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Creatine tops list of promising drugs to combat osteosarcopenia, new review finds
Last reviewed: 27.07.2025
In a new review published in the journal Nutrients, researchers analyzed the effectiveness of promising dietary supplements—such as prebiotics, probiotics, and creatine—in improving muscle and bone health in older adults with osteosarcopenia.
They concluded that these supplements may play a significant role in supporting bone and muscle health and improving physical function in older adults. However, more data is needed to determine their effectiveness and understand which populations benefit most. They also noted that substances that affect bile acid metabolism are emerging as an emerging area of interest within the gut-bone-muscle axis.
The Growing Problem of Osteosarcopenia
Osteosarcopenia is a combination of osteoporosis (weakening of bones and loss of bone density) and sarcopenia (loss of muscle mass with age). This condition significantly increases the risk of falls, fractures, disability, and death in older adults.
By 2050, the number of people over 60 years old in the world will reach 1.5 billion, making osteosarcopenia a major public health problem.
Essential additives and their role
Creatine
- Important for energy production in muscles and the brain.
- Research shows that creatine supplementation combined with resistance training increases muscle mass, strength and function in older adults, reduces the risk of falls and maintains mobility.
- The effect on bone tissue is weak: creatine can improve the structure and strength of bones indirectly, due to an increase in muscle mass.
Hydroxymethylbutyrate (HMB)
- A metabolite of the amino acid leucine.
- May increase muscle protein synthesis and decrease muscle protein breakdown, helping to preserve muscle mass during periods of inactivity or illness.
- However, research results are mixed: the effects on muscle mass and physical performance remain inconclusive.
- There is no data yet on the effects on bones in humans.
Prebiotics and Probiotics
- They influence the composition of the intestinal microbiota, reduce inflammation and improve the absorption of nutrients.
- In animals, it has shown positive effects on bone and muscle health, but there are few high-quality clinical trials in older people.
- The risk of side effects is minimal, but rare complications (such as infections) may occur in people with weakened immune systems.
Conclusions
New nutritional supplements show promise for the prevention and treatment of osteosarcopenia in older adults.
- Creatine has the greatest amount of evidence for its effectiveness, especially when combined with physical activity and adequate protein and vitamin D intake.
- HMB and probiotics/prebiotics require further research to determine their benefits and target groups.
Overall, these approaches are considered safe and may complement standard interventions (physical activity, calcium, vitamin D, and protein) to preserve muscle and bone. However, larger studies are needed to optimize their use and select the best combinations for different populations.