Creatine for Seniors: Boost Muscle & Brain Health?

Clinical Evidence

The review titled “Creatine monohydrate supplementation for older adults and clinical populations” (2025) synthesizes findings from multiple randomized controlled trials (RCTs) and observational studies evaluating creatine’s impact on age‑related declines in muscle mass, strength, bone health, and cognitive function. Across the pooled studies, creatine supplementation consistently produced modest but statistically significant improvements in muscle strength (average increase ≈ 5–10 % compared with placebo; p < 0.05) and lean body mass (≈ 1–2 kg gain; 95 % CI 0.5–2.5 kg). In several trials, participants receiving 3–5 g/day of creatine for 12–24 weeks demonstrated greater gains in knee‑extension torque (effect size ≈ 0.4–0.6) and hand‑grip strength (effect size ≈ 0.3) relative to controls. Bone mineral density (BMD) responses were more variable; a subset of studies reported a 1–2 % increase in lumbar spine BMD after 12 months of supplementation (p ≈ 0.04). Cognitive outcomes, primarily assessed via memory and executive‑function tests, showed small but significant improvements (Cohen’s d ≈ 0.2–0.3) in older adults with mild cognitive impairment. The review notes that benefits were most pronounced when creatine was combined with resistance training, suggesting a synergistic effect.

Mechanisms of Action

Creatine serves as a rapid phosphate donor for ATP regeneration via the phosphocreatine system, thereby enhancing cellular energy availability during high‑intensity, short‑duration activities. In skeletal muscle, elevated intramuscular phosphocreatine enhances the capacity for repeated contractile cycles, supporting greater training volume and subsequent hypertrophy. In bone, creatine may stimulate osteoblast differentiation through activation of the mTOR pathway and increase expression of osteogenic markers (e.g., Runx2). Neuro‑protective mechanisms include stabilization of mitochondrial membrane potential, reduction of oxidative stress, and modulation of neuronal calcium homeostasis, which collectively may support cognitive function.

Safety Profile

Across the reviewed trials, creatine was well tolerated. The most frequently reported adverse events were mild gastrointestinal discomfort (≈ 5 % of participants) and transient weight gain (primarily water retention). No serious adverse events, including renal impairment, were reported in participants with normal baseline kidney function. Contraindications include pre‑existing renal disease, as creatine metabolism increases renal load. Potential drug interactions involve concomitant use of nephrotoxic agents (e.g., NSAIDs) and medications that affect renal excretion; however, the review found no documented clinically significant interactions.

Dosage Information

The majority of studies employed a loading phase of 20 g/day (divided 4 × 5 g doses) for 5–7 days, followed by a maintenance dose of 3–5 g/day taken orally, typically with a carbohydrate‑rich beverage to enhance uptake. Duration of supplementation ranged from 8 weeks to 24 months, with longer interventions (>12 months) required to observe modest BMD changes. Studies consistently reported that adherence to the 3–5 g/day maintenance dose was sufficient to maintain elevated muscle phosphocreatine levels without the need for repeated loading phases.

Evidence Quality Assessment

The review aggregates data from >30 RCTs and several cohort studies, providing moderate‑to‑strong evidence for creatine’s efficacy in improving muscle strength and mass in older adults, especially when combined with resistance training. Evidence for bone density and cognitive benefits is weaker, derived from smaller, heterogeneous trials with limited follow‑up. Overall, the evidence base is robust for muscular outcomes (high‑quality RCTs, consistent effect sizes) but moderate to low for bone and cognitive outcomes due to heterogeneity and smaller sample sizes. The review’s conclusions are supported by statistically significant findings across multiple well‑controlled studies, though further large‑scale, long‑duration trials are needed to confirm bone and cognitive effects.