As people age, they often lose muscle and bone strength, which makes them weaker and more likely to fall or break a bone. This condition, called osteosarcopenia, can lead to frailty, fractures, and even early death.
It's defined as an age-related condition characterized by concurrent reductions in bone mineral and architecture, muscle mass (quantity and quality), strength, and functional ability(1).
The condition is multifactorial, with contributing factors including genomic instability, telomere attrition, epigenetic alterations, impaired protein homeostasis and autophagy, reduced nutrient sensing, mitochondrial dysfunction, cellular senescence, stem cell exhaustion, increased oxidative stress, inflammation, adiposity, and gut dysbiosis(2).
Globally, the prevalence of osteosarcopenia in older adults is estimated at 18.5%.
Individuals with osteosarcopenia face a significantly higher risk of adverse outcomes, including falls, fractures, frailty and premature mortality(1).
Malnutrition is identified as a significant predictor of osteosarcopenia. Current nutritional interventions for osteosarcopenia are limited, highlighting the need for further cost-effective strategies. Adequate protein intake, vitamin D and calcium are well tolerated and appear to be effective at mitigating some aspects of osteosarcopenia; however further cost-effective strategies are warranted(3).
Creatine monohydrate supplementation is proposed as a potential dietary strategy for managing osteosarcopenia.
Creatine is synthesized endogenously and can also be obtained through diet (animal products) or supplementation. Upon ingestion, creatine is absorbed and transported into skeletal muscle, where it is phosphorylated to phosphocreatine.
Creatine and phosphocreatine are crucial for maintaining cellular energy balance, particularly during high-intensity activities(4).
Higher intramuscular creatine levels are associated with a reduced risk of lower strength in older adults. Creatine monohydrate supplementation, especially when combined with resistance training, has been shown to increase total creatine stores in muscles, potentially enabling more effective exercise and leading to improvements in body composition and performance.
Supplementation of creatine monohydrate during resistance training increases total creatine content by 27% and improves whole-body lean tissue mass and muscle strength compared to placebo in older adults.
Meta-analyses and reviews up to 2023 indicate that creatine monohydrate combined with exercise training provides muscle benefits for older adults.
Benefits include:
Recent randomized controlled trials further support these findings, showing that creatine monohydrate with exercise can improve lean tissue mass and gait speed in older women, and strength across various exercises in older adults.
Potential mechanisms for these muscle benefits include influencing cellular hydration, gene expression, growth factors (IGF-I, myostatin), myogenic transcription factors, satellite cell activity, protein synthesis pathways, inflammation, and oxidative stress.
Figure: Purported mechanisms outlining how creatine combined with resistance training can mitigate bone and muscle loss in older adults (adapted from Candow et al 2025(5))
However, these mechanisms need further validation in older adults. Creatine monohydrate supplementation combined with resistance training has also shown potential in decreasing body fat percentage(6).
Creatine can influence bone tissue, as osteoblast cells rely on the creatine kinase reaction for ATP production. In vitro (outside the body) studies suggest creatine can enhance osteoblast metabolic activity and differentiation, potentially stimulating osteoprotegerin production, which inhibits bone resorption.
Indirectly, increased muscle mass from creatine may exert mechanical forces on bone, promoting bone formation.
Research on the efficacy of creatine monohydrate on bone measures is mixed.
Some individual studies have shown that creatine monohydrate with supervised resistance training can increase upper-limb bone mineral content, lower-limb bone area, and femoral shaft subperiosteal width, as well as attenuate hip bone mineral density loss and reduce bone resorption in older adults.
A long-term study (2 years) showed that creatine monohydrate with exercise preserved geometric properties of the femur (section modulus, bone buckling ratio, cortical thickness, subperiosteal width) indicative of fracture protection in older women(6).
However, this same study found no effect of creatine monohydrate on bone mineral density of the whole body, hip, spine, or bone speed of sound. A recent meta-analysis found no significant benefits of creatine monohydrate and resistance training on bone mineral density of the whole body, femoral neck, or lumbar spine(7).
Evidence suggests that creatine monohydrate with resistance training does not consistently affect measures of bone formation or metabolism. There is no evidence that creatine monohydrate alone (without exercise) provides bone benefits in older adults(4).
Current research indicates that creatine monohydrate with resisitance training shows promise for improving lean mass, regional muscle density, and muscle strength in healthy older adults. The transferability of these muscle benefits to individuals diagnosed with sarcopenia needs further investigation.
Some studies suggest that creatine monohydrate with supervised resistance training can improve bone geometry, potentially offering fracture protection, but does not appear to increase bone mineral density in healthy older adults. The effects of creatine monohydrate in older adults with pre-existing bone conditions (osteopenia, osteoporosis) or frailty, and on fracture incidence, are currently unknown.
No studies have yet investigated the effects of creatine monohydrate in older adults specifically diagnosed with osteosarcopenia.
Given the positive findings in healthy older adults, there is potential for creatine monohydrate to be a beneficial adjunct to exercise training in the management of osteosarcopenia.
Implications
The information suggests that creatine supplementation, particularly when combined with resistance exercise, holds promise for improving muscle health in older adults, which could be beneficial in the context of osteosarcopenia. While some evidence indicates potential positive effects on bone geometry and fracture risk, the impact on bone mineral density is less clear.
Further research, specifically focusing on individuals with osteosarcopenia is crucial to determine the clinical utility of creatine in managing this complex condition.
Your body is either getting stronger—or it’s breaking down. If you’re serious about muscle, strength, and performance, creatine isn’t optional. It’s essential.
ATP-Fusion is creatine monohydrate enhanced with a performance-focused dose of sodium and potassium, in order to better aid with creatine absorption and utilization within the body. Trusted by elite athletes to fuel explosive power, faster recovery, and long-term muscle health, it can be used any time of day, including pre or post-workout.
References:
1. Chen S, Xu X, Gong H, et al: Global epidemiological features and impact of osteosarcopenia: A comprehensive meta-analysis and systematic review. J Cachexia Sarcopenia Muscle 15:8-20, 2024
2. Franulic F, Salech F, Rivas D, et al: Deciphering Osteosarcopenia through the hallmarks of aging. Mech Ageing Dev 222:111997, 2024
3. Kirk B, Prokopidis K, Duque G: Nutrients to mitigate osteosarcopenia: the role of protein, vitamin D and calcium. Curr Opin Clin Nutr Metab Care 24:25-32, 2021
4. Candow DG, Moriarty T: Effects of Creatine Monohydrate Supplementation on Muscle, Bone and Brain- Hope or Hype for Older Adults? Curr Osteoporos Rep 23:1, 2024
5. Candow DG, Kirk B, Chilibeck PD, et al: The potential of creatine monohydrate supplementation in the management of osteosarcopenia. Curr Opin Clin Nutr Metab Care, 2025
6. Chilibeck PD, Candow DG, Gordon JJ, et al: A 2-yr Randomized Controlled Trial on Creatine Supplementation during Exercise for Postmenopausal Bone Health. Med Sci Sports Exerc 55:1750-1760, 2023
7. Hong M, Wang J, Jin L, et al: The impact of creatine levels on musculoskeletal health in the elderly: a mendelian randomization analysis. BMC Musculoskelet Disord 25:1004, 2024
