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Background <p>Chronic kidney disease (CKD) accelerates bone loss and immune dysfunction, with limited treatment efficacy due to altered mineral metabolism. Emerging evidence links gut microbiota to bone and immune health, yet data in CKD patients remain scarce.</p> Aim <p>To assess whether adding <i>Bifidobacterium animalis</i> subsp. <i>lactis</i> BB-12 to standard alendronate/vitamin D3 therapy improves bone mineral density (BMD), bone metabolism, and T cell immune function in osteoporotic elderly with CKD stage 3.</p> Methods <p>In this 12-month RCT, 128 patients (≥ 65 years) with CKD stage 3 and osteoporosis received alendronate/vitamin D3 plus either <i>B. lactis</i> BB-12 (<i>n</i> = 64) or placebo (<i>n</i> = 64). Outcomes included BMD changes, bone turnover markers, T cell subsets, metabolic parameters, and safety.</p> Results <p>The intervention group showed greater lumbar spine (5.8% vs. 3.9%) and femoral neck (3.7% vs. 2.4%) BMD gains (<i>p</i> &lt; 0.001). CTX-I reduction was more pronounced (-48.6% vs. -32.4%, <i>p</i> &lt; 0.001). Treg proportions increased (6.8% vs. 5.2%) and Th17/Treg ratio decreased (1.8 vs. 2.6) (<i>p</i> &lt; 0.01). Enhanced T cell mitochondrial respiration (OCR/ECAR: 2.4 vs. 1.8) and reduced inflammatory cytokines (IL-17, TNF-α) were observed (<i>p</i> &lt; 0.01). Adverse events were comparable.</p> Conclusions <p><i>B. lactis</i> BB-12 supplementation enhances standard osteoporosis therapy in elderly CKD stage 3 patients, improving BMD and immune-metabolic profiles via the gut-bone-immune axis.</p>

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Supplementation with the probiotic Bifidobacterium lactis BB-12 improves the efficacy of alendronate sodium/vitamin D₃ therapy on skeletal health in stage 3 CKD

  • 期刊论文

  • 发表日期：

    2026年4月16日

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  • Xiaolu Zhao,
  • Qianqian Zhai,
  • Xinyan Jia,
  • Yunfeng Zhu,
  • Yan Bao,
  • Xu Min,
  • Lu Du,
  • Yun Liu

摘要

Background

Chronic kidney disease (CKD) accelerates bone loss and immune dysfunction, with limited treatment efficacy due to altered mineral metabolism. Emerging evidence links gut microbiota to bone and immune health, yet data in CKD patients remain scarce.

Aim

To assess whether adding Bifidobacterium animalis subsp. lactis BB-12 to standard alendronate/vitamin D3 therapy improves bone mineral density (BMD), bone metabolism, and T cell immune function in osteoporotic elderly with CKD stage 3.

Methods

In this 12-month RCT, 128 patients (≥ 65 years) with CKD stage 3 and osteoporosis received alendronate/vitamin D3 plus either B. lactis BB-12 (n = 64) or placebo (n = 64). Outcomes included BMD changes, bone turnover markers, T cell subsets, metabolic parameters, and safety.

Results

The intervention group showed greater lumbar spine (5.8% vs. 3.9%) and femoral neck (3.7% vs. 2.4%) BMD gains (p < 0.001). CTX-I reduction was more pronounced (-48.6% vs. -32.4%, p < 0.001). Treg proportions increased (6.8% vs. 5.2%) and Th17/Treg ratio decreased (1.8 vs. 2.6) (p < 0.01). Enhanced T cell mitochondrial respiration (OCR/ECAR: 2.4 vs. 1.8) and reduced inflammatory cytokines (IL-17, TNF-α) were observed (p < 0.01). Adverse events were comparable.

Conclusions

B. lactis BB-12 supplementation enhances standard osteoporosis therapy in elderly CKD stage 3 patients, improving BMD and immune-metabolic profiles via the gut-bone-immune axis.