Creatine for Women's Bone Health: What the Evidence Shows

The Question Behind This Article

Can creatine help women protect their bones? It is one of the fastest growing questions in supplement search, and it sits at the centre of a talk that nutrition scientist Dr. Susan Kleiner gave at the Creatine Conference 2025. Kleiner has spent more than three decades writing about nutrition for health and performance, has consulted for professional sports teams, and serves on the scientific advisory board of a creatine industry group. Her presentation was unusual for a scientific conference because it combined three things: her own bone density data, a summary of the clinical research on creatine and bone, and a frank discussion of how creatine should and should not be marketed to women.

This article pulls apart those three threads. It sets Kleiner’s personal story against what the trials actually show, checks her key claims against independent sources, and looks at what the research still cannot answer. The short version is that creatine’s role in women’s bone health is real enough to study seriously but not yet settled enough to promise anything, and the rest of a bone protection plan (lifting, protein, calcium, vitamin D and sleep) is doing most of the heavy lifting.

One Woman’s Osteopenia Experiment

Kleiner’s interest in this topic became personal in 2021. She explains that during the early pandemic she closed her own consultancy and stepped in to run the front desk of her husband’s dental practice outside Seattle, a period she describes as the most sedentary of her life. She was 64 at the time. By her own account, that year combined poor sleep, high stress, reduced physical activity and inattention to diet, which she calls a particularly bad combination at that stage of life.

A bone density scan that year showed osteopenia, meaning bone density below the normal range but not yet in the osteoporosis range. Her physician recommended a prescription medication, most likely a bisphosphonate, which Kleiner says is the standard first line treatment. She asked instead for one year to see whether lifestyle changes could move her numbers, and her doctor agreed.

According to Kleiner, the protocol she built for herself included the following elements:

Resistance training. She returned to powerlifting three times a week with a trainer, something she had done when younger but had stopped. She says she did little dedicated aerobic exercise in the first year and focused on never missing a lifting session.

Protein and energy. She followed what she calls an anabolic diet, eating about 1.7 grams of protein per kilogram of body weight per day and at least 30 calories per kilogram per day, which she judged appropriate for her age and activity.

Creatine. She took 7 grams of creatine monohydrate daily, which she describes as a dose of about 0.1 grams per kilogram (in the talk she misspoke and said 0.01, but 7 grams for her body weight matches the 0.1 figure used in the trials she cites).

Calcium and vitamin D. She aimed for 1,200 milligrams of calcium per day from food and supplements, with plenty of dairy, and supplemented vitamin D to keep her blood levels around 50 to 55, which she considers important in the low sunlight Pacific Northwest.

Sleep. She made sleep a priority after a year of neglecting it.

The results she shared came from repeat DEXA scans. From 2021 to 2022, she says her bone density increased at both femoral necks, the part of the hip that Kleiner notes is treated as the most important site for judging hip fracture risk. By 2024, three years on and now between 64 and 67 years of age, her left femoral neck density was up 0.6 percent and her right was up 5.3 percent from baseline, and her estimated ten year hip fracture risk was very low. She reports that Dr. Darren Candow, one of the most published researchers on creatine and bone, reviewed her data personally and told her that maintaining or slightly increasing bone density at that age is a notable outcome because most women in that age range are losing bone.

Kleiner also describes her doctor’s reaction. When he saw the first year of data, he told her she was not supposed to be able to do that, but he never asked what she had done. She uses this as a broader point: physicians often assume patients will not change their lifestyle, and if they do not know what lifestyle change can achieve, they cannot offer it as an option.

What a Single Case Can and Cannot Tell Us

Kleiner is careful to call her data an N of one, and that honesty matters. A single person’s results, however carefully measured, cannot separate the effect of creatine from the effect of powerlifting, higher protein, calcium, vitamin D, better sleep or simply reversing a year of unusual inactivity. She changed all of these at once. It is entirely possible that the lifting and the nutrition did most of the work, and the research below suggests that is the most likely reading.

Two further cautions apply. First, her starting point was a year she describes as the most sedentary of her life, so some of the improvement may reflect recovery of bone that had been lost unusually fast rather than a gain above her previous baseline. Second, a single set of scans over three years is a small number of data points, and bone density measurement has its own variability from scan to scan.

None of that makes her story uninteresting. It is a well documented example of what a comprehensive lifestyle approach can produce in a motivated older woman, and it is consistent with the direction of the trial evidence on lifting. What it cannot do is tell us how much of the result belongs to creatine.

The Creatine and Bone Research

Kleiner grounds her story in what she calls the most representative trial of the strategy she used: a 2015 study led by Philip Chilibeck with Candow as coauthor. In that trial, postmenopausal women did supervised resistance training three days a week for 12 months while taking either creatine at 0.1 grams per kilogram per day or a placebo. Forty seven women were randomised and 33 completed the year. The creatine group lost about 1.2 percent of bone density at the femoral neck, while the placebo group lost about 3.9 percent, a statistically significant difference. The creatine group also showed an increase in the width of the femoral shaft, a geometric property linked to bending strength, and gained relatively more bench press strength. There were no differences between groups in the other bone sites measured, and no signs of liver or kidney problems.

Kleiner points out, correctly, that the creatine group in this trial still lost bone at the femoral neck. Creatine plus lifting slowed the loss; it did not reverse it. She contrasts this with her own increase and relays Candow’s view that the difference between the trial groups approached clinical relevance because a 5 percent decrease in bone density at the hip is associated with roughly a 25 percent higher fracture risk. That relationship is widely repeated in summaries of the trial, but this article could not trace it to its original source, so it is best treated as a commonly cited rule of thumb rather than an established figure.

The story gets more complicated after 2015, and this is where a careful reader should slow down.

In 2018, Forbes, Chilibeck and Candow published a small meta analysis pooling five randomised trials of creatine plus resistance training in adults over 50 or postmenopausal women, 193 participants in total. Two of the five trials reported bone benefits, but when the results were combined there was no greater effect of creatine on bone density at the whole body, hip, femoral neck or lumbar spine than resistance training alone. The authors concluded that the number of trials was too small to draw firm conclusions.

The bigger test came in 2023. The same research group ran a two year randomised, double blind, placebo controlled trial in 237 postmenopausal women, roughly five times the size of the 2015 study. Participants took creatine at 0.14 grams per kilogram per day or placebo, did resistance training three days a week and walked six days a week, and everyone received calcium and vitamin D. This was the trial the 2015 pilot was designed to justify, and it was powered to detect the 5 percent difference at the femoral neck that the researchers expected would matter for fracture risk. Creatine had no effect on bone density at the femoral neck, total hip or lumbar spine. What it did do was preserve two geometric properties of the femoral neck, section modulus and buckling ratio, that reflect resistance to bending and to collapse of the outer shell. Both worsened in the placebo group and held steady with creatine. A 2025 meta analysis covering 20 trials and more than 1,000 older adults reached a similar conclusion: creatine plus exercise improved strength and reduced body fat percentage but did not significantly change total body bone density.

So where does that leave Kleiner’s claim? Her description of the 2015 trial is accurate. But the larger and longer follow up trial did not confirm a bone density benefit, and the pooled evidence does not show one either. The most defensible summary today is that creatine combined with resistance training may help preserve aspects of bone structure and strength in postmenopausal women, and it clearly supports muscle and strength gains, but it has not been shown to raise bone density or reduce fractures. Anyone who tells you creatine builds bone is ahead of the data.

The Rest of the Protocol

If creatine is not the main driver, what is? The strongest evidence in Kleiner’s protocol belongs to the lifting.

A 2023 network meta analysis of 19 randomised trials in 919 postmenopausal women found that moderate intensity resistance training improved bone density at both the lumbar spine and the femoral neck compared with usual daily life, and that three sessions a week outperformed two. That matches Kleiner’s schedule almost exactly. An earlier pooled analysis found that resistance training combined with weight bearing or impact activity was more effective for hip and spine density than resistance training alone, which is worth knowing for anyone designing a programme.

Her protein target of 1.7 grams per kilogram per day is well above what most bone and muscle guidelines suggest. The European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis recommends 1.0 to 1.2 grams per kilogram per day for postmenopausal women, with 20 to 25 grams of protein at each main meal, and a similar position from the European Society for Clinical Nutrition and Metabolism makes the same case for adults over 65. Higher intakes like Kleiner’s are common in athletic populations and are not considered harmful in people with healthy kidneys, but the evidence that going above 1.2 adds bone benefit is thin. Her choice reflects her performance nutrition background more than a bone specific recommendation.

Her calcium target is exactly what the National Institutes of Health recommends: 1,200 milligrams per day for women aged 51 and older, ideally from food first. Kleiner’s preference for dairy fits that advice. Her vitamin D approach, supplementing to keep blood levels in the 50s in a cloudy climate, also aligns with the same European consensus, which recommends 800 international units per day to keep levels above 50 nanomoles per litre. One caution: the number Kleiner quotes appears to be in nanograms per millilitre, the unit used by most US labs, which is a considerably higher blood level than 50 nanomoles per litre. Either way, she was not deficient.

The remaining pieces, adequate energy intake and sleep, do not have direct bone density trials behind them, but chronic under eating is a well recognised risk factor for bone loss in women, and Kleiner’s emphasis on eating enough to support training is consistent with mainstream sports nutrition guidance.

Where Bisphosphonates Fit

Kleiner says the medications her doctor offered mostly slow bone loss and do not rebuild bone, and that they come with issues that make them less than ideal. That is partly right and partly an understatement of what they do.

Bisphosphonates work by inhibiting osteoclasts, the cells that break bone down. Reviews of the drug class describe them as reducing bone resorption, which lowers bone turnover and increases bone mineral density, and the pivotal trials of alendronate, risedronate and zoledronic acid showed reductions in spine, hip and other fractures compared with placebo. So they do more than slow loss; they produce measurable gains in density and, more importantly, fewer fractures, which is the outcome that actually matters. Kleiner’s point that they are not a rebuilding therapy in the way that some newer anabolic drugs are is fair, and side effects and duration of treatment are real considerations that reviewers discuss at length.

The practical takeaway is not that lifestyle beats medication. Kleiner’s doctor agreed to a one year trial of lifestyle change because her osteopenia was mild and her fracture risk was low. For a woman with osteoporosis or a prior fracture, the calculation is different, and delaying treatment carries risk. What her story does show is that asking your doctor how much time you have, and what a comprehensive lifestyle plan might achieve in that time, is a reasonable question to put on the table.

Creatine Beyond Bone for Women

Kleiner’s broader case is that creatine deserves a place as a foundational nutrient for women, not just a gym supplement, and here the evidence is more encouraging than it is for bone.

A 2021 review in Nutrients, coauthored by Candow, summarises why women may respond differently to creatine. Women have roughly 70 to 80 percent lower stored creatine than men, and their creatine metabolism shifts across the menstrual cycle, pregnancy, the postpartum period and menopause. The review reports that creatine improves strength and exercise performance in premenopausal women, and that postmenopausal women may see gains in muscle size and function, with the most consistent bone effects appearing only when creatine is combined with resistance training.

The cognitive evidence that Kleiner mentions as part of menopause focused marketing has some support. A 2023 meta analysis of randomised trials in healthy adults found a small but significant improvement in memory with creatine compared with placebo. A larger 2024 meta analysis of 16 trials and 492 participants found benefits for memory, attention time and processing speed, with no effect on overall cognition or executive function, and it rated the certainty of the memory evidence as moderate and the rest as low. Notably, subgroup analyses suggested larger effects in women. These are modest effects in short trials, not a treatment for brain fog, but they are real signals.

Mood is more preliminary. An eight week randomised trial of 52 women with major depression found that adding 5 grams of creatine to an antidepressant produced faster and greater symptom improvement than placebo, with remission at eight weeks roughly twice as common. That is a single small trial in a clinical population, so it is a reason for more research rather than a reason to self treat.

On safety, the expert consensus paper Kleiner alludes to when she talks about myths is the 2021 review from Antonio and colleagues in the Journal of the International Society of Sports Nutrition, updated with a second part in late 2024. It concludes that creatine monohydrate is well tolerated at recommended doses of 3 to 5 grams per day or 0.1 grams per kilogram, that the water retention seen in some early studies is small and temporary, that creatine does not increase fat mass, that it does not harm kidney function in healthy people, and that it is not only effective for men. A 2025 safety review adds that gastrointestinal discomfort is reported by some users mainly at high doses and is not universal. Kleiner’s dose of 7 grams sits slightly above the standard maintenance range but within the range used in the bone trials.

Why Women Take Supplements and How Messages Land

The second half of Kleiner’s talk moves from physiology to persuasion, and she is open that this is a science of its own. Her central argument is that good data does not change behaviour unless it is framed as a solution to a problem women already recognise, and that brands and scientists both need to understand what those problems are.

She starts with survey data showing that women take supplements to promote health and as insurance against future illness. That matches a multi year series of consumer surveys published by the Council for Responsible Nutrition, which found that the leading reasons for supplement use are overall health and wellness and filling nutrient gaps, that use is higher among women than men, and that supplement users are more likely than nonusers to exercise, eat well and see their doctor. Kleiner maps these motives onto two established behaviour change models, the theory of planned behaviour and behavioural economics, and argues that this is the right place for creatine messaging to begin.

She then draws on a conversation with Dr. Mary Claire Haver, founder of The Pause Life, a menopause focused brand and education platform. According to Kleiner, Haver tells patients that women have high expectations for their health but that their actual health outcomes run about 20 percent below men’s, that women carry more chronic disease and are unwell for longer, and that restrictive dieting is particularly damaging for muscle and bone in midlife. The specific 20 percent figure could not be verified for this article and should be treated as Haver’s framing rather than an established statistic. The broader point is well supported: a 2024 report from the World Economic Forum and the McKinsey Health Institute found that women live longer than men but spend about 25 percent more of their lives in poor health, with much of that gap falling during working years and much of it tied to preventable failures in diagnosis and care.

Kleiner’s discussion of framing theory is also on solid ground. The classic work by Rothman and Salovey proposed that messages emphasising gains work better for prevention behaviours, such as exercise or healthy eating, while messages emphasising losses work better for detection behaviours, such as screening. A meta analysis of 93 studies found a small but real advantage for gain framed messages in encouraging prevention behaviours, though the effect was strongest for dental hygiene and weaker elsewhere, so the advantage is modest rather than dramatic. Kleiner’s example is practical: she says she recently rewrote a client’s website to talk about better health, energy and focus rather than about lack of memory, lack of focus and lack of energy, on the grounds that the same facts land differently depending on the frame.

She also names three further models that she believes creatine messaging can draw on. The elaboration likelihood model, in her reading, favours health focused messaging that encourages people to think carefully and adopt durable habits rather than trying a product and dropping it. Psychological and emotional appeal, in her view, means offering a sense of personal control over wellbeing, ideally anchored to specific life stages such as pregnancy, postpartum or menopause rather than a generic wellness pitch. And what she calls reducing the medicalisation of everyday life means avoiding language that treats normal transitions in a woman’s body as disorders to be fixed. Kleiner says she dislikes the phrase food as medicine for this reason and argues that women do not want to be told that the male body is the default and theirs is a problem.

Lessons From Brands

Kleiner walks through several brands to show these ideas in practice. She describes The Pause Life as using all five strategies at once: highlighting cognitive and mood benefits during menopause, tying creatine to strength and recovery, publishing educational content that addresses myths about safety, hydration and body composition, positioning creatine within a broader wellness toolkit, and building a community so that taking creatine feels like what women like me do. She acknowledges that choosing one life stage can feel like narrowing the audience but argues it is better to reach an entire life stage than to barely reach everyone, and that women a decade younger will eventually look to the same authority as they approach menopause.

She contrasts this with Women’s Best, which she says targets a fitness minded and typically younger audience with lean muscle, energy and recovery messaging and uses testimonials; Transparent Labs, which she credits with detailed myth busting content on bloating and bulking that builds trust with first time female users; Klean Athlete, which takes a more academic, educational approach through webinars and product guides; and Alani Nu, which leans on Instagram and TikTok workout routines, recipes and question sessions to build community. She notes that innovation in delivery formats, including gummies and what she calls waterless powders, is expanding, and that taste, price, convenience and effectiveness remain what consumers actually rank highest.

Her sharpest warning is aimed at brands that market creatine to women by claiming that ordinary creatine causes gut upset and bloating while theirs does not. Kleiner calls this creating a myth in order to sell against it. She predicts it may work in the short term but will fail over time because women read other sources, talk to other people, and eventually learn that bloating is not a meaningful side effect of creatine at normal doses. The expert reviews cited above support her on the science.

She closes this section with a line from creatine researcher Dr. Richard Kreider, which she paraphrases as the idea that what was once seen as a sports supplement has grown into something that can affect health from infancy to old age. Kleiner likes it because it is health focused, preventive, positive, holistic and empowering all at once. It is worth adding that the evidence supporting that arc is much stronger at some life stages than others, which brings us to what is still missing.

The Research Women Still Need

Kleiner’s final appeal is to the scientists in the room, and it doubles as a useful map of where the evidence is thin.

She calls for more data on female athletes across every life phase, from elite to recreational. The 2021 lifespan review makes the same point and notes that creatine research in women remains understudied relative to men.

On pregnancy and fertility she is openly speculative, wondering aloud whether creatine might one day help some women conceive or improve energy and quality of life through pregnancy and postpartum, and whether a male partner’s creatine status could matter. The current position is that this is hypothesis, not evidence. A 2014 review from Monash University researchers argued from animal studies that creatine supplementation in late pregnancy might protect the fetus against oxygen deprivation, and a 2021 review of creatine in female reproduction found that disruptions to creatine metabolism are linked to poorer fertility and pregnancy outcomes in observational and animal data. Both reviews are explicit that human trials have not been done and that creatine is not currently used or recommended in human pregnancy. The Antonio safety reviews likewise flag pregnancy as a population where evidence is lacking.

She asks for mechanistic studies of creatine and bone that begin before peak bone mass, and for longer studies in younger women. Given that the two year trial in older women was null for density, this is a fair request; if creatine has a bone effect, it may be easier to see during bone building years than during loss.

She raises creatine as a complement to semaglutide and similar weight loss medications, where a meaningful share of the weight lost is lean tissue. This is a live research question rather than a finding: a registered pilot trial led by Chilibeck is randomising 40 people starting these medications to 10 grams of creatine or placebo during 12 weeks of resistance training to see whether lean mass and function are better preserved. Until such trials report, the honest position is that resistance training and adequate protein are the established tools for protecting muscle during rapid weight loss, and creatine is a plausible addition under study.

On cancer, Kleiner is appropriately cautious. She notes that oncologists she has spoken with worry that creatine could fuel the energy needs of a tumour, and that every cancer is different. The literature reflects exactly that tension. A 2024 review describes creatine as having two faces in cancer biology: it can enhance the activity of tumour fighting immune cells in some models and support cancer cell growth and migration in others. Reviews of creatine safety conclude that the available human evidence does not link supplementation to cancer risk, but small trials in patients with advanced cancer have generally not shown the muscle and weight benefits seen in healthy people. This is a clear case for discussing creatine with an oncology team rather than starting it independently.

Finally she asks for data on prehabilitation and rehabilitation in women, on menopause symptoms and quality of life, and on funding, which she acknowledges is scarce.

The Bottom Line

Kleiner’s talk is at its best when it is honest about its own limits, and the honest reading is this. Resistance training three times a week, enough protein, adequate calcium and vitamin D, sufficient calories and sleep form a package with good evidence for protecting bone in postmenopausal women. Her own three year results are consistent with that evidence and are a striking illustration of what a committed older woman can achieve, but they cannot isolate creatine’s contribution.

Creatine itself has one positive one year trial showing slower hip bone loss, a larger two year trial showing no density benefit but preserved bone geometry, and pooled analyses that do not show a density effect. It reliably improves strength and lean mass alongside lifting, has moderate evidence for small memory benefits, and is safe and well tolerated at 3 to 5 grams a day in healthy women. That makes it a reasonable, low risk addition to a bone protection plan, especially for women who lift, and an unreasonable thing to sell as a bone builder.

Kleiner’s marketing advice follows the same logic. Frame creatine around health, strength and control rather than deficits; anchor it to life stages women recognise; tell the truth about side effects; and do not invent myths to sell against. The women you are speaking to will eventually read the research too.