Beyond Calcium and Vitamin D: Exploring Creatine, β-Hydroxy-β-methylbutyrate, Prebiotics and Probiotics in Osteosarcopenia

Abstract

Background/Objectives: Osteosarcopenia, the coexistence of osteoporosis and sarcopenia, in older adults, is an emerging geriatric syndrome linked to functional decline, increased frailty, and higher mortality. Evidence supports the benefits of interventions such as physical exercise and dietary supplementation with vitamin D, calcium, and protein in this population. Additionally, emerging supplements-such as creatine, β-hydroxy-β-methylbutyrate (HMB), probiotics, and prebiotics-are being investigated for their potential to enhance bone density, muscle mass, and physical function. This review aims to examine the current evidence on these novel nutritional strategies and provide a comprehensive synthesis of how these factors may synergistically influence both muscle and bone health. Methods: A comprehensive literature search was conducted across the PubMed/MEDLINE, Embase, Scopus, and Google Scholar databases. Relevant observational studies, clinical trials, systematic reviews, and meta-analyses published from January 2020 to June 2025 were included, and then a reverse search in the bibliography was used to expand on definitions and concepts. Conclusions: Nutritional interventions for osteosarcopenia play a pivotal role in not only improving bone and muscle composition but also enhancing functional outcomes in older adults. Emerging strategies involving creatine monohydrate, HMB, probiotics, and prebiotics show potential as part of a comprehensive patient-centered approach. However, further research is needed to determine the most effective strategies and to identify which patients are most likely to benefit from each supplement.

Keywords: bone; geriatrics; microbiota; muscle; nutraceuticals; osteoporosis; osteosarcopenia; sarcopenia; supplements.

Figure 1

The gut–bone–muscle axis highlights the impact of gut microbiota on osteosarcopenia. Arrows indicate interactions. ↑ indicates an increase; ↓ indicates a decrease. (created in https://BioRender.com).

Figure 2

Summary of nutritional supplements in osteosarcopenia. Arrows indicate interactions. ↑ indicates an increase; ↓ indicates a decrease. (created in https://BioRender.com).