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Getting Down to the Bone: Research on Yoga for Osteoporosis

Excerpts from an article in the KRI Newsletter, Nov 2018, by Nikhil Ramburn and Sat Bir Singh Khalsa, Ph.D

Osteoporosis is the degeneration of bone tissue that occurs when new bone creation doesn’t keep up with the body’s natural process of old bone removal. Individuals may experience a decrease in height over time and localized pain, but many people have no symptoms until they experience a bone fracture.

Women are more likely to develop osteoporosis, and a reduction in estrogen levels in women at menopause is one of the strongest risk factors for developing osteoporosis. Other risk factors include a diet low in calcium, obesity, comorbid inflammatory conditions such as Lupus and Rheumatoid Arthritis, and a sedentary lifestyle.

Osteoporosis is considered a serious public health concern given that over 200 million people worldwide suffer from this disease, and approximately 30 percent of all postmenopausal women have osteoporosis in the United States.

Conventional pharmacotherapy includes bisphosphonates, a class of drugs for preventing bone density loss, although these have possible side effects including gastrointestinal toxicity, death of bone tissue in the jaw and other sites, and severe (and sometimes irreversible) leg cramps and bone pain.

However, bone density is sensitive and responsive to physical activity. Numerous, controlled studies have demonstrated that people who exercise regularly have greater bone density than their sedentary counterparts. Resistance training and weight-bearing exercises can help slow down bone loss in part due to the dynamic loads delivered to the skeleton, which stimulates the deposition of more bone tissue. In addition, a diet containing green leafy vegetables along with nuts and legumes can provide the necessary calcium to reduce the risk of osteoporosis.

Complementary and integrative approaches such as yoga may offer many of the benefits of conventional exercise, while also enhancing balance, posture, flexibility, strength, and quality of life in the elderly. Indeed, yoga exercises may decrease fall risks and fractures because of their positive effects on balance.

In addition, the ability to modify yoga exercises to accommodate individuals with a high risk of falls or fractures and who have limited strength makes this intervention particularly suitable to elderly osteoporotic patients. The combination of mild spinal flexion and extension, which are common within yoga practices, may decrease the risk for vertebral compression fractures whereas the moderate weight-bearing exercises in yoga can strengthen the core muscles that support the spine.

Preliminary biomedical research on the efficacy of yoga for osteoporosis is promising. In a single-group pilot study at the Columbia College of Physicians and Surgeons in New York in 2009, patients with osteoporosis or osteopenia (lower bone density than normal but not yet pathological) practiced a regimen of 10 yoga postures which were modified according to individual limitations. The poses included the triangle pose (Trikonasana), the upward and downward dog poses (Adho Mukha Svanasana and Urdhva Mukha Svanasana) amongst others. Each position was held for 20 to 30 seconds.

Unfortunately, compliance was poor and only 11 patients out of 117 completed the 2-year protocol. Nevertheless, the results revealed statistically significant improvements in bone density scores in yoga practitioners, 5 patients with osteopenia were reclassified as normal, and 2 patients with osteoporosis were reclassified/downgraded to osteopenia, thereby indicating that yoga exercises for as little as 8 to 10 minutes daily will increase bone density in older patients.

A subsequent study with a larger sample size was published in 2016 and documented a 10-year study of 741 internet-recruited volunteers. Participants used a 12-minute DVD of the yoga poses that would stimulate bone density (the same exercises from the pilot study described above). The poses were specifically selected to produce torque and bending of the proximal femur, compression of the pelvis, and twisting of the lumbar vertebral bodies as these are the most common sites of osteoporotic fractures.

The researchers found that bone mineral density improved in hips, spine, and femur in the 227 moderately and fully compliant patients. In fact, monthly gain in bone density scores was significant in both the spine and femur while gains in hip bone density did not achieve statistical significance. Furthermore, no yoga-related injuries were imaged or reported. This current study therefore supports the efficacy and safety of yoga as a treatment for osteopenia and osteoporosis.

The current body of evidence points towards increased bone mineral density with yoga practice, suggests improvements in serum markers of bone growth, and even demonstrates the potential for yoga to reverse bone loss that has reached the stages of osteopenia and osteoporosis.

However, additional studies with larger randomized controlled trials and further investigation including a younger osteopenia-free population are necessary to support these findings and establish the benefits of yoga in relation to conventional exercises.

Finally, some researchers warn that new pain and fractures can occur after participation in yoga flexion exercises given the extreme strain of some yoga positions. An assessment of fracture risk in older persons is critical in designing an effective and safe therapeutic yoga intervention.

Nikhil Rayburn grew up practicing yoga under mango trees in the tropics. He is a certified Kundalini Yoga teacher and has taught yoga to children and adults in Vermont, New Mexico, Connecticut, India, France, and Mauritius. He is a regular contributor to the Kundalini Research Institute newsletter and explores current yoga research.

Sat Bir Singh Khalsa, Ph.D. is the KRI Director of Research, Research Director for the Kripalu Center for Yoga & Health, and Assistant Professor of Medicine at Harvard Medical School. He has practiced a Kundalini Yoga lifestyle since 1973 and is a KRI certified Kundalini Yoga instructor. He has conducted research on yoga for insomnia, stress, anxiety disorders, and yoga in public schools. He is editor in chief of the International Journal of Yoga Therapy and The Principles and Practice of Yoga in Health Careand author of the Harvard Medical School ebook Your Brain on Yoga.