Yoga does three things to your body that no other exercise does — and that makes it the perfect exercise for low bone density. I’ve spent years perfecting a method to safely improve bone health through yoga.
The bone-strengthening method I developed has been put to the test in two exciting clinical studies. Both of which show that your patients can get great results by practicing 12 simple yoga poses a day — all from the comfort of their own home!
Editor’s Note: Download this free education tool, 12 Yoga Poses for Osteoporosis. It’s ready for you to share with your patients so they can have a handy guide to help them safely exercise their bones.
But first, let’s take a look at why yoga is such an ideal exercise for older adults and how it can help your patients stay strong, flexible, and pain-free. Then we’ll dive into those clinical studies I mentioned at the outset.
Click on the video below to hear the benefits of yoga for the joints from Dr. Fishman, and how long to hold a yoga pose for:
Why Yoga is the Ideal Form of Exercise for Older Adults
When you apply force to bones, it stimulates them to grow stronger. Per Wolff’s law, “bone is formed and strengthens along lines of mechanical stress.” This also describes how the greater the forces applied to a bone, the greater the bone-building at the point of stress.1 (For more on Wolff’s law, see Osteosarcopenia: Understanding Muscle-Bone Crosstalk to Help Mitigate Patient Risk.)
So it’s clear why experts recommend high-impact, weight-bearing exercise to stave off bone loss. But it’s also important to consider the joints, and the length of time spent activating the muscles.
So high-impact exercise can do more harm than good by aggravating the joints and causing inflammation. But yoga provides a solution.
Yoga’s gentle, low-impact movements are ideal for those with osteoporosis and osteoarthritis. These movements help distribute synovial fluid, which lubricates the joints and keeps them moving smoothly.
Synovial fluid is composed of water, inorganic salts, and macromolecules, hyaluronic acid (HA), lubricin, and aggrecans — which contribute to the boundary lubrication. As the main boundary lubricant, HA is a high molecular weight polysaccharide that contributes to the high viscosity of the synovial fluid.
More recently, the synergistic interaction of boundary lubricants HA, phospholipids, and lubricin has been shown to play a major role in boundary lubrication of a healthy synovial joint.
In addition to being a lubricant for joint surfaces (lubricin for boundary cartilage-to-cartilage lubrication and hyaluronate for synovium-on-synovium lubrication), synovial fluid is also a source of nourishment for the avascular articular cartilage.
Moreover, synovial fluid contributes to joint stability by forming a hydraulic “adhesive seal” between the two articulating bones.2 Of course this is good news for your joints and bones.
And in terms of bone health, there are three main reasons yoga is an excellent choice.
How Yoga Can Strengthen Bones
Yoga may be a slow and often stationary practice, but don’t be deceived by appearances. In yoga, your body is working incredibly hard. If practiced correctly, yoga can help keep bones strong and healthy. Here’s how:
Yoga puts unusual force on bones, which other exercises don’t. By unusual, I mean two things.
- First, yoga doesn’t just put force on one part of your body. If you play tennis, your racket arm may be especially strong. If you jog, your legs gain the most benefit. But the different positions in yoga accomplish the impressive task of engaging muscles and bones throughout your entire body.
- Second, yoga stresses bones at practically every angle. Yoga positions, or asanas, oppose one group of muscles against another and stimulate muscle-to-bone attachments.
These forces signal osteocytes — mechanosensor cells that reside within the bone matrix and comprise 90% to 95% of all bone cells.3 There was an earlier belief that osteocytes were merely passive “placeholders” in the mineralized matrix.
Now that has been displaced by exciting discoveries that have revealed that this population of cells is a highly sensitive, active, and responsive network.
In fact, recent studies show that osteocytes play a crucial, central role in regulating the dynamic nature of bone in all its diverse functions. Now osteocytes are known to be the principal sensors for mechanical loading of bone.
At the bone matrix level, they regulate local mineral deposition and chemistry. Moreover, osteocytes produce the soluble factors that regulate the onset of both bone resorption and formation. So it appears that osteocytes are the major local orchestrator of many of bone’s functions.4
With an improved understanding of the function of osteocytes, it’s much easier to appreciate yoga’s positive impact on bone.
Yoga Stimulates Bone Building
In yoga, you hold poses for an extended period of time. As mentioned in the video above, the length of time you hold yoga poses is key. Often, yoga poses are held for several seconds. This isn’t something you do in many other forms of exercise.
And research shows that levels of bone-building markers increase in as little as 12 seconds of subjecting bone to stress! So yoga stimulates bone-building due to the length of time you spend holding poses — which places your bones and muscles under continual stress.
Practicing yoga causes your body to release a powerful anti-inflammatory. Exercise causes your body to release peroxisome proliferator-activated receptor gamma coactivator 1-alpha (PGC-1a). PGC-1a is the protein that helps your body benefit from exercise.
Most notably for those with osteoporosis, PGC-1α is a powerful anti-inflammatory (combating the chronic, low-grade inflammation that causes bone loss.) Now, high-impact exercises release PGC-1a, just like yoga.
But as we’ve seen, high-impact exercise can aggravate joints and cause inflammation. With yoga, you get all the anti-inflammatory benefits of PGC-1a — without also causing inflammation. It’s a win, win for your patient’s bones. 5 6
Additional Benefits of Yoga for Osteoporosis
We’ve seen how yoga safely stresses bones without impact, and how the practice supports bone health. And many other benefits make yoga uniquely well-suited for those with low bone density.
Yoga can help improve posture, balance, coordination, strength, and mobility — all key benefits for preventing a fall.7 It also promotes a sense of peace and well-being, which is important since chronic stress can lead to bone loss.
In fact, recent studies show that by various signaling pathways chronic psychological stress is a risk factor for osteoporosis. And mounting evidence confirms the physiological importance of the central nervous system (especially the hypothalamus) in the regulation of bone metabolism.
Both animal and human studies indicate that chronic psychological stress leads to a decrease in bone mass and the deterioration of bone quality by influencing the sympathetic nervous system, hypothalamic-pituitary-adrenocortical (HPA) axis, and other endocrine, immune factors.
Chronic stress activates the HPA axis and sympathetic nervous system. It also suppresses the secretion of gonadal hormone and growth hormone. And chronic stress increases inflammatory cytokines — eventually leading to bone loss by inhibiting bone formation and stimulating bone resorption.8 So by relieving stress, yoga indirectly benefits bone health!
Finally, yoga is highly accessible. It’s easy to practice from the comfort of one’s own home, and you need very little equipment to do it.
10-Year Study Shows BMD Gains in Hip and Femur
For years, I’ve been fascinated by yoga’s potential to improve bone health. So in 2005, I decided to test my theory by running a pilot study. And that pilot study led to a large-scale study published in 2016.
Study #1 - Yoga for Osteoporosis: A Pilot Study
My pilot study involved 11 subjects and seven controls with either osteopenia or osteoporosis. These subjects practiced 12 yoga poses daily for two years. At the end of the study, the subjects who practiced yoga had better bone mineral density (BMD) in the spine and hips compared to the controls.9
Of course, I couldn’t draw a general conclusion from this small pilot study. But the results were encouraging. So I decided to conduct a much larger study next.
Study #2 - Twelve-Minute Daily Yoga Regimen Reverses Osteoporotic Bone Loss
My next study involved 227 active participants. These participants completed a health history questionnaire and shared the results of a recent DEXA scan. All participants were sent a DVD of the 12 yoga poses from the pilot study along with descriptions of each pose.
These participants were on average 68 years old and 83% of them had either osteopenia or osteoporosis. After two years of practicing the 12 poses consistently, participants showed promising results. They reported bone density gains in the spine, hips, and femur.
What’s more, none of the 227 study participants experienced a fracture or injury related to the practice of yoga. That’s with more than 90,000 hours of yoga practiced largely by people with osteopenia or osteoporosis. So overall, the results of this study support the safety and efficacy of the Fishman Method for those with low bone density.”10
Study #3 - New Yoga for Osteoporosis: A Dose Response Study (Ongoing)
Despite the promising results from these studies, yoga hasn’t gained much traction in the medical community. So, I’m conducting another, more robust study to show that properly chosen yoga poses can support strong bones.
Before Your Patients Start: Yoga Foundations
If your patients are new to yoga, encouraging them to work with a qualified instructor to start can be very helpful. That way, they can learn the basics of a safe practice.
But to provide a quick introduction, here are the basic principles of yoga:
The Basic Principles of Yoga
- The Breath. Breathing smoothly and naturally enhances yoga poses. Holding the breath can cause fatigue and block awareness of the body. In general, patients should inhale when lifting up or arching the back and exhale when settling into a pose or folding forward.
- The Foundation. The foundation is the part of the body bearing weight. This is often the feet, hands, or pelvis. The key is to spread the foundation so that the body is well supported. With the feet, it’s important to try and use all four corners of each foot in a balanced way. The toes should be stretched instead of contracted. The same concept applies to the hands.
- The Curve of the Spine. The spine has a natural curve that makes it strong. The goal when aligning the spine is to achieve a balance of strength and flexibility. Always bend from as low down in the spine as possible. Tilt the pelvis from the hips, not the waist. This will minimize any rounding of the spine and keep the back safe.
- The Balance of Opposites. If your patients are new to yoga, they may wonder why poses include actions that are opposite. For example, they may be instructed to press down through their feet and reach up through their arms. This is to create a stable pressure on their bones, which makes poses safer and more effective.
- The Knees. In most poses, the kneecaps should face the same direction as the second toe of the same leg. This can be challenging for some, so they can work toward it gradually. Maintaining this alignment will help protect the knees from dangerous torque.
- The Stance. For many poses, the feet will be wide apart. How wide depends on your patient’s height, proportions, and flexibility. If the stance is too wide, they might feel unstable. Remind your patients to always adjust their stance according to what feels right for them. Their stance should allow for both freedom of movement and stability.
- The Full-Body. Every pose will draw your patient’s focus to certain areas of their body. While standing, they may feel their legs more. While sitting, they may focus on their spine. This is natural. But they should try and open their awareness to their whole body in every pose. They can maximize their yoga routine by engaging their entire body, rather than focusing on just one area.
Yoga for Osteoporosis Takeaways
As discussed, applying force to bones stimulates them to grow stronger. Per Wolff’s law, “bone is formed and strengthens along lines of mechanical stress.
And research shows that levels of bone-building markers increase in as little as 12 seconds of subjecting bone to stress! So yoga stimulates bone-building due to the length of time you spend holding poses — which places your bones and muscles under continual stress. The different positions in yoga accomplish the impressive task of engaging muscles and bones throughout your entire body.
Moreover, yoga stresses bones at practically every angle. Yoga positions, or asanas, oppose one group of muscles against another and stimulate muscle-to-bone attachments. This helps explain the bone-strengthening effects of practicing yoga.
As both of my clinical studies demonstrated, after practicing 12 yoga poses consistently for two years, participants who had a history of either osteopenia or osteoporosis improved their bone strength.
In my pilot study, the subjects who practiced yoga had better BMD in the spine and hips compared to the controls. And in my subsequent study, participants reported bone density gains in the spine, hips, and femur.
What’s more, none of the participants in either study experienced a fracture or injury related to the practice of yoga. So overall, the results of these studies support the safety and efficacy of the Fishman Method for those with low bone density.
The 12 poses in my studies are accessible to almost everybody. When practiced every day, they’ll help your patients cultivate peace, strength, and balance. Plus, they’ll also be doing a wonderful favor for their bones.
- M. Burke, S. Goodman, "Failure mechanisms in joint replacement" in Joint Replacement Technology, 2008 https://www.sciencedirect.com/topics/engineering/wolffs-law
- Anthony J. Freemont, John Denton, "Synovial fluid" in Diagnostic Cytopathology (Third Edition), 2010 https://www.sciencedirect.com/topics/medicine-and-dentistry/synovial-fluid
- Carlos Vinícius Buarque deGusmão, William DiasBelangero "How Do Bone Cells Sense Mechanical Loading?" Revista Brasileira de Ortopedia (English Edition) Volume 44, Issue 4, January 2009, Pages 299-305
- Mitchell B. Schaffler and Oran D. Kennedy "Osteocyte Signaling in Bone" Curr Osteoporos Rep. 2012 Jun; 10(2): 118–125. doi: 10.1007/s11914-012-0105-4
- Christoph Handschin and Bruce M. Spiegelman "The role of exercise and PGC1α in inflammation and chronic disease" Nature. 2008 Jul 24; 454(7203): 463–469. doi: 10.1038/nature07206
- J. Plaza-Diaz, A. Gil, "Use of Probiotics in Inflammatory Bowel Disease" in Microbiome and Metabolome in Diagnosis, Therapy, and other Strategic Applications, 2019 https://www.sciencedirect.com/topics/neuroscience/peroxisome-proliferator-activated-receptor-gamma-coactivator-1alpha
- Lu, Yi-Hsueh PhD; Rosner, Bernard PhD; Chang, Gregory MD, PhD; Fishman, Loren M. MD, B Phil (oxon.) "Twelve-Minute Daily Yoga Regimen Reverses Osteoporotic Bone Loss" Geriatric Rehabilitation: April/June 2016 - Volume 32 - Issue 2 - p 81-87 doi: 10.1097/TGR.0000000000000085
- Kagaku Azuma, Yasuhiro Adachi, Haruki Hayashi, Kin-Ya Kubo "Chronic Psychological Stress as a Risk Factor of Osteoporosis" J UOEH. 2015 Dec 1;37(4):245-53. doi: 10.7888/juoeh.37.245.
- Fishman, Loren M. MD, BPhil(Oxon) "Yoga for Osteoporosis A Pilot Study" Topics in Geriatric Rehabilitation: July 2009 - Volume 25 - Issue 3 - p 244-250 doi: 10.1097/TGR.0b013e3181b02dd6
- Yi-Hsueh Lu, PhD, Bernard Rosner, PhD, Gregory Chang, MD, PhD, and Loren M. Fishman, MD, B Phil (oxon.) "Twelve-Minute Daily Yoga Regimen Reverses Osteoporotic Bone Loss" Top Geriatr Rehabil. 2016 Apr; 32(2): 81–87. Published online 2015 Nov 5. doi: 10.1097/TGR.0000000000000085