Creatine monohydrate for lean mass, strength, and bone density in postmenopausal women: a systematic review and meta-analysis.
Level 1 - systematic review of randomized trials
Systematic review and meta-analysis of randomized controlled trials
PubMed 42141930 · doi:10.1080/15502783.2026.2668435
What was done
Authors searched six databases from 2000 to August 2025 for randomized, placebo-controlled trials evaluating creatine monohydrate supplementation (with or without resistance training) in postmenopausal women aged 40 to 45 years or older. Included trials had intervention durations of at least 6 weeks and reported DXA lean mass, 1RM strength, bone mineral density, physical function, or safety. Risk of bias was evaluated using Cochrane RoB 2, and random-effects meta-analyses with Hartung-Knapp-Sidik-Jonkman adjustment were performed.
What was found
Seven RCTs with 608 randomized participants (mean age ~62 years, duration 12-104 weeks) were analyzed. Creatine increased lean mass (5 trials, n = 338; mean difference +0.37 kg, 95% CI +0.05 to +0.69; I2 = 25%; 95% prediction interval -0.10 to +0.84) and leg-press 1RM strength (3 trials, n = 111; mean difference +7.5 kg, 95% CI +2.2 to +12.8; I2 = 0%). Benefits were observed when creatine was dosed at >= 5 g/day and combined with resistance training; doses <= 3 g/day without resistance training showed no measurable effect. Bone mineral density was unchanged overall. Adverse events were mild and similar to placebo, and renal indices remained unchanged. Risk of bias was mostly rated as "some concerns."
Why it matters
This review clarifies that creatine monohydrate provides modest gains in lean mass and lower-body strength in postmenopausal women primarily when combined with resistance training at doses of at least 5 g/day, while creatine alone does not improve bone density.
Limits
The total evidence base is small (7 RCTs), and individual outcome analyses had limited sample sizes (n = 111 for strength). The 95% prediction interval for lean mass crossed zero. Most included trials had risk of bias concerns, and the systematic review itself was not prospectively registered.
Cited by
- supports Five grams of creatine monohydrate supports muscle strength, exercise performance, and brain health.
- supports Meta-analyses show that creatine supplementation reduces fat mass while increasing lean mass, strength, endurance, and performance in females.
- supports Creatine supplementation has never been shown in scientific studies to provide bone health benefits without concurrent exercise training.
- partial Creatine supplementation has been shown to have beneficial effects on age-related muscle loss, strength loss, bone loss, and brain atrophy in older adults.