Salvio Gianmaria, Ciarloni Alessandro, Gianfelice Claudio, Lacchè Francesca, Sabatelli Sofia, Giacchetti Gilberta, Balercia Giancarlo
Endocrinology Clinic, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, 60126 Ancona, Italy.
Antioxidants (Basel). 2023 Oct 5;12(10):1830. doi: 10.3390/antiox12101830.
Osteoporosis is a condition favored by the postmenopausal decline in estrogen levels and worsened by oxidative stress (OS). Polyphenols are natural compounds abundantly found in fruits and vegetables, and they exert antioxidant and hormonal effects that could be useful in osteoporosis prevention, as suggested by epidemiological studies showing a lower incidence of fractures in individuals consuming polyphenol-rich diets. The aim of our meta-analysis is to evaluate the effects of polyphenols on bone mineral density (BMD, primary endpoint) and bone turnover markers (BTMs, secondary endpoint) in postmenopausal women. Twenty-one randomized control trials (RCTs) were included in our analysis after in-depth search on PubMed, EMBASE, and Scopus databases. We found that supplementation with polyphenols for 3-36 months exerted no statically significant effects on BMD measured at lumbar spine (sMD: 0.21, 95% CI [-0.08 to 0.51], = 0.16), femoral neck (sMD: 0.16, 95% CI [-0.23 to 0.55], = 0.42), total hip (sMD: 0.05, 95% CI [-0.14 to 0.24], = 0.61), and whole body (sMD: -0.12, 95% CI [-0.42 to 0.17], = 0.41). Subgroup analysis based on treatment duration showed no statistical significance, but a significant effect on lumbar BMD emerged when studies with duration of 24 months or greater were analyzed separately. On the other hand, we found a significantly slight increase in bone-specific alkaline phosphatase (BALP) levels (sMD: 1.27, 95% CI [1.13 to 1.42], < 0.0001) and a decrease in pyridinoline (PD) levels (sMD: -0.58, 95% CI [-0.77 to -0.39], < 0.0001). High heterogeneity among studies and unclear risk of bias in one third of the included studies emerged. A subgroup analysis showed similar effects for different duration of treatment and models of dual-energy X-ray absorptiometry (DXA) scanner. More robust evidence is needed before recommending the prescription of polyphenols in clinical practice.
骨质疏松症是一种因绝经后雌激素水平下降而引发，并因氧化应激（OS）而加重的病症。多酚是在水果和蔬菜中大量存在的天然化合物，流行病学研究表明，食用富含多酚饮食的个体骨折发生率较低，这表明多酚具有抗氧化和激素作用，可能有助于预防骨质疏松症。我们进行荟萃分析的目的是评估多酚对绝经后女性骨密度（BMD，主要终点）和骨转换标志物（BTMs，次要终点）的影响。在对PubMed、EMBASE和Scopus数据库进行深入检索后，我们的分析纳入了21项随机对照试验（RCT）。我们发现，补充多酚3至36个月对腰椎（标准化均数差[sMD]：0.21，95%可信区间[CI][-0.08至0.51]，P = 0.16）、股骨颈（sMD：0.16，95% CI [-0.23至0.55]，P = 0.42）、全髋（sMD：0.05，95% CI [-0.14至0.24]，P = 0.61）和全身（sMD：-0.12，95% CI [-0.42至0.17]，P = 0.41）的骨密度没有统计学上的显著影响。基于治疗持续时间的亚组分析没有统计学意义，但当单独分析持续时间为24个月或更长时间的研究时，发现对腰椎骨密度有显著影响。另一方面，我们发现骨特异性碱性磷酸酶（BALP）水平有显著轻微升高（sMD：1.27，95% CI [1.13至1.42]，P < 0.0001），吡啶啉（PD）水平有下降（sMD：-0.58，95% CI [-0.77至-0.39]，P < 0.0001）。研究之间存在高度异质性，并且纳入的研究中有三分之一的偏倚风险不明确。亚组分析显示，不同治疗持续时间和双能X线吸收仪（DXA）扫描仪型号的效果相似。在临床实践中推荐使用多酚之前，需要更有力的证据。
