New Yoga vs. Osteoporosis: a Dose-Response Study

Manhattan Physical Medicine and Rehabilitation

133 East 58th Street

New York, New York

(212) 472-0077

Our previous 10 -year 741-patient study showed yoga to improve bone mineral density as much or more than the conventional medications, as the above graph documents. In spite of positive comments about the study in the New York Times, the Harvard Women’s Health Letter and NPR, the almost free and effective treatment has not gained much application in the medical community.  This is too bad, because osteoporosis is becoming a national and actually world-wide public health problem.

Dr. Ethel Siris, a prominent authority in the field of osteoporosis studied more than 100,000 osteoporotic women who had health insurance covering the cost of osteoporosis medications.  She found that less than 30% actually took these medicines, at least partially because of their common and severe side-effects.  But the side-effects of yoga are better posture, improved balance, greater strength, range of motion and coordination, and lower anxiety, all factors that mitigate against the fractures just about as strongly as the rise in bone mineral density.  Therefore we are beginning a new study, seeking a dose-response relationship between yoga and bone mineral density and possibly bone quality, a more compendious measure of a bone’s resistance to fracture.  The idea is that many of the 55,000,000 Americans with osteopenia or osteoporosis will learn about this method from their doctors.

For those interested in the new study, beginning summer-fall 2016 and ongoing until further notice, the following is relevant.

This study attempts to prove (again) that properly chosen yoga poses can reverse osteoporosis without having negative effects on the joints.  In addition, we hope to establish a dose-response relationship between the quantity and quality of yoga, and rise in bone mineral density, and possibly bone quality.

Conventional medical wisdom puts people in an impossible position: exercise with impact, jogging, for example, is needed to stimulate the cells that build bone, but unfortunately, such exercise fairly reliably brings about arthritic joint destruction. No-impact exercise is harmless to the joints, but unfortunately, leaves the bones to slowly weaken even to the breaking point. You’re darned if you do and if you don’t.

Therefore when it comes to bones, it is literally both ends against the middle. At the same time, it is universally acknowledged that not exercising at all tightens joints and ligaments, weakens muscles and bones alike, and is the worst of both worlds.

As the population of the world grows older, these questions are critical for the continued activity and health of an increasing number of people. Present estimates are that 200,000,000 people suffer from osteoporosis or osteopenia worldwide.

Evidence in the animal literature confirms that unconventional tugs of the sinews and ligaments can arrest, and often reverse osteoporosis. The pilot study detailed below corroborates these findings. The transcriptional coactivator PGC-1alpha is liberated from muscles in exercises such as yoga, and suppresses a broad array of inflammatory responses, likely including arthritis.¹ There are also physiological reasons to believe that yoga improves the circulation of synovial fluid, within joints, slowing the “wear and tear” that may stand at the origins of osteoarthritis.

The proposed study measures osteoporosis through the accepted means, radiographic bone density measurement, dual energy X-ray absorptiometry otherwise known as DEXA scans. We measure progression in osteoarthritis with standard hip and lumbar spine X-rays. Each subject has thyroid functions, standard electrolyte, mineral and liver/kidney function tests, two assays for vitamin D, and a urine test measuring the rate of bone resorption before learning the 12 yoga poses that comprise the program. Bone scans and X-rays, performed at study onset and at the end of year 2, are read by radiologists that have no idea which patients are receiving yoga, and which are not. The study participants will receive a newsletter about developments and research in osteoporosis. A DVD of the poses is for sale to all participants at the bottom of the home page of this site, and it is streamed without cost.

There is an on-line message board for communication between the participants and also with the physicians and yoga teachers involved in the study. People may post messages in English and Spanish. Every two years a statistical analysis will be done, and a scientific paper will be written after results are judged significant.

In order to do a meaningful analysis of the “dose” of yoga, it will be necessary for participants to visit a yoga teacher certified in our method every two weeks.  Your arrangement with the teachers is up to you and the teacher.  It may be a group class or an individual session or a short review. There are currently over 120 certified teachers, in 38 states and 8 countries.  If you are not  located near enough to one of these teachers, then you will still be eligible for the study by Skyping with any one of the teachers, or with us.  We will be conducting more certification sessions in the the fall in Coconut Grove, Florida and Walnut Creek, California.  Recently we have added a state-of-the-art measure of bone quality, that may also be offered to study participants without cost. After receiving the DVD, study participants and qualified others may be able to have every-two-years bone quality studies as well.

 The people in the first large study had an average age of over 68 years, and all had normal laboratory values.  Over 80% had osteoporosis or osteopenia at the study’s onset. In over 100,000 hours of practicing this yoga, there are no reported fractures or  significant injuries of any kind (e.g., herniated disk).  Many of the participants had before-and-after X-rays of their spins and hips.Interestingly, we have over 20 fractures reported from falls on the street, traffic accidents, and the like.

As you can see, the patients that did yoga for two years now have stronger bones than they did when they started. The results of the study are now in, and the statistician has found that yoga does significantly improve bone mineral density for the spine, (P <.05)  the femur (P < .002) and, slightly less convincingly, for the hip (P < .05 on 2 of 3 measures;  not significant for the third).  This work appeared in the peer-review journal “Topics in Geriatric Rehabilitation.”

Sometimes we have had to adapt the yoga poses for people that are unable to use the classical position. The DVD has three versions of each pose, and your teacher will very likely be able to help you with that. The idea is to progress from the simplest level to the more advanced levels in any pose for which it is safe to do so.  Trying hard, putting some effort into the proper alignment with 12 minutes of yoga, is also important.  The Iyengar yoga method that stands behind each of the  poses pays great attention to alignment, enabling people to try hard without injury.

If desired, the DVD  may be purchased by anyone for $25 on the home page of this website.

Please go near to the bottom of the page:

sciatica.org/?id_=124

1.  Handschin C, Spiegelman BM. “The role of exercise and PGC1alpha in inflammation and chronic disease.”Nature. 2008 Jul 24;454(7203):463-9.