{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T12:13:08Z","timestamp":1789042388852,"version":"build-2803163510"},"reference-count":123,"publisher":"MDPI AG","issue":"18","license":[{"start":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T00:00:00Z","timestamp":1788998400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>Osteoporosis is a major skeletal disorder. Increasing evidence suggests that gut microbiota-derived mechanisms may contribute to bone remodeling. The biological rationale for a gut\u2013bone axis is well supported, but the clinical relevance of microbiome-targeted interventions remains uncertain. In this narrative review, we focus on prebiotics, probiotics, synbiotics, and postbiotics. We searched in the literature the progress from mechanistic observations to measurable skeletal outcomes in humans. We searched PubMed, Scopus, and Web of Science for literature published mainly between 2021 and 2026. We also included earlier studies when they were important for the mechanistic framework. The evidence was evaluated according to intervention type and outcome. We focused on bone turnover markers, bone mineral density, and the duration of exposure required for these outcomes to become clinically meaningful. Recent randomized trials and meta-analyses were also compared in a semi-quantitative synthesis to show where findings are consistent and where they remain conflicting.<\/jats:p>","DOI":"10.3390\/nu18182967","type":"journal-article","created":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T11:38:39Z","timestamp":1789040319000},"page":"2967","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Targeting the Gut\u2013Bone Axis with Prebiotics, Probiotics, Synbiotics, and Postbiotics: From Mechanistic Plausibility to Clinical Bone Outcomes"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-3401-1232","authenticated-orcid":false,"given":"Sorina","family":"Ispas","sequence":"first","affiliation":[{"name":"Department of Anatomy, Faculty of General Medicine, \u201cOvidius\u201d University, 900470 Constanta, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-2211-8482","authenticated-orcid":false,"given":"Viviana","family":"Maggio","sequence":"additional","affiliation":[{"name":"School of Medicine, PROMISE Department of Health Promotion Sciences Maternal and Infantile Care, Internal Medicine and Medicinal Specialties, University of Palermo, 90133 Palermo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1555-2820","authenticated-orcid":false,"given":"Adil Farooq","family":"Wali","sequence":"additional","affiliation":[{"name":"RAK College of Pharmacy, RAK Medical and Health Sciences University, Ras Al Khaimah 11172, United Arab Emirates"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2334-2332","authenticated-orcid":false,"given":"Sirajunisa","family":"Talath","sequence":"additional","affiliation":[{"name":"RAK College of Pharmacy, RAK Medical and Health Sciences University, Ras Al Khaimah 11172, United Arab Emirates"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8454-8158","authenticated-orcid":false,"given":"Syed Arman","family":"Rabbani","sequence":"additional","affiliation":[{"name":"RAK College of Pharmacy, RAK Medical and Health Sciences University, Ras Al Khaimah 11172, United Arab Emirates"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4057-7125","authenticated-orcid":false,"given":"Bhoomendra A.","family":"Bhongade","sequence":"additional","affiliation":[{"name":"RAK College of Pharmacy, RAK Medical and Health Sciences University, Ras Al Khaimah 11172, United Arab Emirates"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2786-9630","authenticated-orcid":false,"given":"Imran Rashid","family":"Rangraze","sequence":"additional","affiliation":[{"name":"RAK College of Medical Sciences, RAK Medical and Health Sciences University, Ras Al Khaimah 11172, United Arab Emirates"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5761-2073","authenticated-orcid":false,"given":"Shakta Mani","family":"Satyam","sequence":"additional","affiliation":[{"name":"RAK College of Medical Sciences, RAK Medical and Health Sciences University, Ras Al Khaimah 11172, United Arab Emirates"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5383-8355","authenticated-orcid":false,"given":"Ashot","family":"Avagimyan","sequence":"additional","affiliation":[{"name":"Department of Internal Diseases Propedeutics, Yerevan State Medical University, Yerevan 0025, Armenia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6148-4094","authenticated-orcid":false,"given":"Karolina","family":"Hoffmann","sequence":"additional","affiliation":[{"name":"Department and Clinic of Internal Diseases and Metabolic Disorders, Pozna\u0144 University of Medical Sciences, 61-701 Poznan, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5718-7441","authenticated-orcid":false,"given":"Ioannis","family":"Ilias","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Diabetes and Metabolism, Elena Venizelou Hospital, GR-11521 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0058-2632","authenticated-orcid":false,"given":"Anna","family":"Paczkowska","sequence":"additional","affiliation":[{"name":"Department of Pharmacoeconomics and Social Pharmacy, Pozna\u0144 University of Medical 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