We often consider the frailty and disability associated with osteoporosis and osteopenia (bone loss that is not as severe as osteoporosis) as a normal part of aging. Medical research shows, however, that it’s not aging, but inactivity that causes bones to weaken and easily break. Although medications may be necessary to treat severe osteoporotic conditions, the best preventative strategy is to engage in bone-strengthening exercises, like yoga, and to make sure that you are getting the bone-healthy nutrition you need.
How Common Is Osteoporosis?
It is estimated that more than 40 million Americans suffer from osteoporosis or are at high risk of developing the condition due to low bone density.1 In its early stages, the disease is likely to be painless or nearly painless, but as osteoporosis progresses and bones become brittle and break, the pain and disability can be severe. Many hip fractures occur when someone with osteoporosis falls. The complications associated with these fractures can require long-term nursing care or even lead to death.
In addition to osteoporosis, there are many other age-related health problems that increase one’s risk of falling, including poor balance and posture, poor vision, inner ear imbalances, a decline in proprioception (which helps us know where our body is in space), poor circulation and medications that can cause dizziness. Each of these problems, especially in combination with a decline in bone strength, increases the likelihood of fracturing a hip or vertebrae.
Risk Factors: The condition is usually seen in individuals over 50, but it can strike at any age, and there are factors that put you at higher risk, such as:
- Being female
- Low body weight
- Lack of physical activity
- A family history of osteoporosis
- Early menopause without hormone replacement
- Prior bone fractures
- Chronic use of steroid medications
- Drinking alcohol excessively
Prevention and Treatment:
Yoga: One of the safest preventative measures and treatments for osteoporosis and osteopenia is yoga. It’s something that anyone, any age, can do anywhere; the benefits are many and risks few if done correctly.
A pretty amazing pilot study performed by Dr. Loren Fishman, Medical Director of Manhattan Physical Medicine and Rehabilitation in New York City, showed that when individuals practiced yoga for merely 10 minutes per day over a two-year period, their bone density increased!2 How is this possible? In the 19th century, a German anatomist and surgeon, Julius Wolff, theorized that bone will adapt to the load which is placed on it, i.e., it becomes stronger to resist the load.3 The inverse is also true; as the load decreases, bone becomes weaker. This phenomenon is perhaps best demonstrated by what happens to astronauts in space, who without the force of gravity working on their bones, are at great risk for developing osteoporosis.
In holding yoga poses, tensile (stretching) force and isometric, compressive (weight-bearing) force stimulate the osteocytes (cells found in mature bone) to produce proteins and lay down new bone. Yoga produces both the stress of dynamic loading when moving into a pose and static loading by holding a pose. In addition, yoga stimulates the production of synovial fluid, which not only lubricates and nourishes the joints but also activates chondrocytes (the cells found in healthy cartilage) to lay down new cartilage. By engaging our muscles to both pull and push on the bone, yoga surpasses the bone-strengthening benefits of gravity. The benefits occur when you hold a pose for anywhere between 12 and 72 seconds. I suggest holding each pose long enough to take five to seven deep breaths (about 30 seconds).
Is “the pain worth the gain”? In his book, Yoga and Osteoporosis, Dr. Fishman quotes an ancient guru, who said, “At first, medicine can feel like heaven, but it eventually resembles poison; whereas yoga may feel like poison at first, but eventually it resembles heaven.”4 Even if you already have osteoporosis, practicing yoga can be beneficial in strengthening muscle tissue and bone; however, certain joint movements should be modified or avoided altogether. Consequently, for these individuals, I highly recommend beginning with a customized, one-on-one session with a therapeutic yoga instructor.
A Healthy Diet: To keep our bones strong, it’s also essential that we get enough of the following nutrients:
- Vitamins: C, D, B6, B9, B12, K
Minerals: Calcium, Magnesium, Zinc, Manganese, Copper, Boron, Silicon
Omega-3 fatty acids
Nutritional Supplements: Generally speaking, a diet rich in fruits, vegetables, mono- and poly-unsaturated fats, complex carbohydrates and lean meat (in moderation) will provide the majority of the vitamins and minerals you need. As we age, however, our individual dietary needs and our body’s ability to absorb vital nutrients may change. For this reason, if a patient’s risk factors for developing osteoporosis are high, I often recommend measuring the vitamin and mineral concentrations within his or her body so we can supplement any nutritional deficiencies.
In addition to the nutrients listed above, Strontium has recently been identified as a promising agent in promoting healthy bone maintenance. It has been labeled as a “dual-action bone agent” because of its ability to both decrease osteoclast activity (bone-destroying cells) and increase osteoblast activity (bone-forming cells). In the US, it available in the form of Strontium Citrate, and it has been found to be effective in promoting healthy bone mineralization, supporting healthy vertebrae composition and promoting healthy hip bones. Research studies have demonstrated that the supplement is well tolerated by patients and can be used as an effective alternative to osteoporosis medications.5
Medications: Bisphosphonates, such as Fosamax, Actonel, Boniva, and Reclast, are the usual “go-to” medications for treating osteoporosis because of their effectiveness in reducing osteoclast activity. Unfortunately, however, some of the medications that are used to strengthen bone can produce poor quality bone by interfering with the osteoclastic activity that cleans up dead bone. In addition, patients who take these drugs can experience unpleasant side effects, such as acid reflux, nausea, irregular bowels, musculoskeletal pain, and in rare cases, osteonecrosis of the jaw and femoral fractures. For example, Boniva as an oral or once-monthly injection can increase blood pressure, and Reclast, an annual intravenous infusion, has been associated with atrial fibrillation exacerbation (heart rhythm disorder).6
There are other classes of drugs that can be used to treat osteoporosis such as selective estrogen receptor modulators like Raloxifene; and hormones, such as Miacalcin, Forteo, and Estrogens. Prolia is a monoclonal antibody medication aimed at decreasing the osteoclast (bone destroying) activity that can suppress the immune system and, in some cases, lead to serious infections, including myocarditis (infection of the heart muscle).7 So although there are medications available that can help reduce bone loss, in some patients their side effects may be worse than the risks of living with osteoporosis! (For additional information regarding these drugs, watch: Naturally Healthy Bones: How to Prevent & Treat Osteoporosis, 3-Part Video Series.
How Healthy Are Your Bones?
One indication of bone health is its density, but in terms of strength, the quality of bone is even more important. Its architecture, quality of collagen, the rate of bone turnover, and the size of mineral crystal, all contribute to good bone.
Ask your physician about the painless and brief procedure called a DexaScan that uses two different strength x-ray beams to measure the thickness of a person’s hip or spine. The test results are reported as a percentage from the mean density of a healthy 25-year old (T score). Any value below -2.5% is considered osteoporosis, and any value in the range of -1% to -2.5% is considered osteopenia, which can, but doesn’t always, lead to osteoporosis. There is also a supplemental test called “Ntx” that measures collagen breakdown in the urine associated with increased bone turnover.
These test results, used in combination with other measures of your health, can give you and your doctor a good indication of your bone health and the steps you need to take to prevent or counter osteoporosis. Osteoporosis can’t be cured, but yoga and good nutrition are the best things you can do to prevent the disease or forestall its progression.
1 Fast Facts: What is Osteoporosis? National Institutes of Health Osteoporosis and Related Bone Diseases National Resource Center (online resource visited 9/3/13).
2 Wolff, Julius. The Law of Bone Remodelling. Berlin: Springer-Verlag, 1986. Print.
3 Rubin CT and Lanyon LE. Regulation of bone formation by applied dynamic loads. Journal of Bone and Joint Surgery. 1984. 66-A: 397-402. Fishman, Loren, and Ellen Saltonstall. Yoga for Osteoporosis: The Complete Guide. New York: W. W. Norton &, 2010. Print.
4 Fishman LM. Yoga for Osteoporosis, a pilot study. Topics in Geriatric Rehabilitation. 2009. 25(3): 244–50.
5 Genuis SJ and Schwalfenberg GK. Picking a bone with contemporary osteoporosis management: nutrient strategies to enhance skeletal integrity. Clinical Nutrition. 2007. 26; 193-207. Nielsen SP. The biological role of strontium. Bone. 2004. 35: 583-8.
6 Jordan N, Barry M, Murphy E. Comparative effects of antiresorptive agents on bone mineral density and bone turnover in postmenopausal women. Clinical Interventions in Aging. 2006. 1(4): 377-87.
7 FDA Approved, Medication Guide: Prolia. Amgen Manufacturing Limited, a subsidiary of Amgen Inc. One Amgen Center Drive Thousand Oaks, California 91320-1799. Accessed July 2013.