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56: Does Hypermobility Cause Osteoporosis?
980 Plays1 year ago
Welcome to Episode 56 of the Movement Logic podcast. In this episode, Sarah is talking about hypermobility, and what if any connection exists between hypermobility and osteoporosis.
You will learn:
- Hypermobility, EDS, and Marfan’s Syndrome, explained
- Is there any agreement in the research around hypermobility and osteoporosis
- Why research quality always matters when we’re trying to determine a connection between conditions
- What does ‘statistically significant’ mean and why it matters for research
- What criteria matter when we’re looking at research studies
- Why hypermobile people should be lifting heavy weights, regardless of what the research shows
Hypermobility syndrome increases the risk for low bone mass
Ultrasonographic, axial, and peripheral measurements in female patients with benign hypermobility syndrome
Bone Disease in Patients with Ehlers-Danlos Syndromes
Sign up for our Bone Density Course: Lift for Longevity before the October 8th deadline!
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Transcript
Introduction to Hypermobility and Bone Density
00:00:00
Speaker
So, haha, if we are going to summarize what all this research shows regarding the relationship, if any, between bone mineral density and hypermobility, in other words, does hypermobility lead to a lower bone mineral density? The answer is
00:00:25
Speaker
Welcome to the Movement Logic Podcast with yoga teacher and strength coach Laurel Beaversdorf and physical therapist, Dr. Sarah Court.
Podcast Goals and Episode Introduction
00:00:33
Speaker
With over 30 years combined experience in the yoga, movement, and physical therapy worlds, we believe in strong opinions loosely held, which means we're not hyping outdated movement concepts. Instead, we're here with up-to-date and cutting-edge tools, evidence, and ideas to help you as a mover and a teacher.
00:00:59
Speaker
Welcome to episode 56 of the Movement Logic Podcast. I'm Dr. Sarah Court, I am a physical therapist, and today I'm talking about hypermobility and what, if any, connection exists.
00:01:12
Speaker
between hypermobility and osteoporosis.
Hypermobility Concerns in Yoga and Research Challenges
00:01:31
Speaker
I could just say as a member of the yoga community, when I first heard about this possibility, I was like, ooh, because there are a lot of hypermobile people in the yoga community and in the Pilates community. And there are a lot of people in the yoga community who may not be lifting weights because they have been incorrectly informed that yoga is sufficient for bone density.
00:02:01
Speaker
And then those people might be finding themselves getting a low DEXA scan score and finding out that their yoga or their Pilates or their light weights did not in fact prevent them from getting osteoporosis. It is tough. I'm going to say this because sometimes when there's something that you really want to be true, like I really want there to be a link between hypermobility and low bone mineral density.
00:02:31
Speaker
And I could even see how it could be true because you think like, okay, well, if the muscles and their tendons are what pull on the bones and that is what generates more bone building, that localized stress to the bone, if the tendons are not as strong as they would be because you're hypermobile and your collagen is not as thick or you don't have the same kind or it doesn't build itself the same way,
00:02:55
Speaker
then it makes total sense that being hypermobile would lead to osteoporosis because you can't load your bones as efficiently. But yeah, it's very dangerous to want something to be true. I think that's what's so hard about doing research at all, is that you have to be willing to be like, well, I really thought this was going to be true, but as it turned out, it wasn't.
Listener Engagement and Feedback
00:03:17
Speaker
And there's my paper. It's not as fun of a paper to write, but we're going to get into all of that. But before we get into all of that, we've been reading reviews this, I was about to say this semester. This is not a semester this season. And I have one for you. This is not really a review in that it wasn't left on the podcast page, but
00:03:39
Speaker
This was a direct message I received on Instagram and I got permission from the author to read it to you because it basically is a review. So this is from Alison Lloyd who on her Instagram page says she is a lover of yoga, Pilates, bar, lifting and Frenchtons.
00:03:57
Speaker
She is in Winnipeg, and here's what she had to say. Hi, Sarah. I've been aware of you and your work since my yoga tune-up training back in 2013. I remember you questioning alignment cues and dogma when you were in PT school, which got me thinking back then, but I was still heavily invested in right and wrong ways of moving. Now I am fully on board with you and Laurel and love your podcast.
00:04:23
Speaker
Thank you for getting the word out there and sparking the conversation that there's no hard rules when it comes to bodies. I've listened to every episode and hope there's many more to come.
00:04:35
Speaker
Wow. Thank you, Alison. If you, dear listener, are also moved to write something nice or maybe something not nice, we got a slightly not nice review recently, which we will read. No worries. But if you feel like leaving a review of one or two or any number of stars, I mean, up to five because you can't do more than five, please go for it. You can go on to Apple Podcasts.
00:04:59
Speaker
think that's the best place to leave a review. We really appreciate it. It helps more people find us. And ultimately, it just helps us know that we are speaking your language. We're telling you stuff. We're talking about things. We're debating. We're questioning all the same kinds of stuff that you are interested in. And I also wanted to say I have had a few people reach out
00:05:21
Speaker
by email or direct message to ask us about covering topics. And it turned out for a couple of these emails, we've already done those topics. So if you are newer to the podcast, we have so many episodes for you. So there's season one with 27 episodes for your ears. There's season two with 20 episodes for you. So there's a ton in the archive for you to dig
Hypermobility in Yoga and Strength Training Benefits
00:05:46
Speaker
into. Okay.
00:05:48
Speaker
Let's get down to business. In our recent episode number 52, we had several women record voice memos about what got in the way of them starting to lift heavy weights.
00:05:59
Speaker
And it's a great episode. If you haven't listened, I really love it because I love hearing from you guys. I know my story, but there are so many different stories out there. So Trina Altman and Alex Ellis both recorded voice memos for us for that episode. And they both happened to mention that they were hypermobile and that that was a deciding factor for them in terms of getting into lifting heavy.
00:06:24
Speaker
Now, Trina and Alex are both yoga and movement teachers. And so as a sort of side note, I tried to see if there was any information on the prevalence of yoga teachers or Pilates teachers and practitioners who are hypermobile. I found a study from 2019 that said roughly 12.5% of university aged men and women
00:06:47
Speaker
are hypermobile. So I would estimate that it's at least that much in the yoga world, if not more, because people who are hypermobile, like me, are often originally attracted to yoga for the reason that it's not that hard to do the really bendy poses if you're really bendy. So again, I would estimate at least the same number. So 12.5% or potentially more. I don't know how much more, but I would guess quite a bit more.
00:07:18
Speaker
Now, strength training and lifting heavy are great tools for people with hypermobility, as long as we are, of course, dosing correctly, progressing properly, because they create stability around the joint via the myofascial relationships and the closed loop created particularly by a barbell. So it's a great way to create a lot of the stability that people who have hypermobility can be lacking.
00:07:45
Speaker
Now, we're trying to see if there's another possible reason that you might want to get into lifting heavy if you are hypermobile, which is this question of whether hypermobility and osteopenia or osteoporosis are linked. Today, we're going to dive into the research and see
Understanding Hypermobility: Definitions and Criticisms
00:08:01
Speaker
what's what. We'll start by defining hypermobility, and then we'll go over some of the medical conditions like Ehlers-Danlos syndrome, Marfan syndrome that come with hypermobility as part of their diagnosis.
00:08:14
Speaker
We'll then dive into several papers and see what the research is saying as far as any potential link between hypermobility and low bone density. Let's start by defining hypermobility. You've probably heard of it. You may well have it yourself. And you may have, in the beginning of your yoga practice or career, looked around the room at some of the more bendy people there and wondered how they made it look so easy. Well, they were probably hypermobile.
00:08:42
Speaker
So hypermobility refers to an unusually high range of motion in your joints. This high range of motion is caused by a weakness in the collagen in our soft tissues like ligaments, tendons, fascia, and others. From a medical perspective, it's diagnosed using something called the Baton Scale, which looks at specifically your fifth finger, your pinky finger,
00:09:08
Speaker
your thumb, your elbow, your knee, and your spine, flexibility. And then you get a score out of nine based on the income because you've got two sets of each of the finger, thumb, elbow, knee, and then one spine.
00:09:25
Speaker
A score of zero to three is normal and a score of four to nine is hypermobile. I will link to the Beighton scale in the show notes so you can look at it and see what the criteria are at each of these joints, but it's essentially like bending of the joint past a typical range of motion. Now, just to be clear, there is a lot of criticism of the Beighton scoring system, particularly that it only samples a small number of joints for examination,
00:09:54
Speaker
so that hypermobile joints outside this group will of course be overlooked, which might mean that we incorrectly score someone. And it's also an all-or-none test. It doesn't give us any indication of the degree of hypermobility, merely an expression of the widespread nature of its distribution. In other words,
00:10:18
Speaker
Each of the locations that are tested are a yes, no. There's no gray area. Either you have hypermobility in that joint or you don't, and your score does not actually have to be that high in order to be diagnosed with hypermobility. Now, there is an alternative scale that offers a wider view of joint laxity because it includes other joints, the shoulder, hip, patella, ankle, foot, and toes.
00:10:46
Speaker
And it's a 10 point hospital Del Mar criteria. So I've linked to both of these skills in the show notes, and I don't want to get too bogged down in which test is the better one, but just a note that there is criticism around this testing and its accuracy.
Joint Stability and Hypermobility Syndromes
00:11:02
Speaker
So if your focus is to get into the most complicated yoga pose possible, hypermobility is going to be the easiest way to get there if you have it. But while it might sound like a superpower for that reason, it's honestly not always that great. Hypermobility can sometimes lead to joint pain, instability, and even an increased risk of injuries. If we think about joint wear and tear over time,
00:11:28
Speaker
If I'm constantly pushing into my end range and just hanging out there, I may over time irritate or even damage some parts of the joint more than others. There's also ultimately a much greater value in a range of motion that you can get to and hold using your own strength rather than shoving yourself into a shape.
00:11:50
Speaker
and then, as a lot of people say, hanging out on your joints, which is not an entirely accurate description, but I enjoy the drama of it. But this is why strength training is an extremely valuable practice to get into if you are hypermobile because it does help build and create stability around the joint.
00:12:10
Speaker
Now, in terms of diagnosing conditions, there are a few different ones for you to consider. Not that you're diagnosing, but just for you to know about. So lots of people, including myself, have something called benign joint hypermobility syndrome, which basically means we have hypermobility in our joints, but we don't have a lot of the other systemic symptoms or issues that come up with other conditions
00:12:39
Speaker
due to a weaker collagen production. For people with benign joint hypermobility syndrome or sometimes just called joint hypermobility syndrome, our concerns for the most part are musculoskeletal. We may have some of the other
00:12:59
Speaker
symptoms or conditions or issues that are seen in conditions like Ehlers-Donlos, but we don't have it enough to actually be considered an actual Ehlers-Donlos type diagnosis. Since we're here, let's start talking about this. Probably the most well-known condition that includes hypermobility are the Ehlers-Donlos syndromes, and that's usually shortened to EDS.
00:13:27
Speaker
And I wanted to note in particular the extra S on the end. There are 13 different variations of Ehlers-Danlos syndrome out there. So this, I'm going to read the definition of EDS from the Ehlers-Danlos society webpage. They say the Ehlers-Danlos syndromes are a group of 13 heritable connective tissue disorders.
00:13:55
Speaker
The conditions are caused by genetic changes that affect connective tissue. Each type of EDS has its own set of features with distinct diagnostic criteria. Some features are seen across all types of EDS.
00:14:10
Speaker
including joint hypermobility, skin hyperextensibility, and tissue fragility. This is not an episode about EDS, but I do encourage you, if you are a teacher, to learn more about it because there are a lot of other symptoms that can occur beyond just joint hypermobility. These include vascular issues, because we think about the collagen that makes up the blood vessels,
00:14:32
Speaker
issues with your eyes same thing internal organ fragility because if you think about it collagen is in a lot of structures in our body and if the body's collagen has been impacted severely enough that is going to
00:14:47
Speaker
impact a lot of the functionality of a lot of different systems in your body. So the Ellerstown Society website is a great resource with tons of easy to understand information and I've linked it in the show notes. Bottom line, if someone comes to your class and they say, I have EDS, you can expect them to be hypermobile for sure.
00:15:06
Speaker
And you might want to ask them about anything like if they have any issues with blood pressure, right? Some people have a condition called POTS, which is, oh boy, Postural Orthostatic Tachycardia Syndrome, which basically means they get extremely dizzy if they change from lying down to sitting up, sitting to standing, things like that because of the postural change.
00:15:27
Speaker
the weakness in the collagen in their blood vessels, it's sort of like having low blood pressure, right? But in an extreme way. So that's an example of something that might also be going on with someone who has EDS.
Exploring Connective Tissue Disorders: EDS and Marfan Syndrome
00:15:39
Speaker
So now let's switch gears and talk about Morfan syndrome. This is another genetic condition that affects the body's connective tissue, leading to not only hypermobility, but also issues with the heart, eyes, and bones. And fun fact,
00:15:55
Speaker
I was once tested for Marfan syndrome. I tested negative, thankfully. I sort of look like what people with Marfan syndrome look like, which is tall, lanky, long fingers, and hypermobile.
00:16:09
Speaker
So similar to EDS, people with Marfan syndrome have compromised connective tissue. This time it's with the gene that makes something called fibrillin. Marfan syndrome can have more severe and potentially life-threatening symptoms, which include aortic enlargement or other vascular issues and problems with their lungs, eyes, bones, and even the dura, the covering of the spinal cord. Okay, so in the words of Rihanna, this is what we came for.
00:16:38
Speaker
What is the link, if any, between hypermobility and osteoporosis or osteopenia?
Research on Hypermobility and Bone Mineral Density
00:16:45
Speaker
Now, there's a bunch of papers out there and I went absolutely cross-eyed. And at one point I even tried to convince Laurel that I should change this episode basically because I was like, I can't look at any more research. And she was like, no, this is, you're going to do this episode.
00:17:06
Speaker
I whittled it down to four papers total that I'm going to walk us through here to see what the research says on this topic. As always, I'm going to do my best to give you a sense of the relative value of each piece of research based on its criteria. As we know, not all research is created equal. Then we'll do a little summary at the end.
00:17:31
Speaker
and I might just say more studies are needed because that's almost always the case. There are links to all of these papers in the show notes if you want to read at least the abstract if not the full paper as well. I pay money now and because I pay money now I can access a lot of research papers and it seems to be
00:17:53
Speaker
The only way to really do it consistently, I got by for several years on begging people I knew who were still in PT school with access, academic access, to find papers for me. And then I begged USC to keep giving me access while I was a clinical instructor for some of their PT students.
00:18:15
Speaker
and then that ran out and you know after a while it gets kind of hard but uh now i'm just gonna pay for it and i actually did find a resource for that that seems to work really well but that's a different story okay get to the point court the point is i have read all of these papers even though you may not be able to read the entire thing for all of them
00:18:37
Speaker
Paper number one. This is the one that actually our friend Trina gave us. And she didn't say, hey, you should do an episode about hypermobility and osteoporosis. But I did. But she just, you know, has an incredible habit of being one of the most generous people I know. And so by sharing this research with us, it gave me the idea to do a little deeper dive and see, okay, well, apart from this paper, what else is out there?
00:19:07
Speaker
This is this paper, hypermobility syndrome increases the risk for low bone mass. That's a pretty confident title. Let's see if we think they should be so confident. This is from 2005 and it is a study of 25 pre-menopausal women who have hypermobility. Then there's a control group of 23 women without hypermobility who were matched for age,
00:19:37
Speaker
Menarch age, which is the age when you start your menstrual period, pregnancies, lactation, physical activity, and calcium intake, meaning in all of these categories, there is no statistically significant difference between the control group
00:19:54
Speaker
and the study group, so that the only real difference is that the study group had hypermobility, the control group did not. I'm going to talk about statistically significant difference in a moment, but just to give you a sense that there was a group they were studying to compare of people in all of these same categories of age, etc., but without hypermobility,
00:20:21
Speaker
what is their bone density reading. So can we then extrapoligate or just extrapolate from the results that the hypermobility part
00:20:33
Speaker
was a causal factor. So one of the things I like about this is they chose women that were all pre-menopausal because we know that there are hormonal changes that happen with menopause that impact bone density. So we're just taking that possibility out of the picture. Also, none of them were on any medications or drugs that could impact bone mineral density. Also, I mean, they didn't test them for EDS or Marfans.
00:21:00
Speaker
None of them had what's called blue sclera, which is when the whites of your eyes turn blue, which evidently is something that's very common.
00:21:07
Speaker
for people who have EDS or Marfan. These are also people with just like what I have benign joint hypermobility syndrome. So we're really boiling it down to women who have joint hypermobility, but don't have a more severe and rare genetic condition who are premenopausal. So they're not under the effect of any hormone changes. And then they are also matched for five different criteria.
00:21:33
Speaker
with itself plus a control group that is identical except for the hypermobility. Now, I really like this study. It's simple. It's not trying to over-prove anything. The authors have done their best to control for a lot of factors. They matched a lot of these different factors and they included a control group, which is always an excellent idea. And so what this study found was that the hypermobile group
00:21:59
Speaker
had a significant difference in bone mineral density for the femur, the greater trochanter, the femoral neck, and something called Ward's Triangle, which I had to look up, which is it's an area in the middle of the femur near the neck and the greater trochanter. I don't know why it's called Ward's Triangle. It's probably a man. It's always a man.
00:22:21
Speaker
Now, overall, 16 people in the hypermobile group had a low enough bone-mineral density to qualify as having osteoporosis. And nine people in the control group had low enough bone-mineral density to qualify as having osteoporosis. So the difference between 16 people and nine people
00:22:45
Speaker
is considered in this case statistically significant. Now, if this idea of statistically significant is maybe something you've heard of, but you're not super familiar with what it means, here's what it means. When they run the statistics tests on the data, they're looking for a result
00:23:03
Speaker
that shows a statistic significance, meaning that in this case, the difference between 16 hypermobile people and nine control group people both having osteoporosis is not just a random number or a coincidental number, but from a statistical standpoint, it is a meaningful enough difference to be able to say that you might be proving what you are setting out to prove.
00:23:31
Speaker
Okay, now I hope that makes sense. As an SI and as an FYI, I really hated learning the statistics part of the years worth of research classes that I took in physical therapy school. And so I kind of, in order to pass all of the exams and not explode, I just got in the habit of memorizing what the results
00:23:57
Speaker
like meant without fully understanding why they meant that. For example, the other day, Laurel and I were talking about this study on another episode and the study had a high confidence interval and Laurel asked me, what's a high confidence interval? And I couldn't tell her more than it was a good thing and that you wanted it. I couldn't remember how you got it or why it's good.
00:24:19
Speaker
I know the markers to look for, but I just don't know exactly what they mean. But I know if it's a low number, what that means, and if it's a high number, what that means, or sometimes it's the reverse. If we have any statistics experts out there who are listening and would like to come on the show and do a statistics for regular people episode, we would love to have you. I would love to have you because I would love to understand all of this a lot better than I do.
00:24:49
Speaker
In any event, so overall, paper one, hypermobility syndrome increases the risk for low bone mass. It does point to this being the case. However.
00:25:00
Speaker
We do have to consider any possible negatives. And so in this case, it was a really small study group, right? Like 25 people, 23 people. That's not a lot of people. So this is definitely a more studies are needed, or this study needs to be replicated by other people, which it may well have been. I did not come across that.
00:25:23
Speaker
But overall, yeah, decent paper. I'm not mad at it. But one decent paper does not prove enough things.
Examining Study Discrepancies and Limitations
00:25:32
Speaker
So let's move on to another paper. This paper is part of the Chingford study.
00:25:38
Speaker
And when a study gets a name like the Liftmore trial or the Chingford study, it usually means that this is some research that has done well or it has achieved some level of notoriety or fame in the research world for some reason. So let's find out what this one is all about. And this is one that you can download the whole thing and read for yourself.
00:25:58
Speaker
So the real title of the paper is the relationship of joint hypermobility, bone mineral density, and osteoarthritis in the general population, colon, the Chingford study from 2003. Now different from the first paper, this is a group of post-menopausal women with hypermobility. And what this paper is looking at is any relationship to either osteoporosis and or osteoarthritis.
00:26:25
Speaker
As it turns out, what I discovered was that the Chingford study was a population of about a thousand women that were studied for many different features in multiple studies. So that's why it got its name. You'll see the Chingford study shows up in
00:26:45
Speaker
a bunch of different research. So they just took this group of women and studied all kinds of different things about them. And so this is a group of postmenopausal, mostly white women. And for this study, 716 of the original 1000 women who are aged between 53 to 72 were found appropriate for
00:27:07
Speaker
different criteria to assess for hypermobility, osteoporosis, osteoarthritis, and whether there was any relationship. Now, of these 716 women, only 82 showed evidence of hypermobility anywhere in their bodies. So now we're whittling down, we're looking at these 82 women with hypermobility and we're comparing them with the remaining
00:27:31
Speaker
360 some women, there were a couple that had to drop out, right, who don't have hypermobility. And we're looking to see if there are differences in their bone mineral density. And so they found, this is what's a bit weird about this study, that there was a much lower level of hypermobility in this group, 0.14% than in the general population, which is more like 10%. But this is where we really have to contextualize
00:28:01
Speaker
what's going on here. So first of all, all of these women are postmenopausal, which means all of them, hypermobile or not, have been impacted in some way by hormonal changes, which is going to make a change to your bone mineral density, which means we don't really know if the bone mineral density loss is from menopause or from hypermobility or if it's from both.
00:28:25
Speaker
And it's a bit weird, only one of the hypermobile women had a bait and score of four or more, which is what counts as hypermobility, but they kept every woman who had any positive result. So instead of needing to score positively on four different out of nine criteria, even if you just had one area, one criteria that tested positive, you got put in the hypermobile group.
00:28:54
Speaker
And the other thing that was interesting was that the hypermobile women group did the most exercise, the most physical exercise of any of them, not as part of the study. It just turned out that way, including two hours of vigorous exercise per week. They don't know what kind of vigorous exercise, but I'm assuming that's probably cardiovascular.
00:29:17
Speaker
The authors also note that this is a mostly Caucasian population, and as far as hypermobility, there is a real variety over different ethnicities. The study authors say that it is only generalizable, which means the results can only be extrapolated to older female populations without genetic disorders like EDFs or Marfans. And since none of the hypermobile group
00:29:42
Speaker
had EDS it's possible that the hypermobile number would have gone up if those people were included but ultimately what the study found the people who had mild degrees of hypermobility showed no evidence of either premature osteoarthritis or reduced bone mineral density so this is what happens you get all excited about a paper like the first one and then I'm going to throw this paper at you which says basically exactly the opposite but
00:30:13
Speaker
So what did the study find? Well, it found that for the women with any amount of hypermobility in their joints, there was no premature osteoarthritis and there was no connection to reduced bone mineral density. Well, that's frustrating, isn't it? But there are a lot of things that we have to consider.
00:30:36
Speaker
about this study so here are some of the here are some of the things that the authors note and also that that i am noting okay so even though the study's got a name which as it turns out has more to do with this particular group being studied several times it doesn't really move the needle for us one way or another because
00:30:55
Speaker
I would argue that the group itself may not have been a particularly good one to study for hypermobility and bone mineral density. In particular, it's this very homogenous group.
00:31:08
Speaker
And so that doesn't lead to a lot of generalizability, meaning you can't extrapolate this information across other ethnicities, other ages. You can really only say white postmenopausal women who are hypermobile, according to this study, aren't more likely to have bone mineral density loss.
Promoting Strength Training Programs for Bone Health
00:31:29
Speaker
Even that is a bit, if I would not extrapolate that from this study just because the results are a bit weird, everything about it just reads a bit strange. That's a technical term. You've heard us talking a lot about our upcoming bone density program, Lift for Longevity, which is a six month course of live weekly strength training classes, along with bonus courses, Strength Training 101 and All About Osteoporosis, and
00:31:59
Speaker
a ton of other pre-recorded content showing you all the techniques that you want to review, any safety concerns, all of that good stuff. The reason why we made the program six months long is because that is the point where you can actually see change taking place in bone density.
00:32:18
Speaker
If we are training heavy and attempting to improve our bone density, we need to do it for at least that long before we'll see any results. The big thing with our program, it is properly programmed.
00:32:34
Speaker
which means you start where you are and we focus on technique in the beginning with moderate or maybe even lightweight on your barbell and eventually progress as appropriate for you to get you to the point where you are lifting heavy.
00:32:51
Speaker
Now, this is a barbell program, but if you don't yet have barbells, you can still do it. You can take the information and apply it to using dumbbells or kettlebells. But from our perspective, we believe ultimately that the barbell is a tool that is going to let you lift progressively for life. So we think it's actually the most economic choice long-term. And this program, it's really just us helping you get started over a long course of time. You're going to get lots of learning around
00:33:21
Speaker
how to use weights, how to strength train, how to progressively overload, how to progress to heavy lifting, the best techniques for your barbells, because we want you to keep going and we want to give you ways to continue to use our program so that it's not just you lift for six months and then you give up on it, but you learn how to lift for the rest of your life. You'll get a live class once a week as well as demo videos of all the exercises.
00:33:49
Speaker
You can choose if you want to take a class with us, like a yoga class, Pilates class style, or just watch the demo videos and do the workouts on your own. Other things to think about, the course is yours for life. You get it forever. There is no other guided, live, and recorded follow along class six month program out there. There's just not. We looked, people. We looked. This is the first year that we're doing this, which means next year the price is going to go up.
00:34:19
Speaker
Either way, this is way cheaper than working with a personal trainer. Not the same, of course, we acknowledge, but it's a lot more affordable if that's been a barrier for you. Now, here's the thing. The cart is closing soon on this, October 8th.
00:34:34
Speaker
The last day that you can sign up and we really mean it because the course itself starts on October 14th and we're gonna give everybody who is enrolled enough time to Preview some of the videos and watch any of the stuff they want to before we get started So if you want to join us and we really hope you do it's gonna be such a good time you guys I can't wait for it to start you can go to the link in our show notes and
00:34:59
Speaker
to sign up or you can go to our website and click on bone density program lift for longevity. Moving on so we've got one paper that says yes definitely we've got one paper that says I don't know maybe maybe not hard to say it's got too many conflating issues possibly so okay now we're going to look at our third paper
Insights from Calcified Tissue International Study
00:35:25
Speaker
Our third paper is called ultrasonic axial and peripheral measurements in women with benign hypermobility syndrome. And this paper came out in 1999 in what has to be now my new absolute favorite journal. It's called calcified tissue international. I'm just going to let you think about that for a minute, because does that mean there is a calcified tissue national?
00:35:54
Speaker
Is there enough fascination with calcified tissue that we have to make a journal that is international? How many studies around calcified tissue is anyone doing? I have so many questions. Is this publication still in circulation? I kind of doubt it. Maybe, I don't know, maybe. What do I know? Maybe there is a calcified tissue con going on right now. And I'm just making fun of them over here. But anyway, for in this study, it looked at 25 women
00:36:25
Speaker
age between 19 to 57. So this is a group that has both pre and postmenopausal women in it. Although not very many postmenopausal, only three of the women were over the age of 50. So most of them were premenopausal or perimenopausal. They all had benign hypermobility syndrome.
00:36:45
Speaker
None of them were on hormone replacement therapy or any bone impacting medications. And then they also had a control group, but instead of directly studying a control group, they obtained data on 19 age matched controls. So that means they got data of other women who were only matched for age, but they were comparable to this group.
00:37:11
Speaker
And so they did the DEXA scans and then they did a bunch of other ultrasounds and other scans done. And I'm going to be honest, the statistics was a little rough to get through because there is something going on where the, oh God, I'm so sorry to do this to you. The volumetric density of the bone has to get size matched. Meaning you're like, Sarah, come on. So it has to do with,
00:37:40
Speaker
You know, I'm six feet tall. My bones are bigger than someone who is not six feet tall. Simone Biles, the amazing gymnast, her bones are smaller than my bones. So the volume of the density of the bone, it has to be size matched to actually properly compare the data. And that has to do with a different type of bone that is in your bone, cortical versus trabecular.
00:38:07
Speaker
Cortical is the outer thicker letter, trabecular is the inside honeycomb looking part. I'm going to stop there before I confuse anybody else, including myself. And the only thing that this study was able to say was that the people who had benign hypermobility syndrome have lower DEXA scan results.
00:38:29
Speaker
but that the results don't reach the threshold for actual osteoporosis. So that might mean they reach the threshold for osteopenia. It might mean they don't reach the threshold for osteopenia, but they're close to it.
00:38:45
Speaker
This study did show that the hypermobility group had lower DEXA scan results. So similar to our first paper, maybe another like small column in the small tick rather in the, in the yes, there is a relationship column. Now again, it's a small sample size. Now I don't like this study as much as the first study because the control group is only matched for age.
00:39:12
Speaker
It's not matched for any of the other criteria. That first study had a ton of criteria like pregnancies and lactation and all these kinds of things where they matched their samples. In this case, it doesn't seem like they got that granular. That's a bit of a negative for this paper.
00:39:33
Speaker
You know, maybe showing that the tendency towards a relationship is there. Are you still with me? Did I absolutely murder your brain? Are you slowly dying of boredom? Is this only fascinating to the three super nerds? One of whom is me, the other one of whom is Laurel, and probably Trina?
00:39:54
Speaker
I hope you're hanging in. We've only got one more paper, one more paper to talk about, and then we'll see if we can draw any kind of a conclusion.
EDS Impact on Bone Density and Research Gaps
00:40:01
Speaker
So the last paper I wanted to say, okay, well, what about people who have EDS? What's their story?
00:40:09
Speaker
And the number of people with EDS is a much smaller number than the number of people with benign hypermobility syndrome. Instead of 10% or 12% of the population, it's more like one in 5,000. That's not a helpful way to compare numbers, but those are the numbers that I have. I apologize.
00:40:32
Speaker
Now, the thing is though, because the EDS population tends to have a variety of musculoskeletal pain, chronic joint pain, problems, et cetera, et cetera, you are more likely to run into them in your classes because they may well be seeking out pain relief and coming to yoga or coming to Pilates.
00:40:50
Speaker
So if you have EDS, are you more likely to have bone mineral density loss? So this is paper four. It's called bone disease in patients with Ehlers-Danlos syndromes, and it's from 2020. And it is a review that's looking at a lot of other studies, which is a great form of research. And essentially what it tells us is that there are some forms of EDS that have been proven to impact bone formulation, but not all of them.
00:41:20
Speaker
And this actually is what I was talking about in the beginning. This tendon stiffness is what transmits force from muscle contraction to bone. And for people with EDS, it is decreased. And so they say in the paper, it is conceivable. Whenever I see the word conceivable, I am instantly saying to myself in my head, inconceivable.
00:41:45
Speaker
Anyway, the authors say it is conceivable that altered force transmission from muscle to bone could lead to secondary bone weakness, meaning it's not out of the question, but it is not exactly what we're studying here or what has been found already.
00:42:02
Speaker
So in the same way that I was at the beginning of this episode talking about how it would make sense for hypermobile people to have less tendon stiffness, therefore less stress on the bone, what this paper is saying is that this is also probable slash likely for people with EDS. If we think about some forms of EDS, I should say, if we think about EDS as a condition
00:42:29
Speaker
that has everything that hypermobile people have plus more plus more intensity, it would make sense. And EDS could also impact your bones in a more sort of six degrees of Kevin Bacon way, meaning if you have pain because you have EDS, you may not exercise as much. Or you may have neurologic issues from your EDS that then impact your movement capabilities.
00:42:57
Speaker
And the analysis of the studies that were included in this paper suggests that bone mineral density in people with EDS can vary widely depending on the type of EDS they have. Hypermobile EDS or classical EDS show possible decreased bone mineral density, but there isn't any data to suggest that they have a higher fracture rate. And there seems to be some like abnormal spinal vertebral bone shaping, but they can't
00:43:25
Speaker
draw any conclusions from the papers that they looked at around the cause of that. If we are going to summarize what all this research shows regarding the relationship, if any, between bone mineral density and hypermobility, in other words, does hypermobility lead to a lower bone mineral density? The answer is,
00:43:56
Speaker
more studies are needed. It's so annoying, but I have to say that it's true. As far as research is concerned, I didn't find any large-scale replicated study that shows an indisputable link. Indisputable. Indisputable is a really hard word to earn in research. We get a lot of probables and maybes and seems likes. So far, that's really where we are with this. But, but,
00:44:25
Speaker
Here's what I think is a bigger and actually much more important point than all of this.
Encouragement for Strength Training and Podcast Support
00:44:32
Speaker
There is a category of people who practice yoga and Pilates and who have hypermobility and who have bone mineral density concerns because a lot of these people do not also participate in bone building activities like heavy lifting and impact training. So regardless
00:44:55
Speaker
if research has found a hypermobility and bone mineral density loss connection. These people are very well served to start acting like it has.
00:45:07
Speaker
and start lifting heavy because number one, it's great for hypermobility anyway, as we already discussed. And number two, if you're only doing yoga, you are very likely gonna find out in a very uncomfortable way that it is not building bone density for you. And you might find that out when you hit menopause and get a DEXA scan, you might find that out ahead of time, you might find out later, but why bother waiting?
00:45:37
Speaker
Why take the risk of waiting to find out if your hypermobility might be connected to any potential down the line bone mineral density loss or even potentially currently as we're sitting here, bone mineral density loss. There's no reason to wait for more research to prove the link when we already know that heavy strength training and impact training are proven to improve your bone density
00:46:07
Speaker
And it's really good for your hypermobility anyway, so why wouldn't you be doing it? That's my question. Alright, well I hope you enjoyed this episode, and that even though we couldn't really draw any massive conclusions, and that's how research can just be super frustrating,
00:46:28
Speaker
I hope that I was able to make sense of all of this for you. And now let's all stop listening and go lift. Or maybe you're even listening to this while you're lifting, in which case I say, good on ya.
00:46:39
Speaker
You can check out our show notes for the links to all the references, all of the papers I mentioned in this podcast. There's a lot. And including a link to sign up for our bone density program, Lift for Longevity, which will only be available for a short while longer. Just a couple more weeks, maybe? And that's it. October 8th, that's the last day. Thank you so much for listening. And finally,
00:47:04
Speaker
It helps us out tremendously if you liked this episode to subscribe and to rate and review it on Apple Podcast or wherever you listen to this podcast. And we will see you next week.