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Tai Chi for Osteoporosis

tai chi medical research Sep 21, 2020

Public Health Report by: Eric L. Zielinski

Introduction

Not to be confused with osteopenia, a natural bone loss disorder that affects more than 50 percent of people older than 50 years of age, osteoporosis is a severe bone destruction condition that puts the elderly at a high risk of falls, fractures and various complications. As physicians are increasingly becoming hesitant to prescribe medications due to the severe side effects, the need for proven, alternative methods to help people with osteoporosis is in high demand. The purpose of this report, therefore, is to suggest that the ancient mind-body exercise Tai Chi may be able to answer that call as a budding selection of research supports its benefit to reverse bone loss.

Osteoporosis

Osteoporosis is a disease that causes bones to be so brittle and weak that mild stressors like coughing and falling could cause fractures According to the Mayo Clinic, “Bone is living tissue, which is constantly being absorbed and replaced.” Osteoporosis, therefore, occurs when the creation of new bone doesn’t keep up with the removal of old bone. Typically, there are no symptoms related to bone loss, however, the Mayo Clinic outlines some common issues that occur after bones have been weakened:

Back pain, caused by a fractured or collapsed vertebra.
Loss of height over time.
Stooped posture.
Cone fracture that occurs much more easily than expected.

In general, osteoporosis is an age-related disorder. Since most people reach their peak bone mass in their early-to-mid-twenties, someone’s likelihood of be being affected by osteoporosis is greatly determined by the amount of bone mass developed during these formative years.

However, women are particularly at risk, especially when they experience early menopause. People with a history of long-standing corticosteroid use are also at high risk. Since everyone experiences loss of bone mass as they age, whether or not the bones become brittle is the concern.

The following risk factors are related to osteoporosis:

Reduction in sex hormones estrogen and testosterone.
Thyroid issues leading to too much thyroid hormone production.
Overactive adrenal and parathyroid glands.
Low dietary calcium intake.
Low vitamin D intake and lack of sunlight.
Eating disorders such anorexia.
Gastrointestinal surgery like bariatric or intestinal bypass surgery that reduces the surface area of the organs that absorb calcium.
Sedentary lifestyles.
Alcohol and tobacco use.

Medical Research and Management

Research has found that one of the most beneficial activities someone can do to prevent and reverse osteoporosis is exercise. Weight-bearing, resistance training is particularly effective because it puts healthy stress on the bones and initiates the natural rebuilding/tear-down process and helps create healthy new bone formation. For people whose bone loss has markedly diminished, physicians will oftentimes prescribe medications to help stop the osteoporitic process.

According to the Mayo Clinic, “For both men and women, the most widely prescribed osteoporosis medications are bisphosphonates. Examples include:

Alendronate (Fosamax, Binosto)
Risedronate (Actonel, Atelvia)
Ibandronate (Boniva)
Zoledronic acid (Reclast, Zometa)

The side effects of these drugs include significant gastrointestinal complains such as the following:

Abdominal pain
Esophageal inflammation
Ulcers
Nausea
Rare conditions in which jaw and thigh bones deteriorate and break.

To address hormone imbalances, estrogen therapy is often employed soon after menopause as a preventative measure for women. However, this is widely known to significantly increase the risk of blood clots, breast cancer, endometrial cancer, and heart disease.

It is interesting to note that physicians will often prescribe antidepressant medications for elderly people who are depressed regardless if they have osteoporosis or not. The concern with this is that antidepressant medications can increase the risk of falls older people, especially if they have osteoporosis. Antidepressants have been shown to increase the risk of fragility fractures and data is lacking about the effect of fall rehabilitation programs on clinically significant depression.

According to Toronto researchers, “To date, there have been no recommendations for osteoporosis monitoring and treatment in individuals prescribed antidepressant medications, beyond the usual clinical guidelines. However, treatment of the older depressed person who is at risk of falls provides the opportunity to inquire about his or her adherence with osteoporosis and fracture prevention guidelines.” Therefore, to help prevent falls associated with osteoporosis, researchers recommend, “Based on the current state of knowledge, exercise (particularly Tai Chi) and cognitive-behavioral therapy should be considered for the first-line treatment of mild depression in older fallers.”

Research showing Tai Chi’s ability to help improve osteoporosis

According to University of Maryland Medical Center the benefits of Tai Chi in regards to bone strength lies in its low impact component. “Low impact, weight bearing exercise strengthens bones and can slow bone loss, thus preventing the development of osteoporosis.” Although there are not many studies supporting this, U of M still recommends Tai Chi for people of all ages. A sample of the studies evaluating Tai Chi’s ability to help people with osteoporosis is outlined below:

One of the few clinical trials to directly measure bone metabolism in people practicing Tai Chi was published in The American Journal of Chinese Medicine in 2007. Comparing mind-body exercises with conventional resistance training, researchers randomly selected 28 sedentary elderly volunteers and divided them into two groups. Fourteen participated in 40-minute sessions of Tai Chi three times a week for 24 weeks, and 14 people participated in resistance training within the same parameters. To determine the outcome these exercise regimens had on bone metabolism and osteoporosis reversal the concentrations of serum bone-specific alkaline phosphatase (BAP), pyridinoline (PYD), parathyroid hormone (PTH), calcium, and urinary calcium were measured. After 6 weeks both the Tai Chi and resistance training groups experienced higher levels of serum BAP relative to when patients first started the study, and the Tai Chi group exhibited a greater increase in serum BAP than the resistance training group. Interestingly, there was an increase of serum PYD in the resistance training group and not in the Tai Chi group, whereas the BAP/PYD ratio was higher than when the patients first started the study only in the Tai Chi group. After 12 weeks of exercise, the increase in serum PTH in the Tai Chi group was higher than the resistance training group. In addition, after 24 weeks there was a reduction in the urinary calcium level in the Tai Chi group relative to when patients first started the study. The researchers concluded, “These findings support that [Tai Chi] is beneficial for increasing bone formation in elderly, and long-term application is needed to substantiate the effect of [Tai Chi] as an alternative exercise in promotion of bone health.

It is interesting to note that the Tai Chi group maintained a higher rate of compliance than the resistance training group. The fact that older people are more likely to regularly practice Tai Chi should be considered when developing a care plan for osteoporosis patients.

In 2012, BMC Complementary and Alternative Medicine printed an article that evaluated the impact of Tai Chi on multiple fracture-related risk factors in post-menopausal osteopenic women. Eighty-six women were recruited for this study and were randomly chosen to be part of one of two groups; a nine-month Tai Chi program in addition to usual osteoporosis care, and usual osteoporosis care without the Tai Chi intervention. Researchers measured bone mineral density (BMD), femur and lumbar spine dual-energy X-ray absorption, and blood markers for bone resorption and formation. According to the results, femur BMD changes increased by 0.04 percent in the Tai Chi group in comparison to a 0.98 percent decrease in the control group. Bone formation markers and physical categories of quality of life were also greatly increased in the Tai Chi group in comparison to the conventional care group. The researchers concluded, “[Tai Chi] training offered through existing community-based programs is a safe, feasible, and promising intervention for reducing multiple fracture risks. Our results affirm the value of a more definitive, longer-term trial of [Tai Chi] for osteopenic women, adequately powered to detect clinically relevant effects of [Tai Chi] on attenuation of BMD loss and reduction of fall risk in this population.”

Also in 2012, PLoS One published a trial that set out to determine the manner in which green tea polyphenols (GTP) and Tai Chi could mitigate oxidative damage in postmenopausal women with osteopenia. One hundred seventy one women who fit this criteria were recruited from Lubbock County, Texas and were randomly selected to be part of one of four groups: 1) placebo; 2) 500 mg daily GTP treatment 3) placebo + 60 minutes of Tai Chi three times a week; 4) 500 mg daily GTP treatment + 60 minutes of Tai Chi three times a week. Researchers discovered that a combination of green tea polyphenols and Tai Chi significantly reduced oxidative stress. According to the article, “The elevated concentrations of serum and urinary GTP components demonstrated a good adherence for the trial. A significant reduction of urinary 8-OHdG concentrations was found in all three treated groups during 3-month and 6-month intervention, as compared to the placebo group. The significant time- and dose-effects on mitigation of the oxidative damage biomarker were also found for GTP, [Tai Chi], and GTP + Tai Chi] intervened groups.” Therefore, since it is widely accepted that oxidative stress is a reputed factor for osteoporosis in elderly women, this study offers hope to not only help reduce and reverse osteoporosis, but also to prevent it from occurring.

Doctors from Queen’s Medical Center in Nottingham, UK sum it up perfectly. The evidence regarding the relationship between Tai Chi and physical, neurocognitive and psychosocial outcomes in older people “is an emerging and growing area of research and improvements have often been reported in health functioning, physical and emotional health, reducing falls, fear of falling and risk of falls, and possibly enhancing cardiovascular functioning in older adults although the effects on bone density, cognitive and immunological functioning are less clear.” There are many reasons to believe that Tai Chi can help reverse osteoporosis, however, until researchers spend more time on determining the exact nature in which people are benefited, physicians will be reluctant to include Tai Chi into their regular care plan for osteoporosis patients.

Conclusion

According to a 2012 article from Current Aging Science, “There are some indications that Tai Chi may have the potential to improve bone mineral density and reduce fracture rate particularly in frailer older adults, although more rigorously conducted research is required before satisfactory conclusions can be drawn.” Consequently, the medical community will remain hesitant to recommend Tai Chi to osteoporosis patients until more research confirms and re-confirms what people have known for thousands of years: Tai Chi does wonders for the body and osteoporosis is no exception!