Modulating the gut ecosystem dietary, probiotic, and novel interventions for bone health in postmenopausal women.

Postmenopausal osteoporosis (PMO) is a metabolic bone disorder caused by estrogen deficiency, posing significant risks to the skeletal health and quality of life of middle-aged and elderly women. In recent years, the gut microbiota (GM) has emerged as a novel regulatory target in bone metabolism, attracting increasing research interest. Probiotics may modulate bone metabolism by directly introducing beneficial microorganisms (e.g., Lactobacillus, Bifidobacterium) to improve gut microbiota composition. The gut microbiota may influence the onset and progression of osteoporosis by modulating immune-inflammatory responses, endocrine regulation, nutrient absorption, and the production of metabolic byproducts. This review systematically summarizes the mechanisms by which gut microbiota affects postmenopausal osteoporosis, including the neuroendocrine brain-gut-bone axis, immune regulation, metabolic products such as short-chain fatty acids, intestinal barrier function, and their correlations with bone mineral density. Integrating the latest clinical and animal model studies, we further explore gut microbiota-based intervention strategies, such as probiotics, prebiotics, fecal microbiota transplantation, and dietary modulation. These insights may provide a theoretical foundation and practical guidance for the prevention and treatment of postmenopausal osteoporosis, highlighting the promising role of gut microbiota-targeted therapies in improving bone health in postmenopausal women.