Efficacy of Creatine Supplementation and Resistance Training on Area and Density of Bone and Muscle in Older Adults By: Candow, Darren G., Chilibeck, Philip D., Gordon, Julianne J., Kontulainen, Saija 

Full text: https://journals.lww.com/acsm-msse/fulltext/2021/11000/efficacy_of_creatine_supplementation_and.19.aspx

Creatine + Resistance Training: Key Takeaways for Older Adults

• Creatine + Resistance Training = Stronger Bones
  Creatine supplementation increased total bone area in the distal tibia and tibial shaft, both important for reducing fracture risk.
  
  

• Improved Muscle Quality
  Participants taking creatine saw a significant increase in lower leg muscle density (MuD)—a key factor in reducing fall risk.
  
  

• Biggest Benefits Seen in Men
  Older men on creatine experienced increases in trabecular and cortical bone areas in the tibia. Men on placebo, oddly, showed a small increase in bone density, but not in bone area.
  
  

• No Changes in the Radius (Forearm Bone)
  There were no significant changes in forearm bone or muscle—likely due to the resistance training program having fewer exercises targeting the arms.
  
  

• Why This Matters
  Increased bone area and muscle density contribute to better balance, stronger bones, and lower risk of injury in aging adults.
  
  

Creatine Needs Training to Work
Previous studies using creatine without resistance training showed no benefit. This study confirms the combo is key.

How Creatine Might Help

• Boosts bone-building cell activity (osteoblasts)
  

• Reduces bone breakdown
  

• Enhances muscle growth and repair through improved muscle protein synthesis and satellite cell activity
  

• Bottom Line
  A year of creatine + resistance training may support bone structure and muscle quality—especially in the lower leg—which could help reduce falls and fractures in older adults.

International Society of Sports Nutrition position stand: safety and efficacy of creatine supplementation in exercise, sport, and medicine by Richard B. Kreider, Douglas S. Kalman, Jose Antonio, Tim N. Ziegenfuss, Robert Wildman, Rick Collins, Darren G. Candow, Susan M. Kleiner, Anthony L. Almada & Hector L. Lopez

Full text: https://jissn.biomedcentral.com/articles/10.1186/s12970-017-0173-z?utm_source=chatgpt.com#auth-Richard_B_-Kreider-Aff1

What This Review Looked At:

• Reviewed 1,000+ studies on creatine monohydrate.
  

• Assessed safety, efficacy, and clinical applications.
  

• Included research in sports, exercise, rehab, aging, injury prevention, and clinical populations.
  

Key Benefits of Creatine Supplementation:

• Increases Muscle Strength & Power
  

  • Enhances high-intensity exercise capacity.
    

  • Boosts lean body mass and strength over time.
    

• Speeds Recovery & Reduces Injury
  

  • Reduces inflammation and muscle damage post-exercise.
    

  • Lowers risk of injury, muscle cramping, and dehydration.
    

• Supports Rehab & Injury Recovery
  

  • Helps preserve muscle during immobilization.
    

  • Enhances strength gains during rehab.
    

• Neuroprotective Effects
  

  • May reduce damage from concussions, brain injury, and spinal cord injury.
    

  • Shows potential in neurodegenerative diseases (e.g., Parkinson’s, Huntington’s, ALS).
    

• Improves Aging & Longevity
  

  • Fights sarcopenia and bone loss in older adults.
    

  • May improve cognition, mood, and glucose control.
    

• Safe & Well-Tolerated
  

  • No evidence of harm to kidneys, liver, or hydration status.
    

  • Safe even at high doses (up to 30 g/day for 5 years in clinical populations).
    

 ISSN’s Official Position on Creatine:

1. Most effective ergogenic supplement available for increasing strength and performance.
   

2. Safe across all age groups—including children, adolescents, and elderly adults.
   

3. Creatine should not be restricted based on age; caution labels for <18 are legally driven, not science-based.
   

4. Clinical doses of 0.3–0.8 g/kg/day have been used safely in infants, teens, adults, and elderly.
   

5. Creatine may reduce risk in contact sports due to its neuroprotective properties.
   

6. Monohydrate remains the most proven and effective form.
   

7. Creatine with carbs or protein may enhance muscle uptake.
   

8. Loading (0.3 g/kg/day × 5–7 days) followed by maintenance (3–5 g/day) is most effective.
   

9. More research is encouraged into its use in healthcare and clinical medicine.

 Bottom Line:

Creatine isn’t just for athletes—it’s one of the safest and most researched supplements with widespread benefits across age, sport, and health. Creatine monohydrate = proven performance + long-term health support.
— International Society of Sports Nutrition (ISSN)

Effect of creatine supplementation during resistance training on lean tissue mass and muscular strength in older adults: a meta-analysis

Full text: https://www.dovepress.com/article/download/35430

Purpose of the Study

This meta-analysis set out to determine how creatine supplementation, combined with resistance training, affects:

• Lean tissue mass

• Upper-body strength (via chest press)

• Lower-body strength (via leg press)
  in older adults (ages 57–70).
  

Many individual studies have shown mixed results, so this large-scale analysis aimed to provide clearer conclusions using pooled data.

How the Research Was Done

 Study Design

• Type: Meta-analysis of 22 randomized controlled trials (RCTs)
  

• Participants: 721 older adults (men and women), average age between 57 and 70
  

• Intervention: Creatine monohydrate supplementation + resistance training (2–3x/week)
  

• Duration: 7 to 52 weeks
  

• Control: Placebo + resistance training
  

Outcome Measures

Researchers analyzed:

• Lean tissue mass (via DXA, hydrostatic weighing, or air displacement)
  

• Chest press strength (upper body)
  

• Leg press strength (lower body)
  
  

Supplement Protocols

• Some studies included a loading phase (20g/day for 5–7 days), followed by 3–5g/day
  

• Others used a low-dose daily approach (3–5g/day)
  

• A few studies combined creatine with protein or CLA—these were analyzed both separately and together
  

Key Results

1. Lean Tissue Mass

• Creatine groups gained ~1.37 kg more lean mass than placebo groups
  (Mean difference = 1.37 kg; p < 0.00001)
  

2. Upper-Body Strength (Chest Press)

• Creatine significantly improved chest press strength(Standardized Mean Difference = 0.35; p = 0.0002)
  

3. Lower-Body Strength (Leg Press)

• Leg press strength also improved, which is important as leg strength declines faster with age
  (SMD = 0.24; p = 0.01)
  
  

Consistency of Results

• Even when studies with added supplements or chronic conditions (e.g., diabetes, osteoarthritis) were excluded, the results remained significant
  
  

• Funnel plots showed no evidence of publication bias
  
  

Why Does Creatine Work?

The authors highlight multiple mechanisms that explain the results:

1. Boosts cellular energy (PCr/ATP system), helping older adults train harder
   

2. May stimulate satellite cells, which help repair and grow muscle
   

3. Might enhance muscle protein synthesis and reduce breakdown
   

4. Can increase muscle cell hydration, triggering growth signals
   

5. May improve glycogen storage and glucose metabolism
   

Safety Findings

Across all 22 studies:

• No serious adverse effects
  

• A few cases of temporary bloating or cramping
  

• No negative effects on liver or kidney function, even in studies lasting up to 1 year
  
  

Final Conclusion from the Researchers

“Creatine supplementation during resistance training significantly increases lean tissue mass, chest press strength, and leg press strength in older adults... and is well-tolerated with no serious adverse effects.”

This study supports the use of creatine as a powerful, evidence-based tool to fight age-related muscle loss—also known as sarcopenia—and improve both appearance and performance in aging populations.

Variables Influencing the Effectiveness of Creatine Supplementation as a Therapeutic Intervention for Sarcopenia

Full text: https://pmc.ncbi.nlm.nih.gov/articles/PMC6696725/

Creatine for Aging Muscles: What the Research Shows

Sarcopenia—the age-related loss of muscle and strength—affects up to 13% of adults over 60, increasing the risk of frailty, disability, and disease. This research review explored whether creatine supplementation, especially when paired with resistance training, can help reverse or slow down sarcopenia.

Key Findings

Creatine + Resistance Training = Gains

• Three large meta-analyses found that creatine boosts:
  

  • Muscle mass (avg. +1.2 kg)
    

  • Upper & lower body strength
    

  • Physical performance (e.g., sit-to-stand, walking tests)
    
    

Works Especially Well for Women

Postmenopausal women showed improved lean muscle, strength, and daily task performance when combining creatine with supervised strength training.

Creatine May Be More Effective When Taken After Exercise

• One study showed greater muscle gains when creatine was taken after workouts, rather than before.
  

Even More Powerful With Resistance Training

• Studies without strength training showed mixed results—creatine is most effective when paired with consistent resistance training.
  

Why It Works

• Increases muscle energy: Creatine restores phosphocreatine (PCr) levels, essential for quick ATP (energy) recovery during workouts.
  

• Enhances muscle contractions: Helps calcium cycle more efficiently in muscles.
  

• May reduce protein breakdown: Especially in men, creatine reduced a marker of muscle breakdown.
  

• Potential mitochondrial support: May help combat aging-related oxidative stress and muscle cell damage.
  
  

Things to Know

• Not everyone responds the same: Factors like low baseline creatine, muscle fiber type (type II), and dietary intake can influence results.
  

No serious side effects reported: Some studies noted mild issues like GI irritation or cramping, but no kidney or liver harm.