What type of study is this?

This is a Network Meta-Analysis study (also classified as: Randomized Controlled Trials).

September 10, 2025Open Access

Effects of dietary supplements on bone turnover markers in women after menopause: a network meta-analysis

Key Points

Vitamin E supplementation significantly decreases CTX levels in postmenopausal women, indicating a beneficial impact on bone health.
Combination of vitamin D and K exhibited the highest effectiveness in raising P1NP and OC levels, supporting bone formation processes.
Vitamin K achieved the greatest increase in BAP levels, while calcium supplementation most effectively elevated ALP levels.
Protein supplementation notably reduced NTX levels, revealing its potential role in improving bone metabolism among postmenopausal women.

Abstract

Background Diminished estrogen levels in women after menopause contribute to an elevated risk of decreased bone mineral density (BMD) and disturbed bone metabolism. Dietary supplements are extensively employed as substitutes for prescription drugs, serving as a significant approach to modulate bone metabolism and improve bone health. Nevertheless, a lack of robust evidence prevents clinicians and patients from making the best-informed choices at present. Accordingly, a network meta-analysis (NMA) was performed to provide a comprehensive comparison of the effects of different dietary supplements on bone turnover biomarkers among postmenopausal women. Methods PubMed, Embase, Cochrane Library, and Web of Science databases were retrieved from their inception to November 20, 2024. Randomized controlled trials (RCTs) assessing the strength of dietary supplements in women after menopause were adopted in this research. Primary outcome indicators encompassed C-terminal telopeptide of type I collagen (CTX), procollagen type I N-terminal propeptide (P1NP), osteocalcin (OC), bone alkaline phosphatase (BAP), alkaline phosphatase (ALP), and N-terminal telopeptide of type I collagen (NTX). Risk of bias assessment was performed for each enrolled trial utilizing the ROB 2.0. A Bayesian NMA was conducted utilizing the R software (V4.4.1). Publication bias was assessed utilizing Stata 15.1. Results Forty-three RCTs involving 5,184 postmenopausal women were adopted. Research findings revealed that CTX levels decreased most substantially with vitamin E supplementation (SUCRA: 82.37%). Combining vitamin D and vitamin K most effectively elevated P1NP (SUCRA: 100.00%) and OC (SUCRA: 97.05%) levels. The greatest increase in BAP levels (SUCRA: 95.50%) was observed with vitamin K supplementation. Calcium supplementation yielded the largest elevation in ALP levels (SUCRA: 96.68%). Furthermore, protein supplementation resulted in the most significant reduction in NTX levels (SUCRA: 81.20%). Conclusion Dietary supplementation may serve as an important strategy for enhancing bone health in women after menopause by regulating bone metabolism. By promoting bone formation and inhibiting bone resorption, vitamin D, vitamin E, vitamin K, calcium, and protein may help mitigate the progression of osteoporosis.

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