9. Yoga: Let's Get Specifical

I want a yoga routine that emphasizes poses helpful for kyphosis and osteo in general while excluding poses that might be harmful (forward bends, impact, twisting).  More than just a list of poses, yoga practice needs a sequence that allows one pose to flow into the next, critical for maintaining a meditative mindset.  Bryn Kest's original power yoga series, for example, has great sequencing, but yoga guru Rodney Lee appears oblivious to this concept.

The study cited in post # 7 promised "detailed" description of poses and sequence, but when I emailed the lead author, her reply just noted, "the future report never came to be.  Sorry that I am unable to provide more detail about the poses."

I suspect that's a common issue with research.  A "preliminary" study gathers interest ("breaking news") but really needs more patients, longer follow-up, and/or refined methodology, all which require more intense work (i.e., time and money) than available.  Initial interest wanes, researchers move on, but achieves an almost mythical status, the preliminary status left by the wayside.

That happened with a study of 12 (yes, just a dozen) adults comparing weight management with and without a nutritional breakfast.  The preliminary finding suggested that skipping breakfast was a bad idea, and has been incorporated into the conventional wisdom of modern nutrition.  All without follow-up confirmation.  For some people, sure, but not a panacea.

Same thing with yoga and kyphosis: Does it really help in the long-term for a wide range of osteoporosis patients?  Don't know and perhaps never will.

8. Power Yoga

So what about yoga and reversal of kyphosis?

Could be simple as the cobra pose, or any backward bend, opening up compressed vertebrae, giving space for remodeling, a few minutes to reduce forward pressure, promoting growth of osteoclasts, and an influx of calcium and other matrix material.  

Really? 10-20 minutes a day of a handful of specific poses will do this? 

Or maybe it's the stretching, loosening of ligaments.

Or yoga breathing: a deep, slow, rhythm that restores.... 

7. Yoga and Osteo

Bones cycle between breakdown (aka resorption) and repair (ossification).  Ossification can follow both internal resorption and external fractures.  So what about spinal wedge fractures that lead to kyphosis: can natural bone "remodeling" heal these fractures, reversing kyphosis along the way?

A recent study divided one hundred eighteen women and men aged 60 and older with kyphosis into two groups. The experimental group attended hour-long yoga classes 3 days per week for six months.  The control group attended a monthly seminar and received mailings.  The active treatment group demonstrated a 5% improvement over the control group based on measurements of the kyphotic angle.

What is it about yoga (or any other exercise) that would promote natural healing and the reversal of kyphosis?  When, if ever, is it too late to embark on an exercise regime designed for osteodudes ? (.

6. Kyphosis, aka, Dowager's Hump

Vertebrae are well supported posteriorly (the "facet" wings), but not so much anteriorly (the vertebra body).  Plus the anterior is subjected to more stress when bent over (heavy lifting), or impact stress (riding horseback). Continuous stress can cause multiple small fractures in the vertebral body, leading to compression and forward bend.

This is not bad posture--a problem of past or current weakness or discipline-- not tight ligaments that just need loosening, and not subluxation fixable by chiropractic manipulation, but an irreversible spinal curve.  Really irreversible? Completely?  Well, maybe not, as my next post will suggest.

5. FRAX

It's all about fractures.  Osteoporsis means increased risk of broken bones.  A niece recently broke her arm when her ATV rolled.  I supposed if I had been there instead of her, I might have had several, more serious fractures.  But who's to say?

Well, FRAX says something.  FRAX is the Fracture Risk Assessment tool developed by WHO and British researchers in 2008, using large populations, linking known fractures with demographic and clinical data.  

I went to the FRAX website, entered the requested information, and came up with a prediction that within the next 10 years I have a  27% risk of a major osteoporotic fracture and 16% risk of a hip fracture.  

Not bad, that means this year I have a 1 out of 37 chance of a major fracture. Returning to the tool and plugging in a normal bone density result, I would have only a 1 out of 167 risk of a major fracture.  To be dramatic, my osteoporosis means almost a 500% increase in risk of a major fracture this year. 

But frankly, it's not so much the major fracture I'm worried about, but rather the insidious microfractures that I'll talk about in my next post.

4. Non-Compliance and Faith

A couple of headlines from the past few days:
     "NASCAR will not penalize teams with noncompliant roof flaps"
      and "Forty percent of miners' technical reports are non-compliant"

More than just not following recommendations, "non-compliance" suggests a serious breaking of rules or laws.

Doctors use non-compliance to describe patients who don't take their meds, or don't quit smoking or don't exercise or don't have lab tests done.  For some, the law-breaking insinuation of the term is distasteful and "nonadherent" has been suggested instead, but nonadherent has its own problems.

You can read that some 50% of patients do not take prescribed medications, not unexpected in the 70 year old on 5-10 meds, each with different schedule (morning or night; before or after meals, etc.).  But I just have a once weekly self-injection for arthritis, and a couple of daily supplements (calcium, vitamin D, omega-3 pill) and now the weekly alendronate.  

No big deal if I forget the supplements a couple times a week, but I forgot alendronate dose 2, taking it couple days late, and this morning forgot dose 3; we'll see if I take it tomorrow. No wonder that 30% of osteos on alendronate stop taking it within several months.  I don't and won't feel better taking it--same goes for blood pressure or cholesterol lowering meds, among others--I just take it on faith.

3. Primary Osteo

Many factors disrupt the active bone remodeling described in the previous post.  

Muscles attach to bones.  Pull the muscle hard enough and the bone also gets pulled. Specialized nerve receptor cells in the bones recognize these pulls and respond by stimulating osteoclast activity.  Ergo, bones become stronger (more dense) with weight-bearing exercise.  I don't have an answer why inactivity has the reverse effect (loss of bone density) but it does.

Steroids such as prednisone used by asthmatics, or recipients of organ transplants.  These steroids may keep calcium from reaching bones or may disrupt the osteoclast/osteoblast balance.  The body can overproduce it's own steroids, yielding the same results

Excessive alcohol use and smoking are associated with osteoporosis; alcohol because it inhibits calcium and vitamin D absorption and may directly kill osteoblasts; the smoking link is unclear, perhaps just because smokers are more likely to abuse alcohol and to have poor nutrition.

Too much parathyroid hormone, not enough thyroid hormone, any eating disorder (including the simple deficiency of calcium), and certain cancers and renal disease also increase the risk of osteoporosis. Decreased bone density attributed to one or more of these factors is labelled "Secondary Osteoporosis."

I tested negative for all known risk factors, so I have "Primary Osteoporosis," which means an as yet undiscovered factor, or an acceleration of the inevitable bone loss that occurs with aging, has led to my bone loss.

2. Bone Remodeling

Just like my 100 yr old house that's constantly undergoing remodeling--tearing down and then building up--bones constantly undergo a dynamic remodeling.  Osteoclasts are bone cells that tear down bone structure and osteoblasts build them up.  Bones are healthiest when osteoclasts and osteoblasts balance.

When osteoclasts outrun osteoblasts--tearing down without repair--bones become less dense and more vulnerable to fracture.  It's okay to remove some studs in that wall that you've decided to take down, but if you don't replace that support with horizontal beams or replacement vertical studs, then the house is weakened, vulnerable to winds, earthquakes, whatever, a house of twigs .

1. Biphosphonates

DAY ONE-- of treatment, anyway, a bisphosphonate called  Alendronate 70mg, taken just once weekly as follows:

1. on an empty stomach (food or meds can block absorption)
2. remaining upright for 30 minutes (to prevent reflux into the esophagus, the esophageal sphincter not being totally waterproof),
3. and with a full glass of water (to dilute the alendronate in case some reflux occurs)

I think I'll make it 45-60 minutes, just to be sure.  Alendronate esophagitis is probably the most common serious adverse side effect, ranging from mild heartburn to life-threatening esophageal ulcerations.

Then there is the rare but scary osteonecrosis of the jaw (you have to admit that plugging "necrosis" into any discussion is bound to provoke anxiety), which can occur after major jaw surgery in patients taking biphosphonates such as alendronate.