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Probiotics Associated With Less Bone Loss in Older Women

4/3/2019 3:35:26 PM
bone lossThe gut microbiome modulates the immune system and intestinal endocrine signaling. It is becoming increasingly evident that the gut microbiome also modulates bone homeostasis—via mechanisms that include modulation of inflammation and osteoclast formation. Lactobacillus reuteri ATCCPTA 6475 has been shown to increase bone mineral density (BMD) in mice but has never been evaluated in humans. In a double-blind, placebo-controlled trial, researchers investigated whether L. reuteri 6475 could reduce bone loss in older women with low BMD.

Probiotics studied for osteoporosis, osteopenia

The Effects of Lactobacillus reuteri on Bone in Older Women (ELBOW) study was conducted at a university hospital in Sweden. Women between the ages of 75 and 80, with osteopenia but not osteoporosis (T-score between -1 and -2.5), were eligible to participate. The product was freeze-dried L. reuteri 6475 (BioGaia AB, Stockholm, Sweden) in a total daily dosage of 1 x 1010 CFU.
 
The primary outcome measure was relative change after 12 months in tibia total vBMD. This outcome was chosen because trabecular bone (in the shafts of long bones like the tibia) has a higher turnover rate than cortical bone and will demonstrate a more rapid response to medications. Secondary outcomes were relative changes in total BMD at the hip and spine, trabecular bone volume fraction, cortical vBMD, cortical thickness, serum N-terminal telopeptide, bone-specific alkaline phosphatase, C-reactive protein, tumor necrosis factor, and HbA1c.   
 
Ninety women were randomized, and 70 women completed the study (34 in L. reuteri group and 36 in placebo). The main reason for discontinuation was adverse events (91% in L. retueri group and 78% in placebo), of which gastrointestinal symptoms were the most common.

Study reveals that probiotics improve bone condition

In the intention-to-treat analysis, the mean relative change in tibia total vBMD after 12 months was -0.83% (95% CI, -1.47% to -0.19%) in subjects randomized to L. reuteri 6475 and -1.85% (95% CI, -2.64% to -1.07%) in those randomized to placebo. Similar results were seen in the per-protocol analysis. The mean change in tibia total vBMD was -0.93% (95% CI, -1.45 to -0.40) in women who completed the trial taking L. reuteri and -1.86% (95% CI, -2.35% to -1.36%) in women who completed the trial taking the placebo. The difference between groups was significant, with a p-value of 0.013.
 
There were no significant differences in secondary outcomes in the intention-to-treat analysis. In the per-protocol analysis, there was a significantly lower reduction in trabecular bone volume fraction in the L. reuteri group compared with placebo but no differences in other secondary outcomes. The researchers estimated that a larger sample size of at least 140 participants would have been needed to detect changes in the secondary outcome measure of total hip BMD.

Probiotics can reduce bone loss by half

In sum, this study reports that L. reuteri, taken for 12 months, reduces total vBMD loss by nearly half in older women with low BMD. This is the first clinical trial to report this finding in humans and can serve as a proof of concept for future studies.
 
Reference
Nilsson AG, Sundh D, Bäckhed F, Lorentzon M. Lactobacillus reuteri reduces bone loss in older women with low bone mineral density: a randomized, placebo-controlled, double-blind, clinical trial. J Intern Med. 2018.

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