# Can supplements with prebiotic fibres positively influence bone health in type 2 diabetes? Insights from a randomised controlled crossover trial

## TL;DR

A study found that prebiotic supplements did not improve bone health markers in people with type 2 diabetes, though gut microbiota interactions suggest potential for further research.

## Contribution

The study is the first to investigate prebiotic effects on bone health markers in people with type 2 diabetes using a crossover trial design.

## Key findings

- Inulin-type fructans did not significantly affect serum calcium, magnesium, vitamin D, or bone turnover markers in people with T2D.
- Post hoc analyses suggest possible interactions between gut microbiota and bone health in this population.
- The study does not support prebiotics as a short-term intervention for improving bone health in T2D patients.

## Abstract

Inulin-type fructans did not significantly improve serum levels of calcium, magnesium, vitamin D, or bone turnover markers in people with type 2 diabetes (T2D). However, interactions between gut microbiota and bone health were suggested, indicating the need for further research in this population.

Evidence suggests that a healthy gut microbiome benefits bone health, especially in immunocompromised populations like the elderly and people with T2D.

We investigated the effect of prebiotics (inulin-type fructans) on serum concentrations of calcium, magnesium, 25(OH) vitamin D, and the bone turnover markers N-terminal propeptide of type 1 collagen (P1NP), and C-terminal telopeptide of type 1 collagen (CTX-1) in people with T2D.

Participants (29) were treated for 6 weeks with 16 g inulin-type fructans and 16 g control supplement (maltodextrin) in randomised and double-blind crossover design, with a 4-week washout between treatments.

Compared to the control, inulin-type fructans did not significantly affect serum concentrations (mean ± SEM) of calcium (0.05 ± 0.02 mmol/L vs. 0.02 ± 0.03 mmol/L, p = 0.324), magnesium (0.02 ± 0.01 mmol/L vs. 0.00 ± 0.01 mmol/L, p = 0.352), 25(OH) vitamin D (-3.60 ± 1.94 nmol/L vs. -2.00 ± 1.97 nmol/L, P = 0.564), P1NP (0.81 ± 0.95 ug/L vs. -0.89 ± 0.97 ug/L, p = 0.210), or CTX-1 (-0.01 ± 0.01 ug/L vs. 0.00 ± 0.01 ug/L, p = 0.438). However, post hoc analyses of correlations between changes support that cross-talk between the human host and gut microbiota may influence bone health in this population.

This study does not support that inulin-type fructans may improve serum levels of calcium, magnesium, or 25(OH) vitamin D, nor that they affect bone turnover markers in people with T2D over 6 weeks. Interactions between microbiota and bone health in this population warrants further investigations.

The trial is registered at clinicaltrials.gov (NCT02569684).

The online version contains supplementary material available at 10.1007/s11657-025-01556-x.