New Study: Yoga Builds Bone Mass

In 2005, Loren Fishman, M.D., a physiatrist at Columbia University specializing in rehabilitative medicine, began a small pilot study with 117 patients to determine if a particular form of exercise, yoga, had an effect on bone mass in patients with either osteoporosis or osteopenia.

Four years later, in 2009, the journal Topics in Geriatric Rehabilitation published the results of Dr. Fishman’s study where he concluded that patients who practiced yoga “gained 0.76 and 0.94 T-scale points for spine and hips, respectively, on the T-scale when compared with controls (P=.01). Five patients with osteopenia were reclassified as normal; 2 patients with osteoporosis are now osteopenic. There were no injuries. The researchers concluded that yoga appears to be an effective way to build bone mineral density after menopause.”

The study was small and a number of the patients were not fully compliant with the assigned yoga exercises so Dr. Fishman and his colleagues embarked on a larger study.

The new study, which was also reported in Topics in Geriatric Rehabilitation in November 2015, concluded that 12 yoga poses practiced by patients, “appear to be a safe and effective means to reverse bone loss in the spine and the femur and have weaker indications of positive effects on the total hip measurement of the DXA scan. There is qualitative evidence suggesting improved bone quality as a result of the practice of yoga.”

More on the specific details of that study below.

Impacts of Osteoporosis

In the introduction to his study, Dr. Fishman reminds us that around 200 million people worldwide suffer from osteoporosis and osteopenia. With an aging population, those numbers are likely to go even higher. In the U.S., he cites sources which estimate that the U.S. spends around $19 billion on more than two million fragility fractures each year. Of those, 700, 000 are spinal fractures and more than 300, 000 are hip fractures.

He cites evidence that over 55% of everyone over 50 years will have low bone density, and a woman’s risk of hip fracture is equal to the combined risk of breast, uterine, and ovarian cancer. Women are as likely to die after a hip fracture as from breast cancer. Men over 50 are more likely to contract hip fracture than prostate cancer. But osteoporosis is rarely even mentioned as a chronic disease for men.

According to WebMD, osteoporosis can be prevented and treated in a variety of ways. There’s calcium and vitamin D supplements and exercise, a critical part of strengthening bone mass. There are also drugs on the market such as bisphosphonates that slow bone loss. They work by inhibiting cells that break down bone and slow bone loss.

The New York Times reported on December 21, 2015, that those medications “can produce adverse side effects like gastrointestinal distress and fractures of the femur. Indeed, a recent study published in Clinical Interventions in Aging found that among 126, 188 women found to have osteoporosis, all of whom had Medicare Part D drug coverage, only 28 percent started bone drug therapy within a year of diagnosis many of those who avoided drugs were trying to avoid gastrointestinal problems.”

In October 2010, the FDA required makers of bisphosphonates to add a warning to their labels describing the risk of atypical fractures of the thigh, known as subtrochanteric and diaphyseal femur fractures, in patients who take bisphosphonates for osteoporosis.

Dr. Fishman posited that patients may avoid treatments with such side effect, but may be more inclined to try yoga which “is good for range of motion, strength, coordination and reduces anxiety. All of which contribute to the ability to stay upright and not fall. If you don’t fall, you greatly reduce your risk of a serious fracture.”

Second Study Results

In November 2015, Dr. Fishman and his colleagues reported the results of the second and larger study, Twelve-Minute Daily Yoga Regimen Reverses Osteoporotic Bone Loss by Yi-Hsueh Lu, Ph.D.; Bernard Rosner, Ph.D.; Gregory Chang, M.D., Ph.D.; Loren M. Fishman, M.D., B Phil (oxon.) Click here for the study.

This is a retrospective, single site, non-randomized study.

The study investigators reviewed data for 741 patients who’d included yoga in their exercise routines between 2005 and 2015. Of that group, 227 were identified as having practiced yoga more than every other-day. Women comprised 202 of these high frequency yoga patients. The average age at the beginning of the study period was 68.2 years. Entry DXA bone scans showed that 174 (83%) of the compliant patients had osteoporosis or osteopenia.

Inclusion criteria were osteopenia or osteoporosis as measured by dual energy x-ray absorptiometry (DEXA) scan, that is, T-scale values below -1.0 for spine or hip, and commitment to two years of daily or near-daily yoga.

Exclusion criteria included history of bone disease, such as osteofibrosis cystica or osteomalacia, or metabolic or endocrine disorders specifically affecting bone, as detected by tests listed below, and current pregnancy.

Fishman and his colleagues wrote:

“In approximately 4 years preceding study entry, 128, 130, and 125 patients presented prestudy DXA scans that revealed a mean monthly decline in BMD of -0.0036 g/cm2 for the spine, -0.00008 g/cm2 for the hips, and -0.009 for the femora, over a mean 47, 52, and 48 months, respectively; standard deviations/95% confidence intervals = 0.125/0.118, 0.117/0.183, and 0.317/0.192, for spine, hips, and femora, respectively.

After practicing the 12 assigned yoga poses over 22, 22, and 24 months, respectively, 72, 81, and 83 of these subjects reported mean gains of 0.048, 0.088, and 0.0003 g/cm2 per month, for spine, hips, and femora; standard deviations/95% confidence intervals = 0.551/0.44, 0.103/0.159, and 0.129/0.133, respectively.”

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The study continues:

“Mean rate of improvement in total hip BMD [bone mineral density] increased from baseline by 50% after a mean 23 ± 2 months of yoga, but wide variation in individual improvement caused the confidence intervals to overlap, thus precluding statistical significance.”

The 12 yoga poses were selected specifically to produce torque and bending of the proximal femur, compression of the pelvis, and twisting of the lumbar vertebral bodies. The choice was determined because these are the most common sites of osteoporotic fractures and the anatomical regions measured by the DXA scan.

Dr. Fishman wrote that weight-bearing activity, which is often recommended to patients with bone loss, can be accomplished with the yoga poses. “Yoga puts more pressure on bone than gravity does, ” he said in The New York Times story. “By opposing one group of muscles against another, it stimulates osteocytes, the bone-making cells.”

View From the Yoga Mat

The results of Dr. Fishman’s study are probably not surprising to exercise enthusiasts—whether tennis players, weight lifters, pilates or yoga practitioners. But his data adds to the already large body of evidence that exercise is a key and vital part of an overall treatment plan for osteoporotic patients.

Yoga instructors have noticed the health benefits of this particular form of exercise for years. “Yogis have intuitively known for years about the physical and psychological health benefits of a daily yoga practice. Having those benefits confirmed through scientific studies helps to encourage older adults to start a yoga practice, ” says TC McVey, yoga instructor in Altos del Maria, a mountain community in Panama known for attracting aging gringos.

McVey started her regular yoga practice at age 50 and became an instructor after hundreds of hours of training. Now, 60, McVey says that in her personal experience she has seen improvement in her joint flexibility, stability, balance, overall strength and muscle tone.

Her students (including this writer) are mostly in their 60s and have never done yoga before. Some have had knee or hip replacement surgeries. Using props like bolsters, blocks and straps her students can receive the benefits of yoga. “Being able to explain the yogic purpose of a pose and have that be supported by science, brings a validity to the practice for many students.”

One of her most popular classes is yin yoga, which is a slow but powerful form of yoga poses that are held to a point of compression for five minutes or longer while the student consciously relaxes the muscles using their breath allowing more stress on the connective tissue and the bones. “The long-held poses in yin yoga give the bones, especially the lumbar spine, more time to be stressed, thus allowing for a deeper recovery response and stronger bones, ” added McVey.

The authors of the study acknowledged many limitations to the study, including the use of self-selected volunteers and the lack of a control group. But the team concluded, the results may lend support to Dr. Fishman’s long-held belief that yoga can be a vital part of an overall treatment plan for patients with osteopenia or osteoporosis.