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Yoga for Osteoporosis

Published 8.23.2016
Osteoporosis is a topic that has been of interest to me for about five years. I've been collecting and reading articles (both journal and popular press) about the condition for roughly that period. This will be the first of a series (however sporadic it turns out to be) related to osteoporosis.

Although it's noted in the site disclaimer that is linked at the bottom of this (and every) post, I want to re-iterate for emphasis:
I’m not any sort of medical professional, so I am not going to pretend to be one. My understanding of osteoporosis is based upon my layman’s analysis of the research I’ve read. In no way is anything I wrote to be construed as advice or a recommendation for treating or dealing with osteoporosis.

My path to using yoga as part of my treatment for osteoporosis began with a book. This is my review of Loren Fishman MD's Yoga for Osteoporosis: The Complete Guide.
I’ve owned this book for years, and I have read through parts of it often. This book helped me understand the disease and formulate my response to early onset osteoporosis. I highly recommend this book. The book is essentially divided into two parts. The first part is an explanation of the disease as it is currently understood— and make no mistake about it, osteoporosis is in NO WAY completely understood.

The basic outlines of how the body makes and replaces bone is understood— yes, that’s right, bones are not static. I, at least, always thought that once puberty was reached, your height and bone structure were set. While it’s true that bones no longer lengthen post puberty, it is not true that the body stops making bone material.

As the book makes plain, bones is living tissue. The body both makes and resorbs bone material. In some ways, osteoporosis can be seen as an imbalance between rates of making and breaking down bone material.

The rest of the first part goes through the various treatment options for osteoporosis, pharmaceutical and not— with the exception of yoga. Fishman is not a fan of drugs for treatment, and that seems to be a function of both the potential side effects for the various drugs (those that existed when he wrote the book) and the fact that those drugs only effected one half of the healthy bone balance equation.

Because I know Fosamax best, I will use that as the example. Fosamax works to decreases the action of the osteoclasts (the cells that destroy or resorb bone tissue) but do not increase the action of the osteoblasts (the cells that make the bones.) The result is that though bone density may increase (mine didn’t but for many it does), the bone structure is different and not as strong.

Before continuing, I just want to comment on the ridiculousness of the cell with the word “blast” in its name being associated with bone creation. I mean, who would make such a choice when deciding nomenclature??? Anyway...

The side effects or Fosamax, while relatively rare, are pretty devastating. When the horror stories first received news coverage, apparently many women stopped taking the drug in fear. Eventually it was decided that the problem was long term drug use prior to the onset of actual osteoporosis that was the problem. Doctors had been prescribing the drug for women with osteopenia, which while indicating bone density loss, is not the same as osteoporosis.

And there, in that last paragraph, my lack of medical knowledge i becomes apparent. That’s a bare bones description lacking nuance, which all medicine requires. Fishman has objections to the other drugs, and they of course all have side effects too.

The second section of the book is where the meat is. Fishman doesn’t just dive into a description of yoga poses and say, “Do this.” First he establishes why he thinks yoga (in particular) will be effective for osteoporosis, and then defines the type of yoga that will be effective.

Fishman does note that just about any type of exercise will help with bone health, but that yoga is, in his view, special because it follows Wolff's law.

Wolff's law states that the architectonic of a bone, its underlying structural system of support, follows the lines of force to which that bone is subjected.


Increased force loading on bones results in the formation of more bone, and the reverse is true as well. The forces that strengthen bone are muscular stimulus and gravity. Astronauts arrive back on earth with weaker bones because they haven't had any gravity to exert a load on their bones.

Fishman, however, isn't relying on gravity to create force, instead wants to create dynamic tension and mechanical leverage. The theory is that exercises like yoga, which require a person to hold their body in positions that require the muscles to pull in dynamic tension transversely against the bone will help stimulate the osteoblasts to make more bone material.

After presenting his reasoning for why yoga is best for bone health, as well as some of the advantages and disadvantages, the rest of the book are descriptions and pictures of yoga poses. Three types of poses are presented, poses for increasing bone strength, poses for increasing muscle strength, and lastly poses for improving balance. For each pose three variations are provided: one for people with osteoporosis, one for people with osteopenia, and the traditional yoga pose for people looking to prevent osteoporosis.

I found the descriptions of the poses and the accompanying pictures to be detailed enough that I was able (as a complete yoga novice) do the poses on my own. Of course, there's Youtube presentations of some of his recommended poses. The poses demonstrated are the 12 that he recommends at his website. The book includes many more poses than 12. Of course, no intervention works unless you actually do it. He chose 12 to list at the site to make the program more likely to appeal to people. Essentially, the prescription is to do each of the 12 poses on each side and hold for 30 seconds. In other words, the conceit is better bones with 12 minutes of effort each day.

I prefer the program presented in the book, which includes both easier and more challenging poses to do.

Gym report

As I noted in June, I joined a gym with a friend. That friend generally makes it to the gym once a week in recent weeks, but I have settled into a schedule where I'm going five days a week. I take an hour long pilates class two days a week and an hour long yoga class on each of the other three days. After class on two or three days I stay a bit longer and lift some weights. I suppose I'm "lifting heavy," in that I lift weights that are heavy for me. And of course, I continue to use both my treadmill for cardio and my bike desk or standing desk while working.

Full disclosure: I mostly do the prevention version of poses in Fishman's book, even though were I his patient, he might tell me not to do so because I have actual osteoporosis. The yoga classes I've begun to take at the gym include many of the poses in the book, though seldom are they held for as long as Fishman recommends. I do the full poses in class there too, if I can. If I can't, then I try the modifications the instructor offers, or I don't the pose. It's as simple as that.

Reading the book has allowed me to be more comfortable in class more quickly than if I'd been a complete novice. Teachers (as they always do) vary in terms of the completeness and usefulness of their instructions. I should note that the book lists the Sanskrit names for the poses, but I never paid attention to them. Most teachers simply use the English names for the poses, but some go through all the Sanskrit as they move from pose to pose.

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