Photo: Barbara Süss

What would you do if you at the age of 34 were diagnosed with a condition that normally women twice your age would get? How would you react if doctors told you that with having this disease at such a young age there was a risk that you could be wheel chair bound in your sixties? It’s not only a difficult message to receive or take on board, but even harder when you can’t see or feel the disease in your daily life. Osteopenia/Osteoporosis – weakened bone density – is invisible to the eye and is mostly only diagnosed once a fracture has actually occurred.

Eight years ago I was diagnosed with severe osteopenia, a pre-stage to osteoporosis, following six months of repeated spontaneous rib fractures. My bone density results were very bad, really on the border to Osteoporosis. At the time I had to make quite a few changes not only to my life but also to my yoga practice.I had to become more sensitive and take certain precautions. But my yoga practice has also been an invaluable factor in the process of healing and improving my bone density. Since my diagnosis in 2010, my bi-yearly bone density scans have gradually shown improved results and at the latest scan one week ago I was given the happy news that I am now no longer osteopenic and have normal bone density for my age.

Five years ago I wrote a blog post about practicing yoga with osteopenia/osteoporosis to share my experience with other women who might be in a similar situation. Because the old website has since been deactivated I’ve decided to re-post the article here . I don’t go into detail of what lies behind my weak bones, I might share some of that in a later post. However, it has come to light that this condition is more common than previously thought with younger women who have been very physically active in young years (athletes for example) and whom have not had a good enough intake of good nutrition or whom have lost their periods for certain amounts of time. It may also follow in the steps of eating disorders and other mental health conditions (depression, anxiety, stress etc), problems of mal-absortion and inflammation in the gut and deficiencies in vitamin-D etc.

March 2014

Three and a half years ago following a series of inexplicable/spontaneous rib fractures suffered in yoga practice I was diagnosed with a severe stage of Osteopenia – a pre-stage to Osteoporosis (bone loss). I was 34 years old and had a condition that women my mother’s age would be more likely to suffer from. The reason I ended up with Osteopenia I will not go into. There were most likely many factors at play and I’ll most likely never know what caused what – like the “chicken and the egg story”.

Osteoporosis happens when there is a loss of calcium and mineral in the bones that weakens them and causes them to break more easily. Although Osteopenia is not as bad as osteoporosis the risk of fracture is the same in both cases. The primary risk areas for fractures are the vertebrae in the spine, the hips and the wrists. Some bone loss is natural with aging. Peak bone density occurs during our 20’s but after the age of 35 bone density starts to decline.

When I got my diagnosis in 2010 the doctors seemed quite surprised to have such a young patient with an “old woman’s condition”, yet they didn’t really seem to take it seriously. Maybe they didn’t know what to do. The advice received from my GP (in a letter…) was that I should quit smoking, do more weight bearing exercise and eat more green vegetables. At the time I had been a vegetarian for 18 years, I was very fit (having been a spinning teacher for 11 years, a long distance runner and had a regular strong yoga practice) and I most certainly didn’t smoke (and I never had)…

Eventually, I was put on medication, alendronic acid a substance that is given to old ladies in their 70’s and 80’s. At the time I didn’t question it since I had many other things going on in my life and not the energy to argue. My GP supported that I continue to practice yoga but cautioned me to be careful. And that was that. The lack of engagement from the medical community led me to also not really take the situation seriously. I did a little bit of research and figured I should probably stop long distance running (the bouncing impact not being very good for the spine) and I took care in yoga practice not to fall (I had already dislocated a disc when falling in headstand a year earlier, broken my little toe twice when jumping through and then there were those fracture ribs that had prompted my seeking help in the first place). Otherwise, I figured yoga must be good since it’s definitely a weight bearing exercise.

Over the past few years my yoga practice has deepened and intensified (on both a physical and other levels). My body has become much stronger and stable as well as more flexible. I have gained quite some weight due to increased muscle build but some of it is also an increase in bone mass. When I had my last bone density scan the results had improved – but I still had Osteopenia. Whether the increased bone density was because of the medication or the yoga practice or a combination I don’t know.

I’m sure that yoga is mostly positive, but there are also things in yoga practice that sometimes cause me concern and with time and experience I’ve come to reflect more and more on the effects of the practice. In the – meager – research I did following the diagnosis I learnt that forward bending might be hazardous for people with Osteopenia or Osteoporosis. The increased pressure on the front of the vertebrae in forward bends could lead to fractures on the spine. I also read that back bending would be more beneficial as such movements would strengthen the muscles around the spine. My body welcomed these “facts” as it really doesn’t like to bend forward and doing back bends is more pleasurable.

Recently I decided to look a bit more into the research done on yoga and Osteopenia/Osteoporosis (and I really should have done this much earlier to take responsibility for my own situation, but I guess I was still in some kind of denial). Some of what I found out was quite shocking! Basically all that I am doing in my practice is highly dangerous. According to the research available I play on the edge of disaster every morning and it’s a miracle that I haven’t yet fractured a vertebra or hip.

People with Osteopenia/Osteoporosis may experience spontaneous spinal fractures without warning as the body moves out of the posture back to its original position. Forward bending (spine flexion) is – as mentioned previously – particularly dangerous, but also twisting, arm balancing (risk of falling), shoulder and head stand and deep back bending are not recommended. The only safe postures would be standing postures (which are weight bearing on the large bones of the legs and hips); back bends like cobra pose or shalabasana (locust pose) and seated postures that do not include bending forward. Moving in and out of postures should be done with caution so umping is definitely a “no-go” and Ashtanga yoga is completely out of the question according to the articles I found.

While taking the warnings and risks seriously I think that there a few other things one needs to consider. Most of the research available seems to have been done on people of the age 65+. What about younger people who may have a better overall health, a fitter body in general and are already physically active? I don’t have any medical expertise but from my own experience I would definitely also look at the following aspects:

  • Is the person a beginner or already a seasoned yoga practitioner?
  • Is the person fit or unfit (physically active, overall health etc)?
  • What age is the person?
  • What body awareness does the person have?
  • What is the overall lifestyle of the person?

Each body and each individual are different, but yoga practice has definitely been very beneficial to my overall health (and my bone density has improved). There is also research available that supports the fact that a daily yoga practice may be able to slow and even reverse the condition of Osteopenia. Such a yoga practice obviously has to be adapted according to the individual, but it seems like a combination of weight bearing exercise such as yoga, movement and a good diet may help maintain and even improve bone strength. Yoga, unlike some other weight-bearing activities won’t damage cartilage or stress the joints. Instead, it lengthens muscles and holds them there, creating tension on the bone. It also increases softness and agility to the joints and creates stability in the body as a whole.

A healthy diet – and in particular a plant based diet seems to create a good foundation for healthy bones. Some research shows that too much animal based protein (including dairy products) may actually weaken the bone. Protein creates acid in the blood and when the body gets too acidic it pulls calcium, which is alkaline, from bone to neutralize it. I used to eat a lot of dairy products as part of my vegetarian diet since I was always told that one needed milk (or dairy) to build strong bones. Now I have osteopenia – but I’ll never know if my huge dairy consumption contributed to my current condition. Today I’m vegan and I’ve replaced the dairy products with green leafy veg such as kale and spinach, sesame and almonds which are rich in calcium.

Osteopenia/Osteoporosis is an invisible “disease”. This makes it even more dangerous. No one would be able to see the condition I suffer from, and even I forget it from time to time. I take my condition seriously but I refuse to let it limit my life. Today I approach things with greater care and awareness. The prospect of breaking a hip or sitting in a wheel chair at the age of 60 is not on my agenda.  I continue my daily Ashtanga practice although I have become more careful. I deliberately move more consciously and slowly and try to maintain a stable and deep breath which helps me listen to my body’s signals. The tools of breath, bandha and dristhi which help stabilise the body and mind and turn the awareness inwards, become even more important. 

Although my teacher Sharathji has said that people with Osteoporosis should limit their practice to sitting in padmasana and do breathing exercises, he has not he asked me to change anything in my practice. He’s only directed me to some “safer” practice space in the shala in Mysore to protect me from injury should I fall when practising arm balances. It has been very important to me that he’s provided me with a safe space. I trust his guidance and the guidance I’ve received from other experienced Ashtanga Yoga teachers to whom I’ve turned for advice.

Whether one is a beginner or seasoned practitioner I believe it is important to practice yoga safely and correctly under the guidance of an experienced teacher. With the increased risk of fracture that comes with Osteopenia and Osteoporosis attention to correct alignment in yoga postures is in my opinion crucial. It is important to make sure that the spine remains lengthened and that the space between vertebrae is in no way comprised during the practice. Depending on the individuals fitness and body awareness one may have to work at different pace.  A beginner should stick with beginner’s options and be sure to inform the teacher about his/her condition before class. It is also important to cultivate mindfulness and a presence during practice so that one becomes sensitive to the signals of the body.

If you’d like to know more about the research done on Yoga and Osteoporosis, I’ve added a few links here. Please also feel free to share your experience and questions below.

Some resources on Yoga and Osteoporosis/Osteopenia

Yoga for Osteoporosis – An Interview with Loren Fishman, M.D. and Ellen Saltonstall

http://yogauonline.com/yogatherapy/news/ellen-salstonstall/420121510-yoga-for-osteoporosis-interview-loren-fishman-md-and-e

Yoga for Osteoporosis: A Pilot Study

http://journals.lww.com/topicsingeriatricrehabilitation/Fulltext/2009/07000/Yoga_for_Osteoporosis__A_Pilot_Study.9.aspx

Yoga Osteopenia Osteoporosis

http://www.osteopenia3.com/Yoga-Osteopenia-Osteoporosis.html

Good to the Bone

http://www.yogajournal.com/health/2616

Yoga for the Prevention, Treatment, and Reversal of Osteoporosis and Osteopenia

http://www.happyhealthylonglife.com/happy_healthy_long_life/2010/06/yoga-osteoporosis.html

Yoga Poses to Avoid With Osteoporosis

http://healthyliving.azcentral.com/yoga-poses-avoid-osteoporosis-7232.html