A 2-yr Randomized Controlled Trial on Creatine Supplementation during Exercise for Postmenopausal Bone Health.
Level 2 - randomized trial
Individual randomized controlled trial
PubMed 37144634 · doi:10.1249/MSS.0000000000003202
What was done
A randomized controlled trial evaluated 237 postmenopausal women (mean age 59 yr) assigned to receive creatine monohydrate (0.14 g·kg⁻¹·d⁻¹) or placebo for 2 years. Both groups completed a concurrent exercise program consisting of resistance training (3 d·wk⁻¹) and walking (6 d·wk⁻¹). The primary outcome was femoral neck bone mineral density (BMD), with secondary outcomes including lumbar spine BMD, total hip BMD, proximal femur geometric properties, muscular strength, 80-meter walking time, and lean tissue mass.
What was found
Creatine supplementation showed no significant difference compared to placebo for BMD changes at the femoral neck (creatine: 0.725 ± 0.110 to 0.712 ± 0.100 g·cm⁻²; placebo: 0.721 ± 0.102 to 0.706 ± 0.097 g·cm⁻²), total hip (creatine: 0.879 ± 0.118 to 0.872 ± 0.114 g·cm⁻²; placebo: 0.881 ± 0.111 to 0.873 ± 0.109 g·cm⁻²), or lumbar spine (creatine: 0.932 ± 0.133 to 0.925 ± 0.131 g·cm⁻²; placebo: 0.923 ± 0.145 to 0.915 ± 0.143 g·cm⁻²). Creatine maintained femoral neck section modulus (1.35 ± 0.29 to 1.34 ± 0.26 vs 1.34 ± 0.25 to 1.28 ± 0.23 cm³, P = 0.0011) and buckling ratio (10.8 ± 2.6 to 11.1 ± 2.2 vs 11.0 ± 2.6 to 11.6 ± 2.7, P = 0.011). Creatine also reduced 80-meter walk time (48.6 ± 5.6 to 47.1 ± 5.4 vs 48.3 ± 4.5 to 48.2 ± 4.9 s, P = 0.0008). Muscular strength gains on bench press and hack squat did not differ between groups. In a subanalysis of valid completers, creatine increased lean tissue mass compared with placebo (40.8 ± 5.7 to 43.1 ± 5.9 vs 40.4 ± 5.3 to 42.0 ± 5.2 kg, P = 0.046).
Why it matters
This 2-year trial indicates that creatine supplementation does not augment exercise-induced bone mineral density preservation in postmenopausal women, though it may provide minor benefits to proximal femur geometry and lean mass.
Limits
The study was restricted to postmenopausal women engaging in a high-frequency exercise program, limiting generalizability to sedentary populations or men. Clinical fracture outcomes were not reported, and lean mass improvements were only statistically significant in a completers subanalysis.