Vertebral compression fractures associated with yoga: A case series

Jad G. Sfeir, Matthew M Drake, Vikram J. Sonawane, Mehrsheed Sinaki

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

BACKGROUND: The importance of exercise in skeletal health is increasingly recognized by both patients and providers. However, the safety of prescribed or recreational exercise in at-risk populations remains under-reported and under-publicized. Yoga has gained widespread popularity due to its physical and psychological benefits. When practiced in a population at increased fracture risk, however, some yoga poses may increase fracture risk, particularly at the spine, rather than increasing BMD as noted in recent popular press reports. CASE REPORT: Nine subjects (8 women) with a median age of 66 years (range 53-87), developed vertebral compression fracture (VCF) one month to six years after initiating yoga-associated spinal flexion exercises (SFE). VCF presented with back pain and occurred in the thoracic-spine (N.=6), lumbar-spine (N.=4) and cervical-spine (N.=1). Four patients had osteoporosis by BMD criteria prior to VCF and 2 had osteopenia (median T-score -2.35; range -3.3 to +2.0). Interestingly, all patients had their lowest T-scores at the spine. Three patients had a history of fragility fracture prior to the index VCF. While one patient had primary hyperparathyroidism and another was treated with high dose prednisone, no other risk factors for bone loss including medications or secondary osteoporosis causes were identified in the other patients. CLINICAL REHABILITATION IMPACT: This study identified patients in whom increased torsional and compressive mechanical loading pressures occurring during yoga SFE resulted in de novo VCF. Despite the need for selectivity in yoga poses in populations at increased fracture risk, both scientific and media reports continue to advertise yoga as a bone protective activity. Accordingly, yoga is misconceived as a ‘one-size-fits-all’ prescription. Instead, the appropriate selection of patients likely to benefit from yoga must be a cornerstone of fracture prevention.

Original languageEnglish (US)
Pages (from-to)947-951
Number of pages5
JournalEuropean Journal of Physical and Rehabilitation Medicine
Volume54
Issue number6
DOIs
StatePublished - Dec 1 2018

Fingerprint

Yoga
Compression Fractures
Spine
Exercise
Osteoporosis
Bone and Bones
Primary Hyperparathyroidism
Metabolic Bone Diseases
Back Pain
Prednisone
Patient Selection
Population
Prescriptions
Thorax
Rehabilitation
Psychology
Safety
Pressure
Health

Keywords

  • Bone diseases, metabolic
  • Exercise
  • Fractures, compression
  • Osteoporosis
  • Yoga

ASJC Scopus subject areas

  • Physical Therapy, Sports Therapy and Rehabilitation
  • Rehabilitation

Cite this

Vertebral compression fractures associated with yoga : A case series. / Sfeir, Jad G.; Drake, Matthew M; Sonawane, Vikram J.; Sinaki, Mehrsheed.

In: European Journal of Physical and Rehabilitation Medicine, Vol. 54, No. 6, 01.12.2018, p. 947-951.

Research output: Contribution to journalArticle

Sfeir, Jad G. ; Drake, Matthew M ; Sonawane, Vikram J. ; Sinaki, Mehrsheed. / Vertebral compression fractures associated with yoga : A case series. In: European Journal of Physical and Rehabilitation Medicine. 2018 ; Vol. 54, No. 6. pp. 947-951.
@article{4471bd8c8f504f198f619f525b07eab3,
title = "Vertebral compression fractures associated with yoga: A case series",
abstract = "BACKGROUND: The importance of exercise in skeletal health is increasingly recognized by both patients and providers. However, the safety of prescribed or recreational exercise in at-risk populations remains under-reported and under-publicized. Yoga has gained widespread popularity due to its physical and psychological benefits. When practiced in a population at increased fracture risk, however, some yoga poses may increase fracture risk, particularly at the spine, rather than increasing BMD as noted in recent popular press reports. CASE REPORT: Nine subjects (8 women) with a median age of 66 years (range 53-87), developed vertebral compression fracture (VCF) one month to six years after initiating yoga-associated spinal flexion exercises (SFE). VCF presented with back pain and occurred in the thoracic-spine (N.=6), lumbar-spine (N.=4) and cervical-spine (N.=1). Four patients had osteoporosis by BMD criteria prior to VCF and 2 had osteopenia (median T-score -2.35; range -3.3 to +2.0). Interestingly, all patients had their lowest T-scores at the spine. Three patients had a history of fragility fracture prior to the index VCF. While one patient had primary hyperparathyroidism and another was treated with high dose prednisone, no other risk factors for bone loss including medications or secondary osteoporosis causes were identified in the other patients. CLINICAL REHABILITATION IMPACT: This study identified patients in whom increased torsional and compressive mechanical loading pressures occurring during yoga SFE resulted in de novo VCF. Despite the need for selectivity in yoga poses in populations at increased fracture risk, both scientific and media reports continue to advertise yoga as a bone protective activity. Accordingly, yoga is misconceived as a ‘one-size-fits-all’ prescription. Instead, the appropriate selection of patients likely to benefit from yoga must be a cornerstone of fracture prevention.",
keywords = "Bone diseases, metabolic, Exercise, Fractures, compression, Osteoporosis, Yoga",
author = "Sfeir, {Jad G.} and Drake, {Matthew M} and Sonawane, {Vikram J.} and Mehrsheed Sinaki",
year = "2018",
month = "12",
day = "1",
doi = "10.23736/S1973-9087.18.05034-7",
language = "English (US)",
volume = "54",
pages = "947--951",
journal = "European Journal of Physical and Rehabilitation Medicine",
issn = "1973-9087",
publisher = "Edizioni Minerva Medica S.p.A.",
number = "6",

}

TY - JOUR

T1 - Vertebral compression fractures associated with yoga

T2 - A case series

AU - Sfeir, Jad G.

AU - Drake, Matthew M

AU - Sonawane, Vikram J.

AU - Sinaki, Mehrsheed

PY - 2018/12/1

Y1 - 2018/12/1

N2 - BACKGROUND: The importance of exercise in skeletal health is increasingly recognized by both patients and providers. However, the safety of prescribed or recreational exercise in at-risk populations remains under-reported and under-publicized. Yoga has gained widespread popularity due to its physical and psychological benefits. When practiced in a population at increased fracture risk, however, some yoga poses may increase fracture risk, particularly at the spine, rather than increasing BMD as noted in recent popular press reports. CASE REPORT: Nine subjects (8 women) with a median age of 66 years (range 53-87), developed vertebral compression fracture (VCF) one month to six years after initiating yoga-associated spinal flexion exercises (SFE). VCF presented with back pain and occurred in the thoracic-spine (N.=6), lumbar-spine (N.=4) and cervical-spine (N.=1). Four patients had osteoporosis by BMD criteria prior to VCF and 2 had osteopenia (median T-score -2.35; range -3.3 to +2.0). Interestingly, all patients had their lowest T-scores at the spine. Three patients had a history of fragility fracture prior to the index VCF. While one patient had primary hyperparathyroidism and another was treated with high dose prednisone, no other risk factors for bone loss including medications or secondary osteoporosis causes were identified in the other patients. CLINICAL REHABILITATION IMPACT: This study identified patients in whom increased torsional and compressive mechanical loading pressures occurring during yoga SFE resulted in de novo VCF. Despite the need for selectivity in yoga poses in populations at increased fracture risk, both scientific and media reports continue to advertise yoga as a bone protective activity. Accordingly, yoga is misconceived as a ‘one-size-fits-all’ prescription. Instead, the appropriate selection of patients likely to benefit from yoga must be a cornerstone of fracture prevention.

AB - BACKGROUND: The importance of exercise in skeletal health is increasingly recognized by both patients and providers. However, the safety of prescribed or recreational exercise in at-risk populations remains under-reported and under-publicized. Yoga has gained widespread popularity due to its physical and psychological benefits. When practiced in a population at increased fracture risk, however, some yoga poses may increase fracture risk, particularly at the spine, rather than increasing BMD as noted in recent popular press reports. CASE REPORT: Nine subjects (8 women) with a median age of 66 years (range 53-87), developed vertebral compression fracture (VCF) one month to six years after initiating yoga-associated spinal flexion exercises (SFE). VCF presented with back pain and occurred in the thoracic-spine (N.=6), lumbar-spine (N.=4) and cervical-spine (N.=1). Four patients had osteoporosis by BMD criteria prior to VCF and 2 had osteopenia (median T-score -2.35; range -3.3 to +2.0). Interestingly, all patients had their lowest T-scores at the spine. Three patients had a history of fragility fracture prior to the index VCF. While one patient had primary hyperparathyroidism and another was treated with high dose prednisone, no other risk factors for bone loss including medications or secondary osteoporosis causes were identified in the other patients. CLINICAL REHABILITATION IMPACT: This study identified patients in whom increased torsional and compressive mechanical loading pressures occurring during yoga SFE resulted in de novo VCF. Despite the need for selectivity in yoga poses in populations at increased fracture risk, both scientific and media reports continue to advertise yoga as a bone protective activity. Accordingly, yoga is misconceived as a ‘one-size-fits-all’ prescription. Instead, the appropriate selection of patients likely to benefit from yoga must be a cornerstone of fracture prevention.

KW - Bone diseases, metabolic

KW - Exercise

KW - Fractures, compression

KW - Osteoporosis

KW - Yoga

UR - http://www.scopus.com/inward/record.url?scp=85059796428&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85059796428&partnerID=8YFLogxK

U2 - 10.23736/S1973-9087.18.05034-7

DO - 10.23736/S1973-9087.18.05034-7

M3 - Article

C2 - 29687967

AN - SCOPUS:85059796428

VL - 54

SP - 947

EP - 951

JO - European Journal of Physical and Rehabilitation Medicine

JF - European Journal of Physical and Rehabilitation Medicine

SN - 1973-9087

IS - 6

ER -