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Osteology
Yoga and Osteoporosis
15
Oct
Oct
Before of everything I wanna start this article sharing the DEXA results of one of my yoga class practitioner!!!
At the age of 54 years old we succeeded with a proper nutrition and a regular Yoga program not only to stop the regression but also to improve the score on lumbar spine from 1.8 to 1.0 (green frame) without any drugs or medication from the diagnosis: Osteopenia at 50 years old -> Normal bone at 54 years old.
- INTRODUCTION
What is Osteoporosis ?
Osteoporosis is a bone disease that occurs when the body loses too much bone, makes too little bone, or both. As a result, bones become weak and may break from a fall or, in serious cases, from sneezing or minor bumps.
Osteoporosis means “porous bone.” Viewed under a microscope, healthy bone looks like a honeycomb. When osteoporosis occurs, the holes and spaces in the honeycomb are much larger than in healthy bone. Osteoporotic bones have lost density or mass and contain abnormal tissue structure. As bones become less dense, they weaken and are more likely to break. If you’re 50 or older and have broken a bone, ask your doctor or healthcare provider about a bone density test.
Osteoporosis is Common
Osteoporosis is one of the most widespread chronic conditions in the Western hemisphere, and it’s hard to exaggerate its health effects. Osteoporosis affects 44 million Americans. That’s more than half of everyone over the age of 50. It is 50 percent of all women of whatever age and 25 percent of all men. It affects over 200 million people worldwide. So this is big time.
Osteoporosis is Serious
Osteoporosis causes a million fractures each year, most of which are vertebral fractures and about 300,000 are hip fractures. We worry so much about breast cancer in women, however, in actuality the risk of a hip fracture is equal to the combined risk of breast, uterine and ovarian cancer. And it’s not just women who are at risk. For men over 50, even though we hear a lot about prostate cancer, men over 50 are actually more likely to have a hip fracture than prostate cancer.
Fully 25% of the people that have hip fractures die. Another 25 percent enter a nursing home never to leave, so half of people who contract a hip fracture have a very significant life change.
2. Symptoms
Most people with osteoporosis do not have any symptoms. They do not know they have osteoporosis until they have a bone density test or a fracture.
One early sign can be a loss of height caused by curvature or compression of the spine. Curvature or compression is caused by weakened vertebrae (spine bones). The weakened vertebrae develop tiny breaks called compression fractures. Compression fractures cause the spine bones to collapse vertically. When this happens, the vertebrae become shorter. The shape of each single vertebra goes from a normal rectangle to a more triangular form.
Compression fractures can cause back pain or aching. But the loss of height usually does not cause any symptoms.
Osteoporosis usually does not cause pain unless a bone is fractured.
3. Causes of Disease & Risk Factors
You are more likely to develop osteoporosis if you:
- Are female
- Are 50 or older
- Are postmenopausal
- Have a diet low in calcium
- Have an intestinal problem that prevents calcium and vitamins from being absorbed
- Have an overactive thyroid (hyperthyroidism) or take too much thyroid hormone
- Lead a sedentary lifestyle
- Are thin, low body weight
- Take certain medications, such as prednisone
- Are Caucasian or of Asian descent
- Smoke
- Drink too much alcohol
- Have a family history of osteoporosis
- Have had at least one “fragility” fracture (one caused by little or no trauma)
Who should have BMD testing?
Anyone who belongs to one or more categories above
4. Diagnosis
The most accurate bone density test is DEXA (dual-energy X-ray absorptiometry). DEXA takes 10 to 15 minutes and is painless. It uses minimal amounts of radiation and generally is done on the spine and hip.
Bone Mineral Density is considered normal if the T-score is within 1 standard deviation of the normal young adult value. Thus a T-score between 0 and -1 is considered a normal result.
Low bone mass (medically termed osteopenia): A BMD defines osteopenia as a T-score between -1 and -2.5. This signifies an increased fracture risk but does not meet the criteria for osteoporosis.
Osteoporosis: A BMD greater than 2.5 standard deviations from the normal (T score less than or equal to -2.5) defines osteoporosis.
5. Body Functions
OSTEOCLASTS are large cells that dissolve the bone – collapse the bone. They come from the bone marrow and are related to white blood cells. They are formed from two or more cells that fuse together, so the osteoclasts usually have more than one nucleus. They are found on the surface of the bone mineral next to the dissolving bone.
OSTEOBLASTS are the cells that form new bone – building the bone. They also come from the bone marrow and are related to structural cells. They have only one nucleus. Osteoblasts work in teams to build bone. They produce new bone called “osteoid” which is made of bone collagen and other protein. Then they control calcium and mineral deposition. They are found on the surface of the new bone.
When the team of osteoblasts has finished filling in a cavity, the cells become flat and look like pancakes. They line the surface of the bone. These old osteoblasts are also called LINING CELLS. They regulate passage of calcium into and out of the bone, and they respond to hormones by making special proteins that activate the osteoclasts.
OSTEOCYTES are cells inside the bone. They come from osteoblasts. Some of the osteoblasts turn into osteocytes while the new bone is being formed, and the osteocytes then get surrounded by new bone. They are not isolated, however, because they send out long branches that connect to the other osteocytes. These cells can sense pressures or cracks in the bone and help to direct where osteoclasts will dissolve the bone.
Prevention
As we could saw in previous chapter, osteoporosis is a very serious condition, very common and causes of disease and risk factors are many and mostly can’t be avoided or changed. But fortunately there some factors where we can step in like physical activities, food and supliments
1. Physical activities
Most people have heard of Wolf’s law: The architectonic, the structural support of bone, follows the lines of force to which that bone is exposed. When bone cells get stimulated through being compressed or twisted or elongated, they produce more bone mass until that bone gets strong enough, to resist the pressure. At that point the pressure no longer distorts the bone, and the bone-making cells stop making more. What a wonderful feedback system. In osteoporosis, the bones bend more, so pressure is more effective in stimulating the cells to make bone.
In short, like weight training, yoga works by stressing the bone. Yoga stimulates the bone with isometric contraction at almost every conceivable angle for long periods of time and puts more pressure on bone than gravity does, by opposing one group of muscles against another, as a result: it stimulates osteocytes, the bone-making cells.
Yoga helps grow bone mass, because asanas pull and stretch the bones from every conceivable angle, yoga also may stimulate the formation of a bone structure that is able to resist greater amounts of pressure, as well as many different types of challenges.
There are numerous other important benefits in Yoga that people with osteoporosis can reach, such as improving balance, muscular strength, range of motion and coordination, while lessening anxiety. These are other important benefits of yoga for people with osteoporosis because they each help reduce the risk of falling.
Even if bone density did not increase, improvements in posture and balance that can accrue from the practice of yoga can be protective; Spinal fractures can result from poor posture, and there’s no medication for that, but yoga is helpful … Yoga is good for range of motion, strength, coordination and reduced anxiety, all of which contribute to the ability to stay upright and not fall. If you don’t fall, you greatly reduce your risk of a serious fracture.
Of course, the key to getting the benefits of yoga is to ensure that the yoga postures are done with proper alignment. Every joint in the body and every part of the body has an optimal alignment and this is a scientific process. There are several yoga styles that emphasize this precision of alignment. If the joints are aligned properly, not only do you get best stimulus of the bones, but you have much better balance too.
Contraindications
Twists give such a symmetrical pressure to the vertebral body that it’s not a fracture risk. And even though doctors caution their patients with osteoporosis never to do any twisting, there seems to be no actual evidence that twists are bad in and of themselves.
Of course, if you’re twisting and lifting something at the same time, it’s a different story. However, yoga twists, as I said, provide such a symmetrical pressure, we feel that gentle, supported twists are safe to do as part of one’s yoga practice. And they are very important, because they give such a complete stimulus to the vertebral body.
If you have certain other spine conditions, like a herniated disk, twists can be a problem. However, if all you have is osteoporosis, there’s almost no other way of developing strength and stimulate bone growth than exposing that vertebra to some pressure. We do have to avoid forward bends in people with osteoporosis, and the side bends they can do are limited. So twisting the vertebra is one of the few ways to get all of the vertebrae under some compression and stimulate bone growth in the vertebrae. This is extremely important, because so many osteoporosis fractures happen in the vertebrae.
2. Food & Supliments
One important strategy for maintaining healthy bones is to eat real food. A diet full of processed foods will produce biochemical and metabolic conditions in your body that will decrease your bone density, so avoiding processed foods is the most important first step to improving your bone health.
Certain nutrients, including animal-based omega-3 fat, calcium, vitamin D, K2 and magnesium, are also critical for strong bones as are also exercises.
As mentioned earlier, Calcium, Magnesium, Vitamin D and Vitamin K2 are really important for bone strength. If I were to rank them, the latter two would be at the top of the list, for the mere fact that most people are deficient in them. But all four of these nutrients work in tandem and cannot perform properly without the others:
- Vitamin D helps your body absorb calcium;
- Vitamin K2 directs calcium to your skeleton, while preventing it from being deposited in your organs,
joint spaces and arteries. (A large part of arterial plaque consists of calcium deposits, hence the term “hardening of the arteries”);
- When you take vitamin D, your body creates more vitamin K2-dependent proteins that shuttle the calcium
around your body. Until or unless the K2 comes in to activate those proteins, those benefits cannot be realized;
- Magnesium is another important player needed for the proper function of calcium;
Calcium, magnesium, vitamin K2 and D3 are available in supplement form, but you can also get them naturally from food and the sun, which is typically preferable to a supplement.
Good Sources of:
Calcium
Include raw milk and cheese from pasture-raised cows (that eat plants), leafy green vegetables, the pith of citrus fruits, carob, sesame seeds and wheatgrass, to name a few. Calcium from dietary sources is typically better absorbed and utilized than calcium from supplements.
Magnesium
Dietary sources of magnesium include sea vegetables, such as kelp, dulse and nori. Few people eat these on a regular basis however, if at all. Vegetables can also be a good source, along with whole unprocessed grains. However, grains MUST be prepared properly to remove phytates and anti-nutrients that can otherwise block your absorption of magnesium. As for supplements, I prefer magnesium threonate, as it can penetrate the mitochondrial membrane more efficiently than other varieties.
Vitamin K2
Ideally, optimize your vitamin K through a combination of dietary sources (leafy green vegetables, fermented foods like nattō and raw milk cheeses) and a K2 supplement, as most people don’t get sufficient amounts of vitamin K from their diet to reap its full health benefits.
The form of vitamin K2 that has the most relevance for health benefits is MK7, a newer and longer-acting form with more practical applications. MK7 is extracted from the Japanese fermented soy product called nattō. You could actually get plenty of MK7 from consuming nattō, as it is relatively inexpensive and available in most Asian food markets.
Most vitamin K2 supplements are in the form MK7. You must use caution with vitamin K2 if you take anticoagulants, but if you are generally healthy and not on these types of medications, I suggest 150 to 300 micrograms daily.
Vitamin D3
Exposing your skin to natural sunlight is the best way to get enough of this important nutrient. Vitamin D from sunlight acts as a pro-hormone, rapidly converting in your skin into 25-hydroxyvitamin D, or vitamin D3. A therapeutic UV bed may help you achieve similar results. A third alternative is taking an oral vitamin D3 supplement.
Be sure to monitor your level to be sure you’re within the therapeutic range of 40 to 60 nanograms per milliliter. Also remember to increase your vitamin K2 intake when you take a high dose D3 supplement.
4-Step Plan to Help Protect Your Bones No Matter What Your Age
One of the best ways to achieve healthy bones is a real food diet rich in fresh, whole foods that maximizes natural minerals so that your body has the raw materials it needs to do what it was designed to do. In addition, you need sensible sun exposure along with regular exercise. To sum it up:
- Consume a wide variety of fresh, ideally organic, whole foods, including vegetables, nuts, seeds, organic meats and eggs, and raw (unpasteurized) organic dairy for calcium and other nutrients. Minimize processed sugar and refined grains. Switching to a natural salt like pink Himalayan may also be helpful, as it contains a wide variety of natural minerals needed for healthy bone growth, as explained by Dr. Robert Thompson in his book “The Calcium Lie.”
- Optimize your vitamin D3 through a combination of sun exposure, food and/or an oral vitamin D3 supplement (ideally one that also contains K2). Check your blood levels regularly to make sure you’re within the healthy range of 40 to 60 Nano-grams per milliliter.
- Optimize your vitamin K through a combination of dietary sources and a K2 supplement, if needed. Although the exact dosing (for oral supplementation) is yet to be determined, and you must use caution on the higher doses if you take anticoagulants, if you are generally healthy and not on these types of medications, I suggest 150 to 300 micrograms daily.
- Make sure you do some form of weight-bearing exercise. Examples include body-weight exercises, WBVT and yoga. Strength-training exercises are also important in order to produce the dynamic electric forces in your bones that will stimulate the osteoblasts to produce new bone.
Studies
In a larger follow-up study that lasted from 2005 to 2015, Fishman and three collaborators enrolled 741 volunteers to do 12 yoga poses every day (fully compliant), or at least every other day (moderately compliant).
The average age of the participants was 68 at the outset of the study, and 83 percent of them had been diagnosed with either osteopenia or osteoporosis. The 12-pose regimen, each of which was held for 30 seconds (for a total workout of 12 minutes), included the following.
Participants’ bone density was measured at the outset and at the end of the study. Blood and urine samples, as well as spine and hip x-rays were also taken. Compliance was recorded via an online program.
The results, published in the April / June issue of Topics in Geriatric Rehabilitation, were again quite promising. Those who were either moderately or fully compliant with the exercises had indeed improved their spine and femur bone densities. Bone density in the hip was also somewhat improved, although the difference was not statistically significant.
Additional bone quality testing performed on 18 of the participants revealed they also had “better internal support of their bones, which is not measured by a bone density scan but is important to resisting fractures.”
Another article based on a study of an experimental group vs a control group: http://www.ncbi.nlm.nih.gov/pubmed/19891384
NOTHING IN THIS ARTICLE SHOULD BE CONSTRUED AS MEDICAL ADVICE. OSTEOPOROSIS IS A SERIOUS CONDITION, ALWAYS CONSULT A DOCTOR ABOUT ANY MEDICAL CONCERNS AND BEFORE STARTING ANY EXERCISE REGIMEN.
SOURCES
YOGA for OSTEOPOROSIS by Loren Fishman & Ellen Saltonstall
*Dr. Loren Fishman is an M.D. and an Iyengar-trained yoga teacher, as well as the managing partner of Manhattan Physical Medicine and Rehabilitation.
Ellen Saltonstall is an author, a yoga therapist, a senior certified Anusara yoga teacher and she holds a master’s degree in the field of therapeutic movement education.
http://fitness.mercola.com/sites/fitness/archive/2016/07/01/yoga-for-osteoporosis.aspx
https://www.nof.org/patients/what-is-osteoporosis/
http://sciatica.org/yoga/12poses.html
http://study.com/academy/lesson/osteoclast-definition-function-formation.html
This is guest post written by one of my collaborators, let’s call her D., who I thank it very much for it’s contribution on helping me (and you, I hope) understanding the benefits of Yoga for Osteoporosis and also giving some advice to people who struggle with this medical problem.
