Can Yoga Delivered by PT, OT or ATC Reverse Osteoporosis?

Osteoporosis is a disease that results in decreased bone mass and quality of bone, which may lead to fracture (Ragucci, 2011). The cumulative lifetime fracture risk for a 50-year woman with osteoporosis is as high as 60% (Cummings 1989). Annual direct care expenditures for osteoporotic fractures range from $12 to $18 billion per year in 2002 dollars. Indirect costs (e.g., lost productivity for patients and caregivers) likely add billions of dollars to this figure (Office of the Surgeon General, 2004). 

Yoga is often packaged as a low cost, low risk, very beneficial intervention for osteoporosis (Lu 2016).  Yoga is reported to help to ease symptoms, improve bone density, and lower your risk of osteoporotic “complications.”  But are these claims evidence based?  How about yoga delivered by physical or occupational therapists or athletic trainers vs current medical management of osteoporosis? Not all types of exercise have the same positive effect on bone density (Benedetti, 2018) so is yoga better than other forms of exercise for treating osteoporosis?  Let’s dive in and find out!

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Medical Management of Osteoporosis

Let’s first ask this: does current medical management, or the “gold standard,” do a good job at addressing osteoporosis?  The evidence says no. Pharmacological management of hip fractures are associ­ated with further spontaneous fractures, atrial fibrillation, slowed healing, gastric distress, osteonecrosis, scleritis and episcleritis (Sorensen 2008; MacLean 2008; Reid 2015; Järvinen 2008). It seems likely the common health decline patients see after hip fracture is actually due to pharmaceutical treatment rather than the patient’s initial fracture (Lu 2018). Furthermore, the medical model assumes a subject-object relationship between the therapist and patient. The expectation is that change occurs through medical intervention of some kind, and the patient is a passive recipient of said intervention. The patient is not a proactive participant in her healing process. This model has been not very successful in dealing with osteoporosis as it’s not getting to the root cause or asking the patient to change their lifestyle in order to see improvements.

Yoga Therapy Improves Bone Mineral Denisty (BMD)

Regarding exercise, not all exercise is equal in improving BMD and addressing osteoporosis. For example, walking is often prescribed to those at risk of osteoporosis. Benedetti looked at forty-four systematic reviews on only walking for osteoporosis and found an absence of significant increases in the bone mineral density (BMD) of the lumbar spine or on the femoral neck. They noted, however, walking is effective in maintaining the current level of BMD (Benedetti, 2018).

What is Yoga’s effects on BMD? Lu and collegues (2015) concluded in a ten year study of 741 patients that yoga can reverse bone loss that has reached the stages of osteopenia and osteoporosis. Not only did the participants hip BMD increase by 50%, but also, after 90,000 hours of yoga practiced over 2 years, largely by people with osteoporosis or osteopenia, there was not one incidence of fracture or serious injury of any kind related to the prac­tice of yoga in any of the 741 participants.  It is theorized yoga improves BMD through bending, compressing and twisting and producing torque at the common osteoporotic sites including the proximal femur, pelvis, and lumbar vertebral bodies (Lu 2016). Pharmacological interventions cannot reproduce this mechanical loading and the subsequent positive effects.

 Yoga Therapy Causes Lifestyle Changes

Lifestyle changes supported by the literature are appropriate intake of calcium and vitamin D, increasing weight-bearing exercise, limiting alcohol and caffeine, and avoiding smoking (Ragucci, 2011). Note that data on calcium and vitamin D are mixed and conclusions are hard to draw.

Yoga can improve lifestyle choices by contributions to improved joint mobility and flexibility of muscles, which improve physically activity in general, leading to improved lifestyle choices (ie walking or exercising more frequently) which can decrease osteoporosis (Grabara 2015). 

Yoga Therapy Reduces the Risk of Falls

Yoga reduces the risk of falling, which is the main cause of all other osteopo­rotic fractures (Järvinen 2008; Prado 2014; Ni 2014; Salem 2013). Yoga helps with postural awareness, and improved posture has been shown to reduce falls (Imagama, 2013).  A 2009 six month randomized controlled trial with 118 subjects reported thoracic hyperkyphosis (> 40 degrees) is remediable with yoga intervention. In addition, the yoga group reported less upper back pain, early morning awakening and insomnia (Greendale 2009).

 In summary, there is good evidence that yoga is one of the most effective and safest therapies for easing osteoporotic symptoms, improving bone density, and lowering risk of osteoporotic complications. In our comprehensive continuing education seminar, we outline a specific yoga based, evidence based intervention for patients managing osteoporosis for the physical, occupational therapist and the athletic trainer.  Learn more at www.PTYogi.com Courses are limited to 15 participants and fill extremely fast so sign up today!

Sources:

Benedetti MG, Furlini G, Zati A, Letizia Mauro G. The Effectiveness of Physical Exercise on Bone Density in Osteoporotic Patients. Biomed Res Int. 2018:4840531. Published 2018 Dec 23. doi:10.1155/2018/4840531

Fishman, Loren M. MD, BPhil(Oxon) Yoga for Osteoporosis, Topics in Geriatric Rehabilitation. 2009 (25)3: 244-250 doi: 10.1097/TGR.0b013e3181b02dd6

Grabara M, Szopa J. Effects of hatha yoga exercises on spine flexibility in women over 50 years old. J Phys Ther Sci. 2015;27:361-5.

Greendale GA, Huang MH, Karlamangla AS, Seeger L, Crawford S.Yoga decreases kyphosis in senior women and men with adult onset hyperkyphosis: results of a randomized controlled trial. J Am Geriatr Soc. 2009 September ; 57(9): 1569–1579. doi:10.1111/j.1532-5415.2009.02391.x.

Järvinen TLN, Sievänen H, Khan KM, Heinonen A, Kannus P. Shifting the focus in fracture prevention from osteoporosis to falls. BMJ. 2008;336:124.

Lu YH, Rosner B, Chang G, Fishman LM.  Twelve-Minute Daily Yoga Regimen Reverses Osteoporotic Bone Loss. Topics in Geriatric Rehabilitation. 2016 (32) 2: 81-87.

Motorwala ZS, Kolke S, Panchal PY, Bedekar NS, Sancheti PK, Shyam A. Effects of Yogasanas on osteoporosis in postmenopausal women. Int J Yoga. 2016;9(1):44-48. doi:10.4103/0973-6131.171717

Ni M, Mooney K, Harriell K, Balachandran A, Signorile J. Core muscle function during specific yoga poses. Complement Ther Med. 2014;22(2):235-243.

Prado ET, Raso V, Scharlach RC, Kasse CA. Hatha yoga on body balance. Int J Yoga. 2014;7(2):133-137.

Office of the Surgeon General (US). Bone Health and Osteoporosis: A Report of the Surgeon General. Rockville (MD): Office of the Surgeon General (US); 2004. 5, The Burden of Bone Disease. Available from: https://www.ncbi.nlm.nih.gov/books/NBK45502/

Ragucci KR, Shrader SP. Osteoporosis treatment: an evidence-based approach. J Gerontol Nurs. 2011 Jul;37(7):17-22. doi: 10.3928/00989134-20110602-02. Epub 2011 Jun 15. PMID: 21667891.

Salem GJ, Yu SS, Wang MY, et al. Physical demand profiles of hatha yoga postures performed by older adults. Evid Based Complement Alternat Med. 2013;2013:165763.

Sorensen HT, Christensen S, Mehnert FF, et al. Use of bispho­sphonates among women and risk of atrial fibrillation and flutter: population based case-control study. BMJ. 2008;336: 813-826.

Sorensen MacLean C, Newberry S, Maglione M, et al. Systematic review: comparative effectiveness of treatments to prevent fractures in men and women with low bone density or osteoporosis. Ann Intern Med. 2008;148:197-213.

Sorensen MacLean Reid IR. Short-term and long-term effects of osteoporosis therapies [published online ahead of print May 12, 2015]. Nat Rev Endocrinol. 2015; 11(7):418-428. doi:10.1038/nrendo. 2015.71.