiotics and diarrhoea morbidity among infants in Tanzania: secondary analysis of a randomised clinical trial
- Clinical effects of multi-strain probiotics in extremely preterm infants: a multicenter pre-post implementation study in the Netherlands.
BibTeX
@article{liu2026strainspecific,
title = {{Strain-specific and dose-dependent clinical efficacy of probiotics on bone mineral density improvement in postmenopausal women: a meta-analysis based on RCT studies}},
author = {Lu Liu and Jing Liu and Yi Zhu and Chongxiao Liu},
journal = {Nutrition \& Metabolism},
year = {2026},
month = sep,
doi = {10.1186/s12986-026-01194-1},
url = {https://doi.org/10.1186/s12986-026-01194-1},
note = {CC BY},
}
RIS
TY - JOUR
TI - Strain-specific and dose-dependent clinical efficacy of probiotics on bone mineral density improvement in postmenopausal women: a meta-analysis based on RCT studies
AU - Lu Liu
AU - Jing Liu
AU - Yi Zhu
AU - Chongxiao Liu
PY - 2026
DA - 2026/09/01
JO - Nutrition & Metabolism
DO - 10.1186/s12986-026-01194-1
UR - https://doi.org/10.1186/s12986-026-01194-1
AB - Background Probiotics may provide a safe and feasible alternative or adjuvant strategy for osteoporosis. However, there is no consensus on its strain specificity, dose threshold, and site differences. This meta-analysis quantitatively evaluates the strain-specific and dose-dependent clinical efficacy of probiotics on bone mineral density (BMD) in postmenopausal women. Methods Systematically search PubMed, Embase, Web of Science Core Collection, Scopus, Cochrane, and ClinicalTrials.gov up to December 24, 2025. Randomized controlled trials (RCTs) of probiotic/synbiotic interventions in postmenopausal women were included. A fixed-effects model was used to pool the standardized mean differences (SMD). Subgroup analyses were conducted based on probiotic genus (with Lactobacillus vs. without Lactobacillus), strain number (single vs. multi-strain), dose (≥ 1 × 10¹⁰ vs. <1 × 10¹⁰ CFU/d), and intervention duration. Results A total of 11 RCTs (12 reports, n = 1388) were entered into the analysis. Overall change in BMD was not significant (SMD = 0.01, 95% CI = -0.06, 0.08, I² = 0%). Lumber spine BMD was significantly higher in Lactobacillus subgroup (SMD = 0.19, 95% CI = 0.01, 0.37). Lactobacillus showed negative trends in hip (SMD = -0.07) and femur (SMD = -0.08) BMD. Exploratory analyses suggested a potential dose–response plateau at 1 × 10⁹-7.5 × 10⁹ CFU/d. Prolonged interventions (> 6 months) or higher dose did not increase lumbar gains and conversely turned the hip/femur effect negative. Safety profile did not differ from placebo. Based on the GRADE framework, evidence was moderate for lumbar spine BMD and adverse events but low for hip and femur BMD. This means research is needed to refine these estimates. Conclusions Effect of probiotics on BMD in postmenopausal women is site-genus-dose dependent. A single Lactobacillus strain at 1 × 10⁹-7.5 × 10⁹ CFU/d for 3–6 months is recommended for lumbar spine protection. Clinical trial number Not applicable.
SN - 1743-7075
ER -