Yoga Reverses Osteoporosis
The DEXA scan measures bone mineral density at three locations: The lumbar spine, the femur or thigh bone, and the hip. These are the three sites of most common fracture, and of the most serious fractures. Fully 1/4 of the people sustaining hip fractures pass away, and another 1/4 never leave the nursing home to which they are soon sent. So we researched and analyzed yoga poses, calculating which would be likely to increase bone mineral density at the spine, femur and hip. We selected the yoga poses in the DVD by considering Wolff’s Law, which states: “The architectonic of bone follows the lines of force to which the bone is exposed.” This principle has been studied thoroughly, and validated even down to the molecular level. Mechanotransduction, the transformation of the mechanical force on a bone into an electron volt that powers a chemical reaction which begins a chain of physiological events that can be traced from the mechanical force on bone cells (osteoblasts) to the actual production of osteon, the protein that attracts calcium and phosphorous and creates new bone.
We believed we had found the yoga poses that put stress on the lumbar spine, the hip and the neck of the femur, the sites that are measured in the DEXA scan. But some colleagues and authorities whom we respect warned us that these poses might be dangerous, and actually produce the fractures we were using them to prevent. So we held a two-year pilot study in which I taught volunteers the yoga in my office after hours. When we looked at the difference between their bone mineral densities at the three sites before and after the two years, there was a significant rise in the bone mineral density at all three. Further, there had been no fractures or injuries of any kind. Just a few stiff muscles from time to time.
Why did yoga produce these results? We reasoned that muscles are stronger than gravity, since muscles easily move us against gravity. Further, yoga often pits one muscle group against another (e.g. forward bends), putting pressure on the bones that greatly exceeds gravity. We chose those poses on the theory that increased pressure would result in increased bone production. Emboldened by the efficacy and safety of the poses, I made a DVD and gave it away to 741 people who were interested in a larger, eight year study. The results of the pilot study were duplicated, and made even stronger. According to the findings of the study, the yoga raised bone mineral density 9% for the spine, 3% in the femur, and 1% in the total hip measurement. With more than 100,000 hours of people doing the yoga, more than 80% of whom had osteoporosis or osteopenia, with average age 68.2, there were no yoga-related fractures or other injuries beyond a few stiff muscles.
Here is the study:
Lu Y-H, Rosner, Bernard PhD; Chang, G, Fishman, L.’Twelve-Minute Daily Yoga Regimen Reverses Osteoporotic Bone Loss.’Topics in Geriatric Rehabilitation:doi: 10.1097/TGR.0000000000000085
New Study Beginning
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. 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 bone quality, a more compendious measure of a bone’s resistance to fracture.
For those interested in the new study, beginning summer-fall 2016, the following is relevant.
This study attempts to prove 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.
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.
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 will be made available to all participants at no 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 only 18 certified teachers, mostly in New York and New Jersey, although there are also teachers in Pennsylvania, Texas, Illinois, and California. If you are not located near enough to one of these teachers, then unfortunately you will not be eligible for the study. We will be conducting more certification sessions in the winter in New York and Chicago, and in San Francisco in the summer of 2017. The current list of certified teachers is given below.
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.
We have already completed a ten-year, with a paper published by the peer-reviewed journal Topics in Geriatric Rehabilitation. In it we analyze the outcome of 741 people who completed at least two years of yoga (the intervention group) these same people’s change in bone mineral density during the two year period before they began using the DVD. These people 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.
As you can see, the patients that did yoga for two years now have stronger bones than they did when they started. Statistically, this result was significant.
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 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.
There were no injuries in the ten years of the study. So far, with 741 people in the study, and well beyond 100,000 hours of people doing these poses, many of them having before-and-after X-rays of spine and hips, we have no reported fractures related to yoga. Interestingly, we have over 20 fractures reported from falls on the street, traffic accidents, and the like.
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,” and is available on line ahead of printing at the URL above.
If you would like to have a copy of the disk, ask questions or comment on what we have presented here, please see and write to us through Sciatica.org.
Reference (Click on name to go to reference)
1. Handschin C, Spiegelman BM. “The role of exercise and PGC1alpha in inflammation and chronic disease.”Nature. 2008 Jul 24;454(7203):463-9.
All Interested in the Fall 2016 Yoga vs. Osteoporosis Study Should Fill-out the Following:Information sheetIn order to participate in the Yoga vs. Osteoporosis study headed by Dr. Loren Fishman, we require that you purchase the DVD for $25 on sciatica.org, and complete the following studies. They can be obtained when your physician next draws blood and takes urine. If you need a separate prescription to direct an independent lab such as Quest or Athena to conduct the proper tests, please email or fax us. Otherwise, just give this paper to your physician, and fax or email the results to:Ms. Tina PaulAttn: Yoga Vs. OsteoporosisEmail: Tina@sciatica.org Fax: (212) 472-4127.Necessary Lab tests (done within 6 months of study entry)TSH (Thyroid stimulating hormone), PTH (Parathyroid hormone), ESR (Erythrocyte sedimentation rate), SMA – 18 (standard electrolyte, liver and kidney function tests), Vitamin D 25 – OH, Vitamin D 1,25 – Dihydroxy, Urine NTX (a measure of reabsorbed collagen cross-linkages). Each applicant must also supply a current DEXA scan done within 6 months of application, and a second DEXA performed at least one year in the past.When we have received the entry information form, the laboratory reports, your bone mineral density test or DEXA scan, and recent hip and lumbar spine X-rays, you will be inducted into the study and we will mail you a DVD. Please allow one week for processing.If there are questions, please email Loren@sciatica.org
Yoga vs. Osteoporosis Entry Information Date: _____________________________________Name: ___________________________________ Phone: ___________________________________Email Address: ___________________________
Date of Birth F M Weight
Height Greatest Height
- Hysterectomy? Yes No First monthly period___/___ Last monthly period___/____
- Orchiectomy? Yes No
- Do you take Calcium? Y N *Daily Dose Brand/Type Date started
- Do you take Vitamin D? Y N *Daily Dose Brand/Type Date started
- Do you take Magnesium? Y N *Daily Dose Brand/Type Date started
- Other medicine for osteoporosis? Y N *Daily Dose Brand/Type Date started
- Previous medicines for osteoporosis? Y N *Daily Dose Brand/Type Date started
- Names, Dosage of all other medicines/supplements/vitamins::
- Exposed to Steriods? Y N Dosage and Dates:
- Birth Control? Y N Daily Dose Brand/Type Dates taken
- Hormone Therapy? Y N Daily Dose Brand/Type Dates taken
- Unusual Nutrition: (e.g., vegan for 20 years)
- History of Bone Fractures?
- a. Years of Yoga__________________________________________________________________
- Type of yoga (e.g., Vinyasa, Iyengar) ______________________________________________
- How often and how long? (e.g., 1 x per week, 30 min) ______________________________
How consistent? (e.g., never miss, miss every few weeks, skip weeks at a time, etc) ___ __
- a. Other Exercise (what Type, eg, Swimming) ___________________________________
- How often? (eg, 1 x per week) __ ______
- How long per session?______________________________________________________
- How consistent? ______
- a. Last DEXA scan_______________________
- Last Hip/Lumbar X-rays________________
- Family History (Please mention an family History of Osteoporosis): __________________________________________________________________________________________________
- Medical Conditions, including hip and spine surgeries: __________________________________________________________________________________________________
___________________________________________________________________________________________________ ___________________________________________________________________________________________________ ___________________________________________________________________________________________________ ___________________________________________________________________________________________________ ___________________________________________________________________________________________________
Please scan the results into an email and send them to Liza@sciatica.org.
If the results of any of the blood or urine studies is abnormal, we will direct you to the proper type of physician to help bring your values in line. Once that has occurred, you will be admitted to the study.