Creatine Monohydrate Boosts Muscle, Bone, and Brain Health in Older Adults

As the global population ages, interventions that preserve muscle, bone, metabolic, and cognitive health become increasingly urgent. This 2025 narrative review by Candow and colleagues—published in a special supplement of the Journal of the International Society of Sports Nutrition—provides a thorough synthesis of creatine monohydrate supplementation (CrM) research in older adults and clinical populations, grounded in a detailed explanation of the creatine kinase (CK) energy system.

Creatine is a naturally occurring compound synthesized from arginine, glycine, and methionine, stored primarily as free creatine and phosphocreatine (PCr) in skeletal muscle. The CK system uses PCr as an immediately available energy buffer to regenerate ATP, maintaining cellular energy homeostasis during high-demand states such as intense exercise, illness, or metabolic stress. The authors explain that five distinct CK isoforms are strategically localized at sites of ATP production and consumption throughout the body, underscoring creatine's broad physiological relevance beyond muscle alone.

A critical epidemiological finding highlighted in the review is that approximately 70% of adults aged 65 and older consume less than the recommended 0.95 grams per day of dietary creatine—largely because older individuals tend to eat less meat and seafood. Low dietary creatine intake in this cohort is associated with poorer cognitive function and increased risk of conditions such as angina pectoris and liver disease. Standard CrM supplementation protocols (loading: ~0.3 g/kg/day for 5–7 days; maintenance: 0.05–0.15 g/kg/day) can increase muscle and tissue creatine and PCr levels by 20–40%.

Accumulating evidence reviewed by the authors demonstrates that CrM—particularly when combined with resistance exercise training—produces meaningful improvements across multiple domains: whole-body lean body mass, regional muscle hypertrophy, muscle strength, bone area and thickness, functional mobility, glucose kinetics, and neurological/cognitive outcomes including memory. These benefits are especially relevant for conditions like sarcopenia, osteoporosis, frailty, and metabolic or neuromuscular disorders that disproportionately affect older adults.

The review is authored by an international team of leading creatine researchers and draws on a broad literature base (287 references). While the narrative format provides rich mechanistic and clinical context, it does not employ systematic review or meta-analytic methods, meaning selection bias in study inclusion is possible. Additionally, some dietary creatine intake estimates cited rely on self-reported food records, which carry inherent variability. Overall, the authors conclude that CrM is safe, well-tolerated, and offers a compelling multi-system benefit profile for aging populations.