Charcoal and diamonds are the same fundamental “stuff” (carbon), so why is one crumbly, while the other is one of the hardest substances we know of?

The answer, of course, is twofold: density and structure. So, which would you rather your bones be made of: charcoal or diamond?

Quantity vs Quality

Yes, bone density is important, but when it comes to fracture risk, bone quality is at least as important.

Bone density gets the most attention, perhaps because it is easiest to measure. Get a scan, get some numbers, know the density, adjust diet and exercise to improve it if necessary.

Bone quality is harder to measure, and also harder to improve. Which is unfortunate, because the densest bones in the world might still get a fracture if the structure isn’t good.

Let’s put it this way: the bedrock in California is no less dense than that of its neighboring Nevada, but it most certainly is more prone to fracturing. Why? At risk of making a geological understatement: “the structure isn’t good”.

Same deal with your bones.

A surprising way to improve bone strength, not just density

Creatine is well-established as a way to support building muscle. It won’t build muscle by itself, but if you’re doing muscle-building exercise, it’ll generally enhance that.

However, most research on creatine has shown muscle growth benefits are strongest in younger people, and when it comes to brain health gains, the benefits seem stronger for older people. Younger and older than what, you ask? Younger and older than middle age, really. There is a big research gap in the middle.

We wrote about this here: Creatine: Very Different For Young & Old People

And we highlighted the age-specific cognitive benefits here: Creatine’s Brain Benefits Increase With Age

Most recently, a team of researchers (Dr. Maria Fernanda Contreras-Alvarado et al.) investigated an assortment of interventions against osteosarcopenia, which is a catch-all for “bones and muscles declining with age“. We’ll be focusing on creatine and bones, because

• Creatine scored highest of the interventions they tested
• The benefits come about in an interesting way

How it works: creatine stimulates osteoblast (bone-forming cells) activity—like some kinds of osteoporosis medication do, and it appears to improve bone remodelling.

This is important, because one of the common problems with some kinds of osteoporosis medication (mostly those that slow down osteoclasts, the cells that break down bone) is that because more of the old material is still in place while rebuilding, sometimes the result is a mix of structures (old and new), and before you know it, you basically have the San Andreas Fault in your hip.

You can read about that here: Which Osteoporosis Medication, If Any, Is Right For You?

In older adults, however, the review showed little evidence for creatine contributing to direct increases in bone mineral density. Meaning its benefits are mostly twofold:

1. the structure is better, so the bones are stronger and less likely to break, regardless of density
2. the muscles are at least a bit better (creatine does that, even in older people, just less so than in younger people), which will have indirect benefits to bone density, because one cannot build strong muscles on weak bones (or else using the muscles would just snap the bones), so the body will (unless you are malnourished or otherwise physiologically impaired from doing so) pack on more bone density in order to accommodate the muscle

While the latter part took more explaining, the former part is the more interesting one here, because it’s hard to get that from nutrition/supplementing alone, and the evidence is mixed from exercise (i.e. almost certainly exercise indeed usually helps, but it depends on the specific body mechanics involved in the exercise in question, which is really hard for a study to speak declaratively on unless having a really narrow scope (say, “this one isolated exercise movement has this effect on bone structure”) and then repeating that for every movement possible.

In short: creatine appears to boost bone strength in ways that are hard to get from other sources. The results will barely show up in a bone density scan (because the actual increases in bone density will be small), but your fracture risk will be considerably lower.

You can read the paper in full here: Beyond Calcium and Vitamin D: Exploring Creatine, β-Hydroxy-β-methylbutyrate, Prebiotics and Probiotics in Osteosarcopenia

Want to get more out of it?

The results did show that creatine supplementation is most effective when combined with resistance exercise, amplifying gains in strength (in bones as well as muscles) and physical function. If you’re wondering what exercises to do for bone health from a starting position of poor bone health (i.e., you want to stress your bones enough that they get stronger, but not so much that they break in the process), then check out: Osteoporosis & Exercises: Which To Do (And Which To Avoid)

Furthermore, while we focused on the creatine and the bone strength, the paper did cover more things, and so we will at least mention that while creatine scored highest, adding the other interventions also boosted the gains from creatine (i.e. using multiple interventions at once can have a synergistic effect).

Specifically, the review found that combining creatine with protein, branched-chain amino acids (BCAAs), and/or vitamin D can boost its benefits.

Learn more: What To Eat, Take, And Do Before A Workout

Want to learn more?

Check out:

The Best Way To Take Creatine: Timing, Dosage, & More

Take care!