Yoga for the Prevention, Treatment, and Reversal of Osteoporosis and Osteopenia - A Low-Cost, Low-Risk Way to Strengthen Bones, Improve Balance & Prevent Fractures

Tree Pose

"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:

1. Triangle Pose
2. Upward-facing dog
3. Downward-facing dog
4. Bridge pose (a moderate back-bend)
5. The Wheel or the Iyengar modification  (a back-bend)
6. 1-legged & 2-legged forward bends--with careful attention to form
7. The Boat pose--stimulates the most vulnerable parts of the spine
8. Supta Padangusthasana (a lying down forward bend that supports the spine)
9. Seated spinal twists
10. 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.

The Potential for Continuing Bone Strength Improvements

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: [email protected]

1. 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.
2. 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.
3. 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.
4. Side angle pose
5. The Revolved Triangle
6. The Camel
7. Mild backbends like, the Sphinx, Cobra, Bridge, or Locust
8. 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.
9. 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.
   
10. Seated twists--Marichyasana III or Ardha Matsyendrasana
11. 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.
12. 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).

A Must-Read Comment I Received From a Study Participant

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).

You can read more about my particular journey over on my blog thebonearchitect.blogspot.com, and you can read more about the yoga study at www.sciatica.org. 

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

Huffington Post article by Fishman

Comments

[MG]

Thanks for this post! I'm going to send a link to my [osteopenic] mom. I also just picked up an old copy of a book called Yoga Builds Bones by Jan Maddern. I notice that it is out of print, but there's another book called Yoga for Healthy Bones by Linda Sparrowe that might make a good substitute.

I think may make copies of Maddern's book so that I can send it to my mom. If I end up doing that then I'd be happy to send you a copy, too. I'm also on the lookout for a good basic yoga DVD for my mom (and for me, since I won't have time to attend yoga class during my internship!).

[Betsy]

Oh, thank you, HHL! This is such exciting news! (must have missed your March post but just read that one too.) I have osteopenia and have just started back into yoga after a 30-some-year hiatus. It's so discouraging to see how much flexibility and strength I've lost. Of course I seem to now have scoliosis and an asymmetric pelvis, which makes things even more of a challenge, but I've read some reports that yoga can help with these issues too. I'm going to look into joining the study.

Betsy

P.S. So glad you're back from vacation and in good blogging form again.

[raye lankford]

Hi, thanks for the mention. And I just wanted to let you know that I received my full DEXA print out via snail mail, and it turns out my BMD gains in my spine were even greater than I originally thought. In L2 I gained .90 points! In L1, +.60. Needless to say, I am thrilled. My overall spine score appears lower because I did lose some density in L4 -- which I think has to do with the fact that I stopped doing long distance running once I was diagnosed with osteo. You can see the full scores here: http://thebonearchitect.blogspot.com/2010/06/good-news-bad-news-on-my-complete-dexa.html

To MG, I have the Linda Sparrowe book. It's quite good, but the poses for someone with osteoporosis pretty much amount to reclining poses on the floor. I didn't find it challenging enough for me, but I'm fairly athletic. Depending on your mom's age and fitness level, it might be appropriate. It's certainly an approachable format. But I think I prefer Dr. Fishman's book. It doesn't have that feeling of "everyone else gets to do the fun stuff, and I'm over here with my sack of rocks." The poses are the same for everyone, it's just they have appropriate modifications.

[The Healthy Librarian]

MG: Good luck with your internship and congrats on your graduation!! You're right--I'm sure you'll be practicing yoga at home. I'll ask one of my yoga instructors who is trained as a yoga therapist, and studies with a physical therapist yoga teacher (great combo) if she has a basic DVD she'd recommend for your mom.

Betsy: Thanks for writing. Go easy on yourself since you've had such a long hiatus. Take easier classes at first. I noticed huge improvements in my flexibility & ability to do poses when I went from practicing once/week or every other week to 2 or 3 times a week.

Raye: Thanks for the update and for sharing your DEXA scores. Excellent blog. So glad that I heard from you soon after discovering Dr. Fishman's study. Do you know if Phase 2 is still open to participants?

[raye lankford]

Hey, Healthy Librarian: Why don't you contact Dr. Fishman and ask? [email protected] He's a very approachable guy. Or you could just do the poses from the sciatica.org website without necessarily getting in the program. Although, if you're in the program, there is the benefit of the little 12 minute DVD they send you with someone talking you through all the poses.

One thing I'd recommend: take a print out of the poses with their modifications to a certified yoga instructor so they can help you with your form. We just had a yoga session in Dr. Fishman's office (just two participants and a teacher), and I learned I was doing so many things incorrectly. Having gotten those corrections has made the yoga practice so much more challenging this week.

If someone doesn't have the money for a private session with an instructor, it's not like they wouldn't see results. I've been doing it on my own since October, and as mentioned my DEXA results were fantastic. But working with the instructor made me realize how "off" my form is on my left side. Could this be the reason for my sluggish scores on that hip?

@Betsy: I hear you on the loss of flexibility. I was a dancer in my youth (hey, lemme just put my leg behind my head, okay?), and it has been a very humbling experience doing yoga again. I just do what I can do and try not to compare and despair.

[Betsy]

I just heard back from Dr. Fishman. They are still accepting participants, and I'm going to be one!

@Raye, thanks for the encouragement! Another reason I'm so excited by this post is the link to your blog, which I didn't know about before. Thank you so much for all your work on this topic and all the info you've gathered there. I'm going to follow your recommendation to get help with my form from a yoga instructor. I think I know just the one: a scientist/researcher/yoga instructor at WVU who published a study about yoga for back problems, and as I recall she was doing Iyengar yoga. I started doing yoga with Jess Stearn's Yoga, Youth & Reincarnation, when I was a teenager in the late 60s/early 70s, so for sure my form leaves a lot to be desired. For example, I don't think I ever realized I was supposed to be using muscles in my legs during poses like The Triangle until I read your blog and checked out the 12 poses study. Thanks!

[raye lankford]

Yay, Betsy! I so thrilled for you! Just keep going, and if you ever need encouragement just drop me a line.

[Gael]

It was such a coincidence that you were writing about osteop because I had just that week discovered the NOF site and lucked upon Raye Lankford's success story with Fishman's yoga. And then the next day, you wrote about it. It was a wonderful post and Raye is a hoot! I love her website too.

I was also thinking about the same question you posed about if practicing in regular yoga classes might have the same benefits as Fishman's 12. I got his book last night at Dartmouth Bookstore, so I'll check it out. I signed up for the study. I have to get 3 of the tests done, but all else is current.

[Alexandra]

And I just heard back from Dr. Fishman too, and I am going to be a willing participant; The study is still open as of October 2011. Very interested in the comments about ensuring that the poses are being done properly, and suspect I "take the path of least resistance".

[Sarah in Chicago]

Are you able to share the proportions you used for this recipe: My green smoothie made with kale or chard, apple, grapefruit, berries, and carrots? Thank you!