New research has shown a positive effect of a multistrain probiotic formula on markers of bone breakdown in a cohort of women at risk of developing osteoporosis. 

The researchers are associated with a hospital in Bangkok and their work was published in the journal Nutrients. 

Long ago, probiotics research expanded beyond gut heath parameters to include other indications, such as immune support, cognitive function and mediation of systemic inflammation. 

Another up-and-coming area of research is related to the effects of probiotics on various measurements of bone health. Until recently, most of this evidence could be found in studies done on mice, rats and, in some cases, chickens. 

Now research is starting to focus on human subjects. For most adults, and particularly seniors, the conversation is focused on arresting bone loss. 

Trying to flatten the bone loss curve 

While bones are active structures and are always remodeling, people lose more bone tissue than they gain after age 30, according to the Mayo Clinic. The question is about the steepness of that curve and is most pressing for postmenopausal women, who are at the greatest risk of developing osteoporosis. 

The Thai researchers chose to focus on a condition called osteopenia, which could be thought of as “pre-osteoporosis.” 

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They recruited a cohort of 40 women diagnosed with osteopenia but without full blown osteoporosis. The women were recruited from patients being treated at the outpatient gynecology clinic at the hospital in Bangkok. 

They ranged in age from 45 to 70 years and were generally healthy, except for their suboptimal bone mass. Very thin (body mass index less than 18) or overly heavy subjects (BMI greater than 35) were excluded. The subjects were randomly divided into two groups, one receiving a daily multispecies probiotic formula, the other taking an equivalent placebo. 

The probiotic intervention was a commercially available formula marketed by Thai company CMED Products. It consists of eight species of proprietary probiotic strains manufactured in Taiwan along with a small amount of inulin. The total CFU (colony forming units) count was 7.4 billion. 

Both groups received 1200 milligrams (mg) of calcium daily and 20,000 IU (international units) of vitamin D2 weekly. 

The participants were asked to avoid foods rich in probiotics such as yogurt and kimchi. They were allowed to take their usual medications and encouraged to continue their usual diets and exercise routines. 

Probiotics formula cut expression of bone resorption marker 

The study was set to run for three months. The researchers took blood samples at baseline and again at the end of the study. The primary outcome was the change in the amount of C-terminal telopeptide of type I collagen (CTX), a marker of bone resorption. 

The researchers found a significant difference in the level of this marker between the two groups, suggesting the probiotic intervention may have a protective effect. 

The researchers postulated several possible modes of action for this effect, including the reduction of inflammatory mediators and cytokine levels in the gut and bone marrow, as well as changes in endocrine factors produced by the gut, such as incretins and serotonin, which may also influence bone cells. 

Promising, but preliminary 

Given only a few such studies have been done on humans, the researchers stopped short of advocating for this intervention to become a standard part of care for this category of patients. 

“Our study has demonstrated that multispecies probiotic supplementation for 12 weeks in osteopenic postmenopausal women may retard the increase in serum bone resorption marker CTX by downregulating osteoclast-induced bone resorption without significant adverse effects,” the researchers concluded. “Further experimental research may support our findings and prove its clinical usefulness before considering it as an alternative or add-on modality for the management of osteopenia in the postmenopausal period.”