Nutritional supplementation with Panax ginseng extract and bone health in osteoporotic animal models: a systematic review and meta-analysis

Purpose To systematically evaluate the anti-osteoporotic efficacy of Panax ginseng extract as a nutritional supplement in animal models and provide high-quality evidence. Methods Eight databases were searched for randomized controlled trials comparing Panax ginseng extract with placebo in osteoporotic animals. Data on bone mineral density (BMD), bone microarchitecture, biomechanical parameters, and biochemical markers were extracted. Risk of bias (RoB) was assessed using SYRCLE's tool. Standardized mean differences (SMDs) or mean differences (MDs) with 95% confidence intervals (CIs) were calculated. Heterogeneity was evaluated with I 2 statistics, and sensitivity and subgroup analyses were performed. Results Twenty-eight studies met inclusion criteria. Panax ginseng extract significantly increased BMD ( SMD = 2.21, 95% CI 1.62–2.79, p < 0.000001) and improved trabecular number, thickness, bone volume fraction (BV/TV), and reduced trabecular separation. Biomechanical properties, including maximum load and stiffness, were enhanced. Biochemical analyses showed increased procollagen type I N-terminal propeptide (PINP), estradiol, osteocalcin, serum calcium, and phosphate, with decreased tartrate-resistant acid phosphatase (TRACP), while alkaline phosphatase (ALP) remained unchanged. Subgroup analyses indicated higher efficacy in female and naturally aged models, with ginsenosides as active components at doses ≤ 40 mg/(kg·d), and greater effects via intraperitoneal administration. Sensitivity analysis confirmed robustness. Conclusion Panax ginseng extract demonstrates consistent multi-dimensional anti-osteoporotic effects in animal models, supporting its potential as a multi-target therapeutic candidate. Further studies are warranted to optimize dosage, formulation, and clinical translation. Systematic review registration PROSPERO, identifier: CRD420251232252