Yoga and Osteoporosis

Posted on Posted in Continuing Education, Elder Care, Homestudy

yoga-876744_640By Barbara Boughton

Yoga practitioners have long touted the health advantages of their practice, including increased flexibility, improved balance and posture, and stress reduction.  Some research studies support these claims although the scientific evidence is far from conclusive.  Now, a new study highlights another possible benefit of yoga:  It may improve bone health — even for those with osteoporosis.

Loren M. Fishman, M.D., a physiatrist at Columbia University and a specialist in rehabilitative medicine, has studied the health benefits of yoga for years.  In 2009, Dr. Fishman and colleagues published a pilot study which showed that 11 subjects who practiced yoga regularly over two years showed significant improvements in bone mineral density (BMD) of the spine and hip when compared to seven controls who did no yoga.  To study the bone benefits of yoga in a larger study, Dr. Fishman invested his own money and solicited participants via the Internet to perform, over 10 years, 12 assigned yoga poses each day or every other day.

The results?  Ten years after beginning the yoga program, 227 of the moderately to fully adherent participants showed significant increases in BMD of the spine and femur, but not significant improvements in BMD of the hip, according to the study, published in the journal Topics in Geriatric Rehabilitation in November 2015.  The study’s results are striking because most participants were elderly, with a mean age of 68.  Moreover, 83% had osteoporosis or osteopenia at baseline.

From a DVD, the participants in the study learned the yoga poses.  The participants were instructed to hold each pose for 30 seconds.  Once the participants learned all the poses, the yoga regimen took just 12 minutes to complete.  During the study, the participants used an online program to record how many poses they did and how often.  The researchers collected data on the participants’ BMD.  The researchers also took X-rays of the spine and hips and took blood and urine chemistry at baseline. Ten years later, the moderately or fully adherent participants underwent repeat measurements of BMD and many also had repeat X-rays.

For the yoga regimen, the researchers selected poses that pitted one group of muscles against another and would be most likely to affect BMD of the femur, hip, and spine.  They also chose poses that would be safe for elderly patients with osteoporosis. Thus, the poses required, with a straight back, leg lifts, lunges, and/or twists.  The poses did not require bending the back.  At the conclusion of the study, the researchers wrote, there were no reported X-ray-detected fractures or serious injuries of any type that stemmed from the practice of yoga.

Yoga has distinct benefits over other treatments for osteoporosis because it is low cost and the “side effects of yoga include better posture, improved balance, enhanced coordination, greater range of motion, higher strength, reduced levels of anxiety and better gait,” the researchers wrote in their paper.  By contrast, elderly women treated with osteoporosis medications frequently suffer gastrointestinal side effects, and these side effects are often barriers to treatment compliance.

In fact, a recent study published in Clinical Interventions in Aging (2015) showed that, among 126,188 elderly female Medicare patients, only 28% had initiated and continued treatment one year after being diagnosed with osteoporosis. Gastrointestinal events affected a significant number of patients, including 69% of those patients that were non-adherent.

Still, the authors of the new study on yoga and bone health caution that their research has important limitations.  Many of the study’s participants had weakened bones at the start and were already performing yoga.  The participants’ behavior may have influenced the results.  Also, the study did not assess BMD in the thoracic spine, the forearm, or ribs — places where many osteoporotic fractures occur.  Most importantly, the design of the study — including the use of the Internet as a recruitment tool and the lack of a control group — may have selected participants likely to benefit from yoga and may have limited the conclusions clinicians can draw from the results.

While yoga may have health benefits for patients — and may even improve bone health — clinicians should also consider the potential for injury among elderly participants, especially those with osteoporosis.  Many orthopedic surgeons report that women who do yoga can suffer agonizing pain and serious wear and tear on the hip that can progress to arthritis, according to an article — by writer and book author William Broad — published as an editorial in The New York Times in 2013.

Among orthopedic surgeons, yoga poses are well known for causing hip injuries. The reason for the injuries — especially among women — is that the extreme leg motions of yoga can cause hip bones to strike one another repeatedly, according to the editorial in The Times.

There is much that is still unknown about the true benefits and risks of yoga. Studies on yoga have documented hip damage from the practice, for instance, but research also shows that yoga can help patients cope with the pain of osteoarthritis and fight joint inflammation.

To obtain health benefits from yoga and avoid injury, it is crucial to practice gentler forms of this exercise and to moderate poses if they are painful. “Better to do yoga in moderation and listen carefully to your body.  That temple, after all, is your best teacher,” wrote author William Broad in the Times’ editorial.

References:

  1. Lu YH, Rosner B, Chang G, et al. Twelve-minute daily yoga regimen reverses osteoporotic bone loss. Topics in Geriatric Rehabilitation. November 2015.
  2. Fishman L Yoga for osteoporosis: A pilot study. Topics in Geriatric Rehabilitation. 2009; 25 (3): 244-50.
  3. Siris ES, Yu J, Bognar K, et al. Undertreatment of osteoporosis and the role of gastrointestinal events among elderly osteoporotic women with Medicare Part D drug coverage. Clinical Interventions in Aging. November 5,
  4. Brody JE. Twelve minutes of yoga for bone health. The New York Times. December 21, 2015.
  5. Broad WJ. Women’s flexibility is a liability (in yoga). Editorial, The New York Times. November 2, 2013.

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