Who gets Osteoporosis?
Men and women can get osteoporosis, but it is considerably more prevalent in women, and generally begins at a younger age.
‘…..women aged 50 years or older have a four times higher rate of osteoporosis…..compared with men’
(Khaled A.Alswat ‘Gender Disparities in Osteoporosis’, Journal of Clinical Medicine Research)
There are two phases of bone loss in women – one related to menopause, and a later phase that is age related. 45% of post-menopausal women have osteoporosis. Men do also suffer from osteoporosis, but at a lower level than women, as their bone loss is linked only to the age-related phase.
Why do more women than men get osteoporosis?
Levels of oestrogen decrease in women post-menopause, affecting the bone turnover cycle, in effect reducing bone density
Women tend to have smaller bones, so any bone loss has more impact
(the good news for those of Afro-Caribbean origin is that your bones are generally bigger and therefore at less risk)
Women generally live longer than men, and are therefore more likely to live longer with less bone strength
What is osteoporosis?
‘Osteoporosis, a multifactorial systemic skeletal disease, is characterized by low bone mineral density (BMD) and micro-architectural deterioration of bone tissue resulting in bone fragility’
(‘Primary Osteoporosis in Postmenopausal Women’ Meng-Xia Ji, Qi Ju, Chronic Diseases and Translational Medicine, 2015)
In very simple terms, more bone is lost than is created. This weakening of the bones results in a ‘honeycomb’ type structure rather than a solid structure.
The increased fragility of this type of bone means that you are far more likely to sustain a fracture if you fall.
Falls and Fractures
Falls are the most common cause of osteoporotic fractures, increasing in incidence after the age of fifty. Women in their 50s are most likely to sustain a wrist fracture, in their 60s mini spinal fractures can occur, and in their 70s the hip fracture is the most likely result of a fall.
90% of hip fractures are as a result of a fall. Hip fracture in older age can mean the difference between living independently or moving into a supported living environment. Previously self-sufficient people can become dependent on others, potentially also leading to a loss of self esteem.
Of major concern is that hip fractures can lead to even more serious consequences – a British Medical Journal article states that 30% of people who suffer a hip fracture die within a year. This is obviously connected to the fact that many hip fractures are sustained by elderly people who may be frail and may also be suffering from a number of different conditions, but often the hip fracture signals the end of living independently and the beginning of a general decline.
Risk factors you can’t change
· Age – as you age, your risk increases
· Sex – women are more likely to have osteoporosis than men
· Ethnicity – those of Afro-Caribbean origin tend to have bigger bones and are therefore less likely to suffer fractures
· History – a history of broken bones tends to mean that future broken bones are more likely
· Medical Conditions & Medication – some can affect bone strength
Risk factors that you can influence
· Low body weight (less ‘padding’ makes broken bones more likely if you fall)
· Smoking – slows down the production of cells that build bone
· Excess alcohol consumption – affects the cells that build bone. Also makes you unsteady on your feet
· Poor balance, coordination and reflexes – makes you more likely to trip and fall
· Medical Conditions & Medication – some can be improved through lifestyle changes e.g. Diabetes type 2
5 ways Yoga can help
Bone is a living structure, and can therefore be influenced.
‘Made mostly of collagen, bone is living, growing tissue. Collagen is a protein that provides a soft framework, and calcium phosphate is a mineral that adds strength and hardens the framework. This combination of collagen and calcium makes bone strong and flexible enough to withstand stress.’
(National Institutes of Health, Osteoporosis & Related Bone Diseases National Resources Centre)
In addition to managing the risk factors already mentioned, regular exercise is key. However, the type of exercise, and the way that it is implemented, is as important as the regular practice. Yoga has many benefits.
1. Weight bearing
Weight-bearing improves bone mineral density (BMD).
Timothy McCall MD, medical practitioner and author of ‘Yoga as Medicine’, believes that yoga practitioners may benefit from the fact that they weight-bear in lots of different places (feet, knees, hands, shoulders, top of head).
McCall notes that, interestingly, activities such as walking and running, although beneficial for weight-bearing, do not strengthen the femur at the point where most hip fractures occur i.e. the neck of the femur. He posits that Yoga may be of greater benefit because of the differing weight-bearing locations.
2. Muscle strength
Muscle strength is important, as it helps us to maintain good alignment, thereby rendering us less likely to sustain a fall.
If our muscles are not strong enough, we may develop a tendency to ‘lock’ our joints, putting extra pressure on the joints and risking damage. In Dru Yoga, the joint is kept relaxed, to facilitate correct use of the muscle when holding a position e.g. holding the arms outstretched in the Warrior poses (Virabhadrasana)
The NHS website notes that resistance exercises using muscle strength are valuable, as the action of the tendons pulling on the bones builds bone strength. Yoga often uses one’s own bodyweight as resistance e.g in the Sun Salutation (Surya Namaskara) where we find movements such as Downward Dog ( Adho Mukha Svanasana) or Plank pose (Dandasana).
3. Balance
Most hip fractures are as a direct result of a fall. Avoiding the fall in the first place, through an increased awareness of balance and proprioception (sense of where your body is in space) seems to make sense.
Yoga is recommended by the NHS to improve balance and co-ordination. Yoga, through the process of various balancing postures, helps to stimulate and strengthen the body/brain connections.
Balancing movements are an intrinsic part of a yoga practice. This starts with the basic standing posture of Mountain pose (Tadasana), where we learn how to most efficiently distribute our weight over our feet. Something as seemingly simple as standing on two feet is a balance in itself.
We can progress to standing on one leg, or balancing on hands, or even the head. Moving balances such as the Dru Tree sequence (Vrksasana) are more challenging than the static balances, and will help you to maintain balance in real life situations such as tripping over a curb.
4. Posture
Understanding correct postural alignment, and striving to achieve it, will help to ensure that the body is in its most stable position as you move through your daily life.
Many people have a mechanically ineffective posture – head thrust forward, upper body ahead or behind the rest of the torso, hip rigidity - but older people also have a tendency to lean forward as they walk, especially if they have a ‘dowager’s hump’, or weak abdominal muscles. This means that they are already in an unbalanced position, and any slight trip is more likely to become a major fall. Understanding and sensing when their body weight is evenly balanced is essential in preventing these falls.
In Dru Yoga, the standing position of Mountain pose (Tadasana) is practiced with feet at hip distance apart, providing a stable foundation. Care is taken to ensure that the participant is able to find the sweet spot, the point at which they feel that their weight is neither forward nor back, but rooted in perfect alignment.
Many yoga postures encourage postural alignment, which in turn means that the correct muscles are recruited to ensure effective, balanced movement. The repetition of movement on both the left and right side of the body also improves postural awareness.
5. Stress Resilience
We all know about the benefits of Yoga for the reduction of negative stress. But why would this be considered a factor for prevention of osteoporosis? Interestingly, there appears to be a link between stress and osteoporosis.
‘Stress alters the levels of growth hormones by modifying the HPA axis, growth hormone-releasing hormones, and growth-inhibiting hormones. When this balance is upset by chronic stress, a decrease in growth hormones can develop, leading to bone loss’
(Rheumatology Advisor ‘Cause or Effect? The Link Between Psychological Stress and Osteoporosis’ online article 3rd June 2019 )
Using the stress reduction techniques familiar to yoga practitioners, eg the various breathing techniques, and the guided relaxation practices, would therefore appear to be useful additional tools for anyone concerned about osteoporosis. Dru Yoga Energy Block Release (EBR) sequences are an effective way to release the build-up of negative stress. EBRs use a physical sequence of movements, combined with breath awareness, to release stress before it settles deep within our bodies.
Conclusion
I have only mentioned five ways – there are of course many more. Timothy McCall lists 27 different ways in which Yoga can help to prevent osteoporotic fractures, in a handout from his excellent CPD course.
If you, or a loved one, are seeking ways to prevent or manage osteoporosis, Yoga provides many benefits, and is easily accessible for a wide range of people with differing fitness and ability levels.
And if you are a parent or guardian, please bear in mind that the important time for creating good bone health is in the early stages of growth, up to the early 20s. Its never too late to affect our bones in a positive way, but its much better to start early.
Namaste,
Michelle
Michelle Helstrip
DRUVA Founder & Yoga Therapist
www.druva.co.uk
Sources of Information/ Further Reading:
Royal Osteoporosis Society https://theros.org.uk/information-and-support/osteoporosis/causes/
Khaled A.Alswat ‘Gender Disparities in Osteoporosis’, Journal of Clinical Medicine Research
‘Primary Osteoporosis in Postmenopausal Women’ Meng-Xia Ji, Qi Ju, Chronic Diseases and Translational Medicine journal, 2015. Article includes a detailed description of osteoporosis
BMJ article on hip fractures ‘Reducing mortality from hip fractures: a systematic quality improvement programme’ Radcliffe Lisk, Keefai Yeong, 2014
Timothy McCall M.D. ‘Preventing Osteoporotic Fractures with Yoga’ CPD training, & Author of ‘Yoga as Medicine’ http://www.drmccall.com/
Bone & Osteoporosis https://www.bones.nih.gov/health-info/bone/bone-health/what-is-bone
Stress & Osteoporosis https://www.rheumatologyadvisor.com/home/topics/osteoporosis/cause-or-effect-the-link-between-psychological-stress-and-osteoporosis/
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