"Physical activity is profoundly beneficial for bone health. Sure, walking is great for the prevention of hip fractures, but it won't do much for wrist or spinal fractures, so we need other exercises to keep our upper body bones strong. And the bones that are strongest are the bones that we put stress on."
-Dr. Walter Willett, M.D. PhD, Harvard School of School of Public Health from the "Building Bone Vitality" People's Pharmacy Podcast click here-
"Evidence in the animal literature confirms that unconventional tugs of the sinews and ligaments can not only arrest, but reverse osteoporosis. In a pilot study we compared twelve people who completed two years of yoga (the intervention group) with seven people that did not do yoga, the controls. These people had the same average age (66 years), very nearly the same amount of bone loss when the study started, and all had normal laboratory values. By doing 10-12 minutes of yoga a day, the mean bone mineral density of all the patients has improved well beyond that of the controls."
-Dr. Loren Fishman, M.D., chief investigator, Columbia College of Physicians-
If you've received this post via email click here for the web version to get all the links.
Back in March 2010 I was on a mission to find studies that showed the benefits of yoga on bone strength. It made good sense to me. One of my yoga instructors said she went from osteopenic to normal after practicing yoga regularly for a few years. And two friends of mine noticed improved DEXA scans after they began a regular yoga practice.
Hmm? Could it be? Is yoga equal or perhaps superior to Fosamax? What exactly is all that positive weight-bearing stress that's put on every single bone in the body while practicing yoga doing for our bones? Think about it--what other exercise targets all the bones that we can potentially fracture? Wrists, ankles, spine, hips, ankles, the whole package.
All I came up with was one promising article out of Thailand, of all places. Click here to read that post.
Then, right before I left for vacation, 3 weeks ago, I serendipitously came across Dr. Loren Fishman's exciting pilot study, that looked at a group of men and women--all with osteoporosis or osteopenia--practicing 10 specific yoga poses for about 10 minutes a day--and holding each pose for 20-30 seconds. Modifications were made for those with osteoporosis--or limited abilities. Dr. Fishman's article can be found here: "Yoga for Osteoporosis: A Pilot Study" Topics in Geriatric Rehabilitation 25(3):244-250, 2009.
Here is the evidence that a simple yoga practice can improve and prevent osteoporosis and osteopenia if followed regularly.
Fishman had observed that yoga practitioners "seem to live long and fracture-free lives that suggests that the unusual and unusually prolonged pulls they voluntarily self-administer may be a stimulus to bone health." Many animal and human studies have shown that muscle stress & strengthening improve bone density--so he figured, "Why not take a look at the effects of yoga on osteoporosis?"
Turns out Fishman's hypothesis was right. Everyone in the yoga group (except for one participant-whose BMD remained close to baseline) improved their bone density well beyond that of the control group after 2 years of practice.
Why so few participants in the study? It was very hard to get people to follow-through with a home-based practice. Although 110 participants entered the study, compliance was poor. In the end, only 11 people completed the 2 year study--with an additional 7 in the control group. This was a disappointment to Fishman--but have no fears. He's dedicated to continuing with the study until he gets a statistically relevant group. Phase II began in September 2009 and is on-going.
Note: To be included in the pilot study patients had to free of bone, metabolic, or endocrine diseases. They also had to have normal lab values for parathyroid hormone, thyroid stimulating hormone, electrolytes & blood chemistry, blood cell count, vitamin D 25-OH, & the D1,25-dihydroxy tests.
Yoga Group Improvements
- Hip BMD: mean increase of .867 units on the T-scale.
- Spine BMD: mean increase of .563 units on the T-scale
- Five patients with osteopenia were reclassified as normal after 2 years of practice
- Two patients with osteoporosis were reclassified as osteopenic after 2 years of practice
- Compared to the controls, the yogis gained .76 T-scale points in their spines
- Compared to the controls, the yogis gained .94 T-scale points in their hips
Control Group's Bone Loss
- Hip BMD: mean loss of -0.12 units on the T-scale.
- Spine BMD: mean loss of -0.07 units on the T-scale.
What could be easier than doing 10 or 12 yoga poses for 10 minutes every day?
No side effects like those associated with the typical osteoporosis drugs--like GI discomfort, esophageal erosion, osteonecrosis of the jaw or other sites, leg cramps, or bone pain. Who knows what adverse effects are still yet to be uncovered? Don't forget about the drug cost savings!
And then there are the side benefits that come with practicing yoga--all of which in one way or another actually prevent potential falls--which is the best way to prevent fractures.
- Reduced back pain
- Reduced anxiety
- Reduced arthritis
- Gait improvement
- Better balance
- Neural plasticity improvements associated with motor learning
Poses used in the pilot study:
- Triangle Pose
- Upward-facing dog
- Downward-facing dog
- Bridge pose (a moderate back-bend)
- The Wheel or the Iyengar modification (a back-bend)
- 1-legged & 2-legged forward bends--with careful attention to form
- The Boat pose--stimulates the most vulnerable parts of the spine
- Supta Padangusthasana (a lying down forward bend that supports the spine)
- Seated spinal twists
- Jathara Parivarthanasana (a lying down twist) A pose that stimulates the spine without exacerbating arthritis of the hips.
If you're new to yoga don't get put off by the names of these poses. Everyone can learn do them--and the benefits extend far beyond bone strength.
Fishman says it's likely that the benefits of an on-going yoga practice will just continue to grow. Practicing for 6 years would likely give one 3 times the benefit that his participants saw after one year.
Here's the best part: According to Dr. Fishman, "At that rate, a person with osteopenia (a T-score of -1.0 to -2.5) or minimal osteoporosis (a T-score of -2.5) will have spine and hip bone mineral density that is neither osteoporotic nor osteopenic within 6 years of a quiet, costless, and virtually riskless practice of 10 minutes a day."
Now For The Twelve Bone-Strengthening Poses in Fishman's Phase 2 Study
You can find detailed photos, instructions, and modifications for all these poses at this link to Dr. Fishman's web site.It may still be possible (can't really tell) to sign up for this study, which includes a timed DVD of the poses, and involves follow-up. Click here & scroll down to "Open Door Policy" for more info, or contact Dr. Loren Fishman at e-mail: Loren@sciatica.org
- Tree pose--It stresses and thereby stimulates the bones of the hip, pelvis, spine and shoulders. It also improves balance, and thereby reduces the likelihood of falls.
- Triangle pose--This pose is good for sacroiliac joint pain, and puts strong, stimulating pressures on the bones of the hip, lower lumbar spine and pelvis.
- Warrior pose II--This pose strengthens muscles of the legs, trunk and shoulders, and places strong but safe stress on the femur, lumbar and thoracic vertebrae, pelvis, knees hips and ankles.
- Side angle pose
- The Revolved Triangle
- The Camel
- Mild backbends like, the Sphinx, Cobra, Bridge, or Locust
- Downward-Facing Dog--This pose is a valuable transition from back bends to forward bends, but also stimulates the posterior vertebral bodies as well as the bony elements of the many facet joints in the spine, while putting major stresses front-to-back on the hips, pelvis, shoulders and arms.
- Reclining leg stretch--This is one of the few forward bends that does not even tempt you to
curve your back forward in a dangerous way. It is nearly ideal for
osteoporosis for another reason: it engages just about every muscle and
stresses almost every bone below the neck.
- Seated twists--Marichyasana III or Ardha Matsyendrasana
- Lying-down twist--Jathara Parivatanasana. People with limited hip range of motion have trouble with twists, but they are all-important for retaining strength in the transverse vertebral processes and contiguous vertebral bodies. This twist is easier on the hips than some others, but strengthens the trunk muscles well.
- Savasana--Corpse Pose. Mr. Iyengar (the founder of a safe therapeutic style of yoga) comments: "By remaining motionless for some time and keeping the mind still while you are fully conscious, you learn to relax. This conscious relaxation invigorates and refreshes both body and mind. But it is much harder to keep the mind than the body still. Therefore, this apparently easy posture is one of the most difficult to master." (Light on Yoga,1979 edition, Schocken Books: page 422).
Coincidentally, a week ago, out of the blue, I received an email from a current participant in Dr. Fishman's 2nd-round yoga study, after she had read my previous post on the Thailand yoga & osteoporosis study. Here's what she had to say:
"Hey, there! I can tell you, your friends' (BMD)improvement was definitely related to yoga.
In 2007, Dr. Loren Fishman of Columbia University started a pilot yoga program to study the effects of yoga on osteopenia and osteoporosis.
The study lasted for two years, ending in the summer (Fall?) of 2009. Every single woman who was in the program (and practiced faithfully) made significant gains in BMD. One woman gained 1.5 points in her hips. On average, the scores were +0.7 in the hips, and +0.5 in the spine.
I joined the second round of the study which began in September of 2009, and after only 10 months of daily yoga, I have gone from osteoporosis to osteopenia in three out of five test sites (only my left hip neck and femur are a little sluggish).
NOTE: Be sure to read the updated comment from Raye Lankford. Her full DEXA scan was even better than she thought!
It's Not Just Bone Mineral Density & DEXA Scans That Count
Bone mineral density is just one measure of bone strength--and maybe not the best. Bones aren't solid--they have an inner network, called the trabecular, which is a crisscross of crosspieces & struts that support the bone, making it strong, and preventing fractures.
The ability of bones to withstand traumatic stress also depends on the quality of the bone (the strength of the inner trabecular support system)--in addition to the bone mineral density.
Important point: There is good evidence that only exercise increases the "all important" trabecular bone. The bisphosphonates primarily add density to the outer cortical bone, which of course is what is measured with the DEXA scan.
Unfortunately, the DEXA scan doesn't measure the strength of this inner network--it measures the outer region of cortical bone. Which means that it's very possible to have an adequate BMD & still be at risk for fractures because the bone quality is poor.
If you want to really know how strong bone is--you would need a non-invasive way to measure this inner trabecular core of the bone. That's still in development.
Source: Fishman's article and Dr. John Abramson's book, Overdosed America: The Broken Promise of American Medicine. 3rd ed. HarperCollins, 2008. Chapter on Osteoporosis.
So, What's It Going to Be? A Pill or Twelve Poses?
I'm putting my money on the poses. My question to Dr. Fishman is whether the daily 10 minute pose practice trumps taking an hour-long yoga class 2 or 3 days a week. I'll let you know if I get an answer.
Dr. Loren Fishman's newly released book, Yoga for Osteoporosis