Chinese Medicine, 2010, 1, 1-4
doi:10.4236/cm.2010.11001 Published Online June 2010 (http://www.SciRP.org/journal/cm)
Bikram Yoga as a Countermeasure of Bone Loss in Women
Apurba Mukherjee1, Prithwis Mukherjee1, Robert R. Rude2
1Bikram’s Yo g a C oll e ge of In dia , Los Angeles, USA
2Keck School of Medicine, University of Southern California and Orthopedic Hospital of Los, Los Angeles, USA
Received May 28, 201 0; revised June 10, 2010; accepted June 20, 2010
Abstract
The purpose of this pilot study was to observe whether Bikram Yoga training helps bone growth or arrest
bone loss in women. In this study, the bone mineral density (BMD) was measured at the hip, spine and
whole body for a group of 14 pre-menopausal women (11 Caucasians, 2 Asians and 1 African American).
These 14 women had participated in Bikram Yoga classes (26 yoga postures) at least 3 times a week for 3 or
more years. DEXA sc ans were used to measure BMD at the lumbar spine, hip and the whole body. In addi-
tion, the Z-scores were calculated for each subject at these three locations. The s tudy results indicate that the
BMD at these body areas of this group of women is generally above the mean BMD expected for normal,
healthy, women of comparable age and ethnicity. Overall, the study findings suggest that the intervention of
Bikram Yoga training may be beneficial for skeletal health and could prevent bone loss.
Keywords: Osteoporosis, Bone Mineral Density (BMD)
1. Introduction
A pilot study was initiated to examine whether preven-
tion/recovery from bone loss is possible through Bikram
Yoga postural exercise intervention. Bone loss is a seri-
ous medical problem [1], and an estimated 200 million
adults (both men/women) have this condition worldwide.
The sharp decline of production of the hormone estrogen
following menopause contributes greatly to bone loss for
the elderly women population. Bone loss also results
from joint disuse and reduced movements. The study was
aimed to explore the possibility of using Bikram Yoga
postural exercise intervention as a possible means of
preventi on/ r e covery for bone loss.
In general, the skeleton reaches its peak bone density
for people between the ages of 20 and 30, and after age
35, the body begins to lose more bone than the body can
rebuild. According to the Surgeon General’s Report
(2004) [2], there are over 10 million Americans over the
age of 50 with osteoporosis and an additional 34 million
with low bone mass or osteopenia. An estimated 1 .5 mil-
lion Americans suffer from fractures related to bone dis-
ease every year. In addition, about two -thirds of the peo-
ple suffering from osteoporosis are women, as they
abruptly lose the bone-protecting estrogen hormone at
menopause [3]. However, men also suffer from osteopo-
rosis as they age. In fact, one in four elderly men in
America suffers from osteoporoti c fract ure in older age.
Bones are living tissues and are continually broken
down and rebuilt in human bodies. Consisting of 75%
minerals, (like calcium and phosphorous), and 25% gela-
tin matrix of water and collagen, bones continue to be
reshaped and renewed all the time. While bones appear
solid they can be quite flexible and strong at the same
time.
There is a delicate balancing act that goes on daily with
minerals and human bones. A healthy body reabsorbs
bone at the same rate as new bone growth occurs. Special-
ized cells called osteoclasts will remove bone while os-
teoblasts build bone. Thi s cycle cont inues over and over.
Bikram Yoga, which is a certified form of exercise by
the State of California [4], is suitable for the young as
well as the elderly people. Although Bikram Yoga is
widely practiced in over 1500 studios in USA, Canada,
Europe, Japan, Australia, Thailand, India and many other
countries around the world, there have been limited ef-
forts to scientifically study and document the far reaching
benefits of Bikram Yoga to the mind and body.
2. Study Methods
All study subjects were enrolled by Bikram’s Yoga Col-
lege of India in Los Angeles and they signed informed-
consent forms for Bone Mineral Density (BMD) meas-

A. MUKHERJEE ET AL. 2
urements at the Orthopedic Hospital in Los Angeles. Th e
subjects were Bikram Yoga teachers and they consis-
tently practiced and taught Bikram Yoga on a daily basis.
The Bikram Yoga exercise intervention is a 90-minute
protocol of specially designed sequence of 26 postures
and two breathing exercises, which can be practiced by
men or women of any age. These are static isometric
postural exercises and there are no dynamic movements.
These exercises, which involve both the mind and the
body, collectively stimulate all the vital organs of the
body. The details of the different 26 postures are de-
scribed in reference [5].
Bikram Yoga is a standardized yoga program that is
designed to scientifically warm up and stretch muscles,
ligaments and tendons. In all parts of the world, Bikram
Yoga teachers train participants to perform the same 26
postures, in the same sequence, at 105 degrees Fahren-
heit. Bikram Yoga is a standardized system of yoga and
no deviation is allowed between classes. In fact, all Bik-
ram Yoga teachers are trained and certified by the Bik-
ram’s Yoga College of India. All certified teachers also
undergo periodic evaluations and their teaching certifi-
cates are revalidated every three years. The 26 exercises
systematically move fresh, oxygenated blood to each
organ [6].
Bone mineral density (BMD) was determined utilizing
a Hologic bone densitometer. Bone mass is commonly
expressed as Z-scores as defined below.
Z-score: The Z-scores are calculated by comparing pa-
tient’s BMD with the corresponding BMD of women of
the same age. sex and race. Z-scores are calculated as
follows:
Z-score = (BMD-Expected BMD)/S. D.
BMD = patient’s BMD
Expected BMD = BMD of someone of the same age,
sex and race.
S. D = Standard Deviation corresponding to the above
“expected BMD”.
Z-score is a statistical concept.
The Z-score compares the BMD to age, gender and
ethnicity of the individual. Data presented here therefore
are the Z-scores.
The Z-score value lower than –2.0 is a warning sign
that the patient has less bone mass (and/or may be losing
more rapidly) than expected for someone of correspond-
ing age, sex and race.
3. Results
The bone mass density (BMD) for each subject was cal-
culated for the lumbar spine, hip, and whole body. Table 1
shows the BMD data, in addition to basic demographic
data, for each of the 14 study participants.
Figure 1 demonstrates the standard interpretation of
Z-score for the whole body and Figure 2 demonstrates
the Z-scores for the study population.
Figure 2 demonstrates that whole body calcium of all
the 14 subjects are in the above average calcium group of
population. In addition, Figures 1 and 2 show that 6 out
of 14 subjects have bone density higher than 84% (or in
the top 16%) of the population.
Table 1. Age, yoga experience and DEXA scan BMD data.
Age (years) Total # of yoga classesYears of Yoga practiceZ-score (spine)Z-score (hip) Z-score (whole body)
Subject 1 46 450 3 2.0 1.7 2.1
Subject 2 47 800 4 1.2 0.6 1.2
Subject 3 49 600 4 0.6 –0.5 0.2
Subject 4 39 975 4 –0.3 0 –0.3
Subject 5 41 700 4 –0.8 –0.5 –0.7
Subject 6 47 675 3 –0.4 0.4 0.7
Subject 7 31 975 4 2.1 1.5 2.6
Subject 8 50 950 4 1.4 0.9 3.7
Subject 9 47 950 4 –1.3 –0.9 –1.1
Subject 10 45 900 4 –0.5 –0.4 0.3
Subject 11 41 525 3 –0.8 –0.1 –0.3
Subject 12 49 525 3 1.0 0.5 1.9
Subject 13 45 700 4 –0.5 –0.2 0
Subject 14 44 600 3 –0.6 0.6 1.6
Mean 44 738 3.6 0.22 0.26 0.85

A. MUKHERJEE ET AL. 3
Figure 1. Standard interpretation of Z-score (whole body).
Figure 2. Z-score (whole body) by the number of Bikram Yoga classes.
Figure 3. Photo of a DEXA sc an (lumbar spine ) .

A. MUKHERJEE ET AL. 4
Figure 3 shows a typical DEXA scan photo from the
HOLOGIC bone densitometer at the Orthopedic Hospital
in Los Angeles.
4. Discussion
The results demonstrate that the mean bone mineral den-
sity of all 14 subjects at the lumber spine, total hip, and
the whole body are above aver age considering their ages
and ethnicities. This is most notable for the total body
calcium where the Z-score (whole body) is nearly one
standard deviation above the mean. The data suggests
that an intervention trial of Bikram Yoga exercise activ-
ity may arrest bone loss in women.
5. Practical Applications
The practice of Bikram Yoga may provide another means
to stabilize bone mass and prevent bone loss and osteo-
porotic fractures.
6. Acknowledgements
This study was supported by Bikram’s Yoga College of
India in Los Angeles. The contribution of Travis Liggett
in the early stage of study in obtaining the Institutional
Review Board (IRB) approval is gratefully acknowl-
edged. In addition the contribution of Anita Mukherjee
(Stanford University) in statistical analysis and develop-
ing Figures 1 & 2 from the data of this article are ac-
knowledged.
7. References
[1] B. W. Watts, B. Ettinger and M. S. LeBoff, “Perspective,
FRAX Facts,” Journal of Bone and Mineral Research,
Vol. 24, 2009, pp. 975-979.
[2] U. S. Dept, “Bone Health and Osteoporosis,” Health and
Human Services, Washington, D.C., 2004. http://www.
surgeongeneral.gov
[3] “Risk and Benefits of Estrogen Plus Progestin in Healthy
Post Menopausal Women,” Journal of the American
Medical Association, Vol. 288, No. 3, 17 July 2002, pp.
321-333.
[4] State of California License to Bikram Choudhury for
Bikram Yoga College of India, 2005.
[5] B. Choudhury, “Bikram’s Beginning Yoga Classes,”
Penguin Putnam Inc., New York, 2000.
[6] B. Choudhury, “Bikram Yoga,” Harper Collins Publis hers,
New York, 2007, p. 84.