Is there evidence that creatinine supplementation improves bone health?

Creatine Supplementation for Bone Health: Evidence-Based Assessment

There is no evidence that creatine supplementation improves bone health in older adults, and it should not be recommended for this purpose. The highest quality randomized controlled trial directly addressing this question found no benefit after 2 years of supplementation 1.

Critical Evidence Against Bone Health Benefits

The most definitive study on this topic is a 2-year, double-blind, placebo-controlled trial in 200 postmenopausal women with osteopenia 1. This study found:

• Creatine monohydrate (3 g/day) did not prevent bone loss at the lumbar spine, femoral neck, or total femur compared to placebo 1
• No improvements in bone microarchitecture parameters or biochemical bone markers were observed 1
• The number of falls and fractures was unchanged with creatine supplementation 1
• Importantly, creatine also failed to increase lean mass or muscle function in this population, despite previous claims of anabolic properties 1

Supporting Evidence from Additional Trials

An 8-month randomized trial in aging adults (mean age 55 years) examined creatine timing around resistance training and found:

• No effect on bone mineral content or density at any skeletal site, regardless of whether creatine was taken before or after exercise 2
• A small decrease in femoral neck BMD occurred across all groups (including placebo), with no protective effect from creatine 2

Important Clinical Caveat: Creatinine vs. Creatine

A critical distinction must be made: your question asks about "creatinine supplementation," but creatinine is a waste product of muscle metabolism, not a supplement. The evidence reviewed addresses creatine supplementation, which is the relevant compound. Creatinine itself is not supplemented and has no therapeutic role 3.

Monitoring Consideration

If creatine supplementation is used for other purposes (e.g., cognitive or athletic performance), clinicians should be aware that:

• Creatine increases creatinine generation, which may falsely suggest acute kidney injury on creatinine-based eGFR measurements 4
• This does not represent actual kidney damage, but serum creatinine should be monitored to avoid misinterpretation 3

What Actually Works for Bone Health

Based on high-quality guidelines for osteoporosis management in adults:

• Calcium (1,000-1,200 mg/day total from all sources) and vitamin D (800-1,000 IU/day) are the foundational supplements for bone health 3
• Vitamin D plus calcium supplementation reduces hip fracture risk (RR 0.84,95% CI 0.74-0.96) and any fracture risk (RR 0.95% CI 0.90-0.99) 3
• Bisphosphonates (alendronate, risedronate, zoledronic acid, ibandronate) are first-line pharmacologic agents for osteoporosis prevention and treatment 3

Safety Profile of Creatine (If Used for Other Indications)

While creatine does not benefit bone health, its safety profile is well-established:

• The primary side effect is 1-2 kg body mass increase due to water retention 4, 5
• No significant negative health effects occur when appropriate protocols are followed (3-5 g/day maintenance dose) 4, 5
• Creatine supplementation is relatively well-tolerated at recommended dosages 5

Bottom Line for Clinical Practice

Do not recommend creatine supplementation for bone health improvement. The evidence conclusively demonstrates no benefit for bone mineral density, bone microarchitecture, or fracture prevention in older adults 1, 2. Instead, focus on evidence-based interventions including calcium, vitamin D, and bisphosphonates when indicated for osteoporosis management 3.