Are Probiotics the New Calcium and Vitamin D for Bone Health?
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NUTRITION, EXERCISE AND LIFESTYLE IN OSTEOPOROSIS (S SHAPSES AND R DALY, SECTION EDITORS)
Are Probiotics the New Calcium and Vitamin D for Bone Health? René Rizzoli 1
&
Emmanuel Biver 1
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose of Review Calcium and vitamin D supplementation is recommended for patients at high risk of fracture and/or for those receiving pharmacological osteoporosis treatments. Probiotics are micro-organisms conferring a health benefit on the host when administered in adequate amounts, likely by influencing gut microbiota (GM) composition and/or function. GM has been shown to influence various determinants of bone health. Recent Findings In animal models, probiotics prevent bone loss associated with estrogen deficiency, diabetes, or glucocorticoid treatments, by modulating both bone resorption by osteoclasts and bone formation by osteoblast. In humans, they interfere with 25-hydroxyvitamin D levels, and calcium intake and absorption, and slightly decrease bone loss in elderly postmenopausal women, in a quite similar magnitude as observed with calcium ± vitamin D supplements. A dietary source of probiotics is fermented dairy products which can improve calcium balance, prevent secondary hyperparathyroidism, and attenuate age-related increase of bone resorption and bone loss. Summary Additional studies are required to determine whether probiotics or any other interventions targeting GM and its metabolites may be adjuvant treatment to calcium and vitamin D or anti-osteoporotic drugs in the general management of patients with bone fragility. Keywords Bone turnover . Bone mineral density (BMD) . Osteoporosis . Gut microbiota . Nutrition . Dairy products . Intestinal absorption
Introduction Supplements of vitamin D ± calcium are recommended for osteoporotic patients with low calcium intake or absorption, vitamin D insufficiency, or under pharmacological treatment for osteoporosis [1]. Intakes of 800–1000 mg/ day of calcium and 800 IU of vitamin D are recommended in the general management of patients with osteoporosis [2•]. However, the efficacy of calcium and vitamin D treatment on fracture risk reduction and hence its role in
This article is part of the Topical Collection on Nutrition, Exercise and Lifestyle in Osteoporosis * René Rizzoli [email protected] 1
Service of Bone Diseases, Geneva University Hospitals and Faculty of Medicine, 1211 Geneva 14, Switzerland
osteoporosis treatment have been challenged over the last decade. Calcium supplements associated with vitamin D treatment, not calcium supplementation alone, are associated with a modest reduction in fracture risk. Adverse events of calcium supplementation include mainly gastrointestinal symptoms and renal stones. Higher cardiovascular risk resulting from calcium supplementation at appropriate doses has not been confirmed by current evidence. In addition, high loading dose of vitamin D may increase the risk of fall and fracture and is no more recommended [3–5]. Probiotics are live micro-org
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