Creatine for Bone Health in Women: Does it Help?

randomized-controlled-trial PMID: 37144634

Quick Summary: A study found that creatine, when combined with exercise, didn't boost bone density in postmenopausal women. However, it did improve bone strength and walking speed.

Does Creatine Help Bone Health?

This research looked at how creatine affects bone health in women after menopause. The study showed that creatine, taken with exercise, didn't increase bone mineral density (BMD). But, it did improve the structure of the bones, making them stronger. It also helped women walk faster.

What The Research Found

Bone Density: Creatine didn't change bone density in the hip or spine.

Bone Strength: Creatine improved the structure of the bones in the hip, making them stronger and better able to handle stress.

Walking Speed: Women taking creatine walked faster.

Muscle Mass: Women taking creatine gained more lean muscle mass.

Muscle Strength: Creatine did not improve muscle strength during bench press or hack squat.

Study Details

Who was studied: 237 women, average age 59, who had gone through menopause.

How long: The study lasted for 2 years.

What they took: Half the women took creatine supplements (0.14 grams per kilogram of body weight per day), and the other half took a placebo (a dummy pill). Everyone did resistance training 3 times a week and walked 6 times a week.

What This Means For You

Creatine and Exercise: If you're a postmenopausal woman, creatine combined with exercise might help improve your bone structure and make you more mobile.

Not a Bone Density Cure: Creatine alone isn't a magic bullet for boosting bone density.

Talk to Your Doctor: Always talk to your doctor before starting any new supplements.

Study Limitations

Not Everyone Finished: Some people dropped out of the study, which could affect the results.

No Bone Density Change: While bone structure improved, bone density didn't.

Exercise Matters: The study didn't separate the effects of creatine from the effects of exercise.

No Fracture Data: The study didn't look at whether creatine reduced the risk of broken bones.

Key Findings

This 2-year trial found that creatine supplementation combined with exercise did not improve bone mineral density (BMD) at the femoral neck, total hip, or lumbar spine in postmenopausal women. However, it significantly improved key bone geometric properties predictive of structural strength at the femoral neck: section modulus (indicating bending strength; P = 0.0011) and buckling ratio (indicating reduced cortical instability under load; P = 0.011). Creatine also reduced 80-meter walking time (P = 0.0008) and increased lean tissue mass in valid completers (P = 0.046), but showed no effect on muscular strength (bench press or hack squat 1RM).

Study Design

This was a 2-year randomized controlled trial (RCT) involving 237 postmenopausal women (mean age: 59 years). Participants were randomized to creatine or placebo groups, all engaging in a structured exercise program: resistance training 3 days/week and walking 6 days/week. The primary outcome was femoral neck BMD; secondary outcomes included lumbar spine BMD, proximal femur geometry, strength, walking speed, and body composition.

Dosage & Administration

Participants received creatine monohydrate at 0.14 g·kg⁻¹·d⁻¹ (approximately 9.8 g/day for a 70 kg woman) or a matched placebo. Supplementation was administered daily alongside the 2-year exercise intervention.

Results & Efficacy

BMD: No significant differences between groups at femoral neck (creatine: 0.725→0.712 vs. placebo: 0.721→0.706 g·cm⁻²), total hip, or lumbar spine (all P > 0.05).
Bone Geometry: Creatine maintained section modulus (1.35→1.34 vs. placebo: 1.34→1.28 cm³; P = 0.0011) and improved buckling ratio (10.8→11.1 vs. placebo: 11.0→11.6; P = 0.011).
Function: Walking time decreased by 1.5 seconds in creatine vs. no change in placebo (48.6→47.1 vs. 48.3→48.2 s; P = 0.0008).
Body Composition: Lean mass increased significantly in valid completers (40.8→43.1 vs. placebo: 40.4→42.0 kg; P = 0.046). Strength gains (bench press, hack squat) were similar between groups.

Limitations

The high attrition rate (only "valid completers" showed lean mass benefits) limits generalizability. BMD outcomes showed no clinical improvement despite positive geometric changes, raising questions about functional relevance. The exercise protocol was identical for both groups, so creatine’s isolated effects cannot be determined. Lack of dietary control and no fracture incidence data are additional constraints. Future studies should assess longer-term fracture risk and optimal dosing.

Clinical Relevance

For postmenopausal women, creatine + exercise may enhance bone structural integrity (not BMD) and functional mobility, potentially reducing fall risk. The 1.5-second improvement in walking speed suggests meaningful real-world mobility benefits. However, creatine alone is insufficient for osteoporosis prevention given the lack of BMD improvement. Clinicians might consider it as an adjunct to exercise for improving lean mass and bone geometry, but not as a primary osteoporosis treatment. Users should prioritize weight-bearing exercise alongside supplementation.