With increasing age muscle strength, lean/muscle mass and functional ability decline. This is commonly referred to as sarcopenia. Sarcopenia decreases the ability to perform activities of daily living (1). It is also associated with reductions in bone mass/strength and cognitive function (2). Creatine has been proposed as a possible countermeasure of sarcopenia. Accumulating research over the past few decades shows that creatine supplementation, primarily when combined with resistance-type activities, has some beneficial effects for older adults.
Creatine: what is it?
Creatine is a nitrogen-containing compound derived from reactions involving the amino acids arginine, glycine and methionine in the liver and brain (see blogs A and B). Alternatively, creatine can be consumed in the habitual diet (primarily from red meat and seafood; 1 kg of meat = ~ 5 grams of creatine) or through commercially manufactured products containing creatine. The vast majority of creatine products are in the form of creatine monohydrate. While skeletal muscle does not synthesize creatine, it houses approximately 95% of total body creatine stores (3). Subsequently, ≤ 5% of creatine stores are located in other tissues such as bone and the brain. Inside the cell, creatine becomes bound to phosphate and stored as phosphocreatine (PCr). Following formation of PCr, creatine is non-enzymatically degraded to creatinine (metabolic by-product) which is excreted in urine (3). Creatine plays a pivotal role in the maintenance of the ATP/ADP ratio through its involvement in the PCr energy system (3).
Creatine effects on muscle
The vast majority of research involving creatine supplementation in older adult populations has focused on changes in lean tissue mass and muscle performance (i.e. strength) in response to resistance training. Collectively, results across studies show that the creatine-resistance training ≤ 2 years combo increases whole-body lean tissue mass by about 1.4 kg over time (4). There is minimal evidence that creatine supplementation without exercise produces muscle benefits in older adults. While lean tissue mass is not muscle mass, a recent randomized controlled trial using a technique called peripheral quantitive computed tomography (pQCT) in older adults showed that creatine supplementation (0.1 grams/kg/day) with supervised whole-body resistance training for 1 year weeks significantly improved lower leg muscle density compared to placebo (5).
Muscle density is an independent risk factor for disability and falls in older adults. The combination of creatine supplementation and resistance training also increases upper- and lower-body strength (4) and functional ability (6) and decreases fat mass and body fat percentage in older adults (7). These benefits may be related to creatine supplementation influencing cellular hydration status, energy expenditure, myogenic transcription factor and satellite cell activity, muscle protein kinetics and inflammation and oxidative stress (4, 6). Importantly, the vast majority of these mechanistic and/or cellular effects from creatine supplementation have not been verified in older adults.
Creatine effects on bone
In addition to muscle, there is a small body of research which has focused on creatine supplementation and measures of bone biology in older adults. Creatine is taken up by bone and plays a crucial role in bone energy metabolism (8). Creatine increases the metabolic activity and differentiation of cells involved in bone formation (osteoblasts). Thus, creatine supplementation has been suggested to augment the bone remodeling process in favor of bone formation and serve as an effective intervention to maintain or improve bone mass and strength in older adults. However, only a few studies have shown favorable effects on measures of lower-body bone maintenance or strength in older adults from creatine supplementation and resistance training (9). The vast majority of research shows no bone benefits over time.
Effects of creatine on the brain
In addition to effects on muscle and bone, more recently studies have started to investigare the effects of creatine on the brain. There is emerging research demonstrating that creatine supplementation can improve indices of cognition and memory in older adults (10).
Conclusions about effects of creatine in older adults
In summary, the combination of creatine supplementation and resistance training increases lean tissue mass, muscle strength and measures of functional ability in healthy older adults. While there is some evidence that creatine and exercise can preserve regional bone structure, creatine does not increase bone mineral density in older adults. From a brain health perspective, creatine supplementation shows promise for improving measures of cognition/memory in healthy older adults.
References
Kirk B, Phu S, Brennan-Olsen SL, Bani H E, Duque G. Associations between osteoporosis, the severity of sarcopenia and fragility fractures in community-dwelling older adults. Eur Geriatr Med. 2020;11:443–50.
Arosio B, Calvani R, Ferri E, Coelho-Junior HJ, Carandina A, Campanelli F, et al. Sarcopenia and Cognitive Decline in Older Adults: Targeting the Muscle-Brain Axis. Nutrients. 2023;15:1853.
Wyss M, Kaddurah-Daouk R. Creatine and creatinine metabolism. Physiol Rev. 2000; 80:1107-1213.
Chilibeck PD, Kaviani M, Candow DG, Zello GA. Effect of creatine supplementation during resistance training on lean tissue mass and muscular strength in older adults: A meta-analysis. Open Access J Sports Med. 2017; 8:213-26.
Candow DG, Chilibeck PD, Gordon JJ, Kontulainen S. Efficacy of creatine supplementation and supervised resistance training on area and density of bone and muscle in older adults. Med Sci Sports Exerc. 2021;53:2388-95.
Candow DG, Forbes SC, Chilibeck PD, Cornish SM, Antonio J, Kreider RB. Effectiveness of creatine supplementation on aging muscle and bone: Focus on falls prevention and inflammation. J Clin Med. 2019;8: 488-502.
Forbes SC, Candow DG, Krentz JR, Roberts MD, Young KC. Changes in Fat Mass Following CreatineSupplementation and Resistance Training in Adults > 50 Years of Age: A Meta-Analysis. J Funct Morphol Kinesiol. 2019;4(3):62.
Wallimann T, Hemmer W. Creatine kinase in non-muscle tissues and cells. Mol Cell Biochem. 1994;133-134:193–220.
Candow DG, Chilibeck PD, Forbes SC, Fairman CM, Gualano B, Roschel H. Creatine supplementation for older adults: Focus on sarcopenia, osteoporosis, frailty and cachexia. Bone. 2022;162:116467.
10. Candow DG, Forbes SC, Ostojic SM, Prokopidis K, Stock MS, Harmon KK, et al. “Heads-Up” for Creatine Supplementation and Its Potential Applications for Brain Health and Function. Sports Med. 2023;53:49-65.
