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Yoga for Osteoporosis & Bone Mineral Density

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There is one study that pops up repeatedly in discussions about the ability of yoga to improve bone mineral density. This research study Twelve-Minute Daily Yoga Regimen Reverses Osteoporotic Bone Loss was conducted by Loren M. Fishman, MD, et. al. and published in 2016.


The study concluded, “The 12 yoga poses studied here 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.”And is often cited by yoga teachers as proof that yoga improves bone mineral density.


As a yoga teacher I would love nothing more than for this study to definitively prove that yoga does indeed improve bone mineral density. However, the research is lacking conclusive proof.


 

Study Details: Twelve-Minute Daily Yoga Regimen Reverses Osteoporotic Bone Loss


(Pay particular attention to how the numbers decline throughout the course of the study.)

  • The research includes 1 study that ran from 2005-2015

  • Volunteers only had to participate for 2 years

  • 741 people were recruited via the internet

  • Participants were sent a DVD of the 12 postures

Image of 12 yoga postures for osteoporosis from "Twelve-Minute Daily Yoga Regimen Reverses Osteoporotic Bone Loss"
12 Yoga Postures for Osteoporosis from "Twelve-Minute Daily Yoga Regimen Reverses Osteoporotic Bone Loss" (Image: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4851231/)
  • There were 3 versions of each posture,

    • “the classical pose”

    • an intermediate or transitional version”

    • an “elementary pose” that “stressed safety and simplicity”

  • Of the 741 patients who joined the study…

    • only 227 (31%) were found to be compliant with the study protocol

    • 202 were women (with a mean age of 68.2 years)

    • 174 (23%) had osteoporosis or osteopenia

  • The level of compliance of the 174 women with osteoporosis was graded as “high”, “moderate”, or “low” depending on the versions of the postures women did.

  • 57 women were identified as having “moderate to full compliance” and therefore included in the data analysis for the study.

  • Of the 57 women who were fully compliant, the following DXA scan bone mineral density (BMD) measurements were attained:

    • 29 measurements of the spine

    • 25 measurements of the hip

    • 18 measurements of the femur

  • Only BMD measurements of the spine and femur – not the hip – showed statistically significant improvements.

  • 43 patients (6%) showed some BMD improvement

    • 27 (3.6% of total participants) showed improvement at the spine

    • 16 (2% of total participants) showed improvement at the hip

    • 14 (1.9% of total participants) showed improvement at the femur

  • 18 (2.4%) participants completed the study


 

The Cons: Yoga for Osteoporosis & Bone Mineral Density


The amount of data included in the analysis – the numbers can be misleading.

Those who quote this study as evidence that yoga improves bone mineral density often state that it was a 10-year study of 741 people. That sounds impressive initially, however…

  • volunteers only had to participate for 2 years

  • only 57 participants (7.7%) provided enough data to analyze

  • only 43 participants (5.8%) saw improvement

  • only 18 participants (2.4%) actually completed the study


The abstract for “Twelve-Minute Daily Yoga Regimen Reverses Osteoporotic Bone Loss”

states that it was a 10-year study of 741 volunteers. This leads one to believe that the conclusion is based on data from 741 individuals over the course of 10 full years. However the participation requirement was 2 years and only 2.4% of the volunteers finished the study.


 

The Pros: Yoga for Osteoporosis & Bone Mineral Density


The research is hopeful. Perhaps further research in this area will more conclusively demonstrate that yoga can improve BMD. However more and better controlled research is needed.


There were no reported yoga-related injuries. It is common for physicians to tell clients not do certain yoga postures, particularly twists. Twist were intentionally included in this study and there were no reported adverse events.


Yoga may reduce fall risk¹﹐². While yoga may not improve bone mineral density, it does improve things such as mobility, balance, and coordination which helps to reduce the risk of falls which, in turn, reduces the risk of bone fractures.


 

Discussion: Yoga for Osteoporosis & Bone Mineral Density


Aside from the diminishing data points, when assessing the long-term implications of this study it is important to consider the quality of this research on doing yoga for osteoporosis.


There was no control group in this study. In this case, a control group would have been a similar group of women with osteoporosis who did not participate in the yoga program. Without a control group the results of the yoga intervention can’t be compared to a baseline and there is no way to conclusively determine whether similar improvements may have occurred in the general population.


Volunteers were sent a CD so they could do the yoga for osteoporosis protocol at home. They were then asked to log their yoga activities online. In an effort to please researchers, it is possible participants stated that they were doing yoga more often than they actually were. In addition, as participants were not observed in a clinical setting, there is no way to assure that the yoga postures were performed as indicated or that each posture was held for the required 30 seconds.


Since participants specifically chose to be involved in a yoga-based study we could assume that they wanted to do yoga. If so, they could have been doing yoga more often than specifically required, thus skewing the results.


This study wasn’t strictly controlled, meaning participants weren’t limited to doing only the 12-pose yoga intervention. Consequently, researchers can’t definitively discern whether improvements in bone mineral density as a result of the yoga protocol or if they resulted from some other activity participants were engaging in (in addition to yoga) that researchers didn’t account for such as jogging, hiking, tennis, strength training, etc.


 

Other Research on Yoga for Osteoporosis & Bone Mineral Density


Contrary to the study discussed above, numerous studies have demonstrated that yoga does not improve bone mineral density (BMD). Here are a few examples:


Our results suggest that mind-body exercises, such as Pilates and Yoga, did not produce a significant improvement on BMD among adult women when compared with the control groups.


“Statistically, a significant difference was found in the BMD score posttraining as compared to the pretraining T-score. However, the clinically beneficial effects of the selected integrated yoga could not be commented upon in terms of functional improvement of the participants as the only difference in the T-score was measured pre- and post-intervention.


“The findings of this study suggest that 8 months of Ashtanga-based Yoga had a small positive effect on bone formation but did not improve bone density or geometry in premenopausal women.”


There are few well-designed, long-term RCTs to support the benefits of other forms of exercise training on hip and/or spine BMD in postmenopausal women, including Tai Chi, Yoga and Pilates.


 

Types of Exercise that Improve Bone Mineral Density


Currently there are only two research-backed forms of exercise that have been demonstrated to improve BMD: Progressive Resistance Training (Strength Training) and Impact Training.

That’s it.


I love yoga. That’s why I became a yoga teacher. If you love yoga too, keep doing it. It has a ton of benefits for your physical and mental well-being, unfortunately, strengthening your bones just isn’t proven to be one of them.


Your bones are precious. So is your time. If you’re going to spend time exercising with the intention of maintaining and/or improving your bone mineral density you may want to focus on the exercises that have been demonstrated to have the greatest effect.


Not sure where to begin? I can help…


I have helped women with osteoporosis and osteopenia to attain measurable improvement in their bone mineral density utilizing research-backed techniques. Email me or call 732-690-9497 to arrange a consultation.


 

Additional References:

1. Tiedemann A, et. al. A 12-week Iyengar yoga program improved balance and mobility in older community-dwelling people: a pilot randomized controlled trial. J Gerontol A Biol Sci Med Sci. 2013 Sep;68(9):1068-75. doi: 10.1093/gerona/glt087. Epub 2013 Jul 2. PMID: 23825035. https://academic.oup.com/biomedgerontology/article/68/9/1068/596627

2. Jeter PE, Nkodo AF, Moonaz SH, Dagnelie G. A systematic review of yoga for balance in a healthy population. J Altern Complement Med. 2014 Apr;20(4):221-32. doi: 10.1089/acm.2013.0378. Epub 2014 Feb 11. PMID: 24517304; PMCID: PMC3995122. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3995122/

3. Sundh D, et. al. High-Impact Mechanical Loading Increases Bone Material Strength in Postmenopausal Women-A 3-Month Intervention Study. J Bone Miner Res. 2018 Jul;33(7):1242-1251. doi: 10.1002/jbmr.3431. Epub 2018 Apr 27. PMID: 29578618; PMCID: PMC6055617. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6055617/

4. Karinkanta, S. et al. A multi-component exercise regimen to prevent functional decline and bone fragility in home-dwelling elderly women: randomized, controlled trial.Osteoporos Int 18, 453–462 (2007). https://doi.org/10.1007/s00198-006-0256-1

5. Engelke, K., et al. Exercise maintains bone density at spine and hip EFOPS: a 3-year longitudinal study in early postmenopausal women. Osteoporos Int 17, 133–142 (2006). https://doi.org/10.1007/s00198-005-1938-9

6. Watson SL, et. al. High-Intensity Resistance and Impact Training Improves Bone Mineral Density and Physical Function in Postmenopausal Women With Osteopenia and Osteoporosis: The LIFTMOR Randomized Controlled Trial. J Bone Miner Res. 2018 Feb;33(2):211-220. doi: 10.1002/jbmr.3284. Epub 2017 Oct 4. Erratum in: J Bone Miner Res. 2019 Mar;34(3):572. PMID: 28975661.

7. Multanen J, et. al. Effects of high-impact training on bone and articular cartilage: 12-month randomized controlled quantitative MRI study. J Bone Miner Res. 2014 Jan;29(1):192-201. doi: 10.1002/jbmr.2015. PMID: 23775755. https://asbmr.onlinelibrary.wiley.com/doi/10.1002/jbmr.2015

8. Martyn-St James M, Carroll S A meta-analysis of impact exercise on postmenopausal bone loss: the case for mixed loading exercise programmes British Journal of Sports Medicine 2009;43:898-908.

9. Marques, E.A., et. al. Exercise effects on bone mineral density in older adults: a meta-analysis of randomized controlled trials. AGE 34, 1493–1515 (2012). https://doi.org/10.1007/s11357-011-9311-8

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