Creatine is now linked with improved bone health in postmenopausal women.
If you’re into fitness, especially weightlifting, you’ve probably heard about the benefits of creatine. The supplement is often connected to body builders, who have been using it to build muscle mass for years. Talk about its use as a more general fitness supplement has also been on the rise. But now, according to a University of Regina researcher, postmenopausal women may have as much cause to take it as gym rats.
The kinesiology and health studies professor says the nitrogen-containing compound, when combined with exercise, has beneficial effects on bone strength in postmenopausal women.
“It’s really quite groundbreaking and has huge implications for postmenopausal women who typically suffer hip and other bone fractures as they age,” Candow says. “In Canada alone, hip replacement surgeries and accompanying rehabilitation efforts cost our medical system $800 million annually. Creatine, when combined with exercise, is now something we can safely offer older women to help preserve bone strength, which may help prevent these fractures from happening in the first place.”
Creatine is located mostly in the body's muscles as well as in the brain, and can be found naturally in seafood and red meat, although at levels far below those found in supplements.
In addition to building muscle mass, creatine has also been used to treat certain brain disorders, neuromuscular conditions, and even congestive heart failure. But this new research suggests it also plays a role in maintaining bone strength in postmenopausal women.
Originally from Corner Brook, Newfoundland, Candow traveled to the University of Saskatchewan two decades ago to work with Dr. Phil Chilibeck, one of Canada’s most renowned clinical researchers in the area of healthy aging. After pursuing his master’s and PhD in exercise, nutrition, and sports performance in Saskatoon, studying under Chilibeck, Candow came to the University of Regina in 2007.
“I was fascinated how creatine could increase strength and endurance in athletes, making them bigger, stronger, and faster, and was curious to find out if this supplement could also impact bone health in postmenopausal women,” he says.
“Could these women live longer in their own homes and not have to rely on extended care if they had stronger bones?” he asks. “Our winters are long and cold, and we tend to have more falls and hip fractures as a result. I wanted to find out if more older women could survive these kinds of falls with healthier bones.”
So Candow teamed up with his mentor from the U of S and began a small-scale creatine study to generate pilot data.
“It was an opportunity to shift the focus from the muscle benefits of creatine impacting male athletes, to bone health impacts of creatine on older adults,” explains Chilibeck from his Saskatoon office. “While we saw some benefits on bone improvements with older men, it was postmenopausal women who saw the most dramatic improvements. We knew this was where we needed to dedicate our research.”
Chilibeck is proud of his former student, who first secured provincial funding with the Saskatchewan Health Research Foundation for the pilot, and then landed a larger grant through the Canadian Institutes of Health Research to study bone health in older women.
In 2013, the two professors put out a province-wide call through email, posters, and word-of-mouth, seeking postmenopausal participants from across Saskatchewan for the larger study. Over 500 women responded, and more than 250 volunteers were selected.
“Usually, studies of this nature are university-specific, but we wanted a sample size from across the province, and we got it,” Candow says.
Participants were assessed for bone strength at the beginning of the research program, with half of the participants given a placebo and the other half given large doses of creatine monohydrate. Depending on the weight of each participant, the creatine group received between 8-11 grams of creatine per day based on the formula of 0.14 grams of creatine per kilogram of body weight per day.
All participants were closely monitored for 24 months and performed supervised weight-bearing exercises three times per week as well as walking six times per week. The study took almost six years to complete, taking several more years to analyze data, with the results published just this spring. In total, the research took 10 years to complete.
“It was the largest randomized control trial in the world to examine the effects of creatine and exercise in postmenopausal women,” Candow explains. “We carefully measured kidney and liver function to make sure there were no side effects from creatine. All told, we put in over 1,000 hours of direct research. Those who took the creatine supplement had greater bone benefits, primarily bone strength, compared to those who took the placebo.”
“We now have verifiable proof that this compound can significantly improve measures of bone health in postmenopausal women. And that’s something to celebrate.”
Candow and Chilibeck also presented their results at the American College of Sports Medicine Conference in Denver, Colorado, this past June. Candow has since been on various podcasts and social media outlets discussing their novel findings.
Both Candow and Chilibeck caution that the success of creatine supplementation for postmenopausal women is only evident when taken in conjunction with exercise, primarily weight training.
“There’s no such thing as sitting on the couch, taking a wonder supplement, and being cured,” says Candow. “You still have to put in the effort. Creatine only works with exercise.”
Chilibeck concurs. “This is not a magic bullet to fix bones. It has to be used in conjunction with a larger program to work aging muscles as well.”
Candow adds that postmenopausal women need to be careful when browsing the supplement store aisles or shopping online. “Just any kind of creatine won’t do. It has to be creatine monohydrate. Other forms of creatine are not as effective or safe.”
Candow says his research has taken on a life of its own, and it’s inspired him to keep pushing further. “I want to find out if creatine can effectively reverse osteoporosis damage and maintain bone structure longer, or even prevent osteoporosis from happening in the first place. I want to know about creatine’s impact on younger females who may be prone to osteoporosis. Could creatine supplementation in adolescent girls increase bone density so they never get the disease? These are all questions that need to be answered.”
Candow notes that Saskatchewan currently has one of the highest levels of the bone-weakening disease of any province in Canada.
“Our winters are long and cold, and most people are inactive from about November to April,” says Candow.
“While that doesn’t cause osteoporosis, it certainly doesn’t help matters when it’s too cold to go outside and exercise. Our bones and our muscles are meant to move. When you compare osteoporosis rates in British Columbia, for example, to Saskatchewan, our osteoporosis rates per capita are significantly higher.”
Candow is hoping to reduce pain and suffering, as well as the enormous costs associated with bone fractures and hip replacements due to weakened bones.
“Creatine isn’t just for bodybuilders,” he says confidently. “We now have verifiable proof that this compound can significantly improve measures of bone health in postmenopausal women. And that’s something to celebrate.”