Manhattan Physical Medicine and Rehabilitation, LLP
August 5, 2008
In July, as America celebrated its declaration of independence from Great Britain, the French remembered outraged citizens storming the Bastille, and we all recognized many new dependencies and interdependencies, there was another reason to feel a little bliss: Even at this early point, the 11 people in our study that have been doing yoga for two years to improve their bone mineral density (BMD) have shown a statistically significant rise in their DEXA scans' scores for both the vertebral column and the hip!
The patients doing ten minutes of yoga daily showed an increase in spine BMD equivalent to .563 units on the T-scale; their hip BMD increased .867 units. Control values were -.12 and +.07 for spine and hip respectively over the two year study period. There were so few patients that had stayed with the study for two years that we thought it was pointless to do any statistical analysis, but when the editor-in chief of Topics in Geriatric Rehabilitation suggested we publish the data thus far as a pilot project, and we looked at the strong trend toward boney improvement, we thought it might be worthwhile to take a look.
There were only seven patients in the control group, so we analyzed these results versus the null hypothesis, the proposition that yoga did not improve bone mineral density. This is a strong condition, since in many large studies, the BMD of untreated patients over the age of 30 declines. Using one-tailed t-tests, these results proved significant, p>.01 for both the spine and the hip. This table has the numbers:
We will certainly continue our study; these early findings are encouraging for those individuals that would declare their independence of daily, weekly, monthly or annual medicines.
Good Medical News
Although offering the road less-travelled, there are some glad tidings on the Toll-road as well: The intravenous medication for osteoporosis, Zoledronic acid, given once a year, has also proven effective in reducing the incidence of breast cancer. Since both of these issues focus on women, there is an obvious economy of side-effects and risks in this.
More than we Bargained for
On the other hand, Denosumab, a developing drug that works as an antibody, does seem to have an undesirable side-effect. It works by slowing down the production RANKL, a stimulus for osteoclasts, the cells that dissolve bone and return calcium to the blood stream. However, Denosumab also seems to increase the number of infections in people taking it. (1) Since it has not been approved by the FDA yet, this is not something anybody needs to watch out for, but it bodes not well for a previously promising alternative to the gastrointestinally-upsetting bisphosphonates.
A White Girl's Problem
A King's College, London study (2) has found two genetic variants associated with development of osteoporosis appearing in approximately 20% of a group of 6463 Europeans. The interesting genes appear on chromosomes 8 and 11. The authors believe these factors to be as important as 'environmental' influences such as diet, exercise and exposure to the sun.
This means that one person in 5 will need to work harder to avoid osteoporosis. It is also possible that some parties would use this as a screening tool. For our purposes, it is a perfect invocation of Reinhold Niebuhr's serenity prayer:
Give me the serenity to accept the things I cannot change,
The courage to change the things I can,
And the wisdom to know the difference."
**Thanks to Ellen Saltonstall for pointing out the source of this otherwise anonymous quote.
References:
Osteoporosis expert sees hurdles to U.S. approval of denosumab
Comments, Questons, Criticism Suggestions
e-mail: Loren@sciatica.org
or write
Elise Weiss, M.D.
1009 Park Avenue
New York, NY 10028