Shhh. Listen. If what you hear is nothing, then maybe you’re onto something.
Noise envelops us. Some of it, like the sound of a Broadway musical, the waterfall laughter of a giggling child, or the deep resonant breath of a humpback whale surfacing amid floating cubes of ice in Alaska can give us peace, pleasure and joy.
Many noises, however, are irritants or worse. We step out of a loud airplane onto a jetway, where loudspeakers announce the boarding in group four of a flight awaiting takeoff. We walk through a crowded airport, as fathers shout to their children, a woman calls to ask Breanne if she “wants fries with her burger,” and a man informs his wife that he “has to pee so badly that he’s not sure he’s going to make it.”
We step outside of the airport, where whistles from people directing traffic echo in our ears and where officials in orange vests bark orders at drivers to “vacate this spot immediately!”
We try to ignore many of the harsher and more abrasive sounds, even though our nervous system tracks noises as a way to protect us in case someone yells something we need to hear.
And then there are those wonderful moments when we hear nothing, not even the buzzing of a lightbulb, a dog drinking in the next room, or a cat cleaning himself on a nearby chair.
Silence.
If it lasts long enough, it’s the pause that refreshes, giving our ears a rest and our brains a chance to hear an inner voice that might otherwise get lost.
We can find those moments when we’re on our own. When we’re surrounded by others, the silence is harder to discover, as we either speak or hear the noises they make as they unwrap a newspaper, chew their gum, or shake their leg up and down so rapidly that the material from their pants makes a repetitive rubbing sound.
But then, we can go to a meditation or yoga class or a religious or memorial service and reflect with others who sit still like a slope of shaded stones in an Ansel Adams photo.
During those moments, we can slow our breathing, think beyond the constant fast twitch need to act and react to our phones, and can allow our minds to make unexpected connections.
During one of those recent times, I pondered symmetry in nature, where you can draw a line down the middle of something like our faces, and see that the image on one side, excluding freckles, beauty marks, and that scar from the time we tripped and got stitches, is incredibly similar to the one on the other.
With so much chaos in nature, I wouldn’t expect such symmetry. At a distance, most leaves have remarkable symmetry, as do the shape of most animals. Human designs often have a pleasing symmetry, with windows, flying buttresses and A-frame houses looking remarkably similar on the left and right. Almost every field or arena for a sporting event has some symmetry, except for those with irregular outfield fences.
During a recent service, I enjoyed time when I couldn’t look at my phone and when I could read religious text. I haven’t considered these texts in a while and was drawn in by their drama and story value, as opposed to the spiritual and life guidance I often imagine. Basic struggles for power, sibling rivalries, and the search for food and stability dominate these narratives, which makes it clear why religion (and mythology) continue to offer connections for people whose lives, at least on the surface, are considerably different from the ones people lived lo those many years ago.
Ultimately, silence can be refreshing, giving us auditory time and space to reflect and to clean a cognitive filter cluttered with chaos and cacophony.
500-Acre Property Boasts World-Class Arboretum & Flower-Lined Public Walking Trails
Pinelawn Memorial Park and Arboretum, known for its exceptionally beautiful grounds and world-class arboreta announces its 2022 event schedule. Included in the calendar are the park’s many educational programs that celebrate the importance of various beloved insect species including butterflies, praying mantis, and ladybugs, and the vital role they play in the environment. Pinelawn will also host ten outdoor Yoga classes, including Yoga Under the Stars and Sunset Yoga, as well as old-fashioned trolley tours of its premier arboretum which recently was awarded Level II status from the International Arboretum Accreditation Program, ArbNet.
Pinelawn’s sprawling property features flowing fountains, historic monuments, vibrant flower beds, and many notable trees. “Visitors will be surrounded by the beauty of our trees. Our oldest is a 120-year-old Weeping Beach that has a crown size of 74 feet,” said Justin Locke, President, Pinelawn Memorial Park and Arboretum. “Receiving the ArbNet Level II accreditation is a testament to our staff’s hard work, and a gift to our families and the community who often visit to reflect and be with nature at our spectacular park-like grounds.”
“Our grounds are magnificent and continue to flourish as a result of our enduring work to preserve, protect, and take great care of the property,” continued Locke. “Over the years we’ve found that many enjoy visiting the property to take in its beauty whether they have loved ones laid to rest here or not. So today, we invite visitors to attend our events and enjoy the grounds as much as we do.”
The 2022 Calendar of Event Schedule Includes:
Morning Yoga Flow – Sunday, June 5
Old-Fashioned Trolley Arboretum Tour – Sunday, June 12
Morning Yoga Flow – Sunday, June 26
Morning Yoga Flow – Sunday, July 10
Butterfly Release – Sunday, July 17
Morning Yoga Flow, Kids and Me Yoga – Sunday, July 24
Sunset Yoga with Essential Oil Guided Meditation – Friday, August 5
5th Annual Ladybug Release – Sunday, August 7
Yoga Morning Flow – Sunday, August 28
Sunset Yoga with Essential Oil Guided Meditation – Saturday, September 17
Honey Bee Experience – Sunday, September 18
Yoga Under the Stars, Hatha Centering Class – Friday, September 30
Fall Foliage Yoga Flow – Saturday, November 5
Fall Foliage Old-Fashioned Trolley Arboretum Tour – Sunday, November 6
Throughout the year, Pinelawn also hosts Online Grief Support Workshops where families learn how to optimize healing benefits including simple meditation techniques, ways to engage with one’s senses, gratitude rituals, and more.
All of Pinelawn’s events are free of charge and open to the public. To find out more details, click here to see the full 2022 calendar of events and to sign up for email updates.
Pinelawn Memorial Park and Arboretum, 2030 Wellwood Avenue, Farmingdale, is a non-sectarian cemetery prided on creating and maintaining a beautiful and serene environment where families can find tranquility and comfort. Its open and expansive landscape features hundreds of acres of manicured grounds, unique architecture, flowing bronze fountains and flower-lined walks. Its beautiful memorial gardens offer all who visit, scenic beauty where they can reflect upon their loved ones in peace. For more information on Pinelawn Memorial Park and Arboretum, or to schedule a tour of the property, visit www.pinelawn.com or call 631-249-6100.
Save the date! The Meadow Club, 1147 Route 112, Port Jefferson Station will be hosting the 7th Annual United Nations Day of Yoga on June 21 from 10 a.m. to 3 p.m. The event is open to all and will include a variety of yoga classes for all ages and levels, meditation sessions, vendors and more.
This event is being sponsored by Indu Kaur, Director of The Meadow Club; Jas Singh, founder of ReflectandRespond; Sharmila Nigam, founder of One Love Generation; and Marcy Guzman of The Healing Center at Port Jeff Salt Cave, along with 14 holistic teachers and volunteers.
Brookhaven Councilmember Jonathan Kornreich, Suffolk County Legislator Kara Hahn, Director of the Staller Center Alan Inkles, and President of the Port Jefferson Station/Terryville Chamber of Commerce Jennifer Dzvonar, to name a few, will be in attendance for the candle lighting ceremony to start the morning program.
A vision of Indu Kaur, owner of The Meadow Club, the event is intended to promote harmony, world peace, health and wellness through the various practices of yoga and holistic modalities.
Event speakers include Dr. N who is Board certified Doctor of Integrative Medicine, Alternative Medicine and Doctor of Humanitarian services with PhD graduated from International Quantum University of Integrative Medicine; and Meditation teacher Bhante Kottave Nanda from Long Island Meditation Center.
Attendees will be able to learn and practice various forms of yoga such as Hatha, Chair, Kundalini, Restorative, Vinyasa, Yin, Yoga Nidra and more from local instructors of Yoga, Pranayama breathing, Ayurveda, Holistic health lifestyle, meditation, Reiki, financial wellbeing and more.
In addition, a delicious vegan vegetarian buffet will be available for a nominal fee along with raffle of baskets valued at $200+ to support this fully volunteered sponsored event and raise awareness of peace with yoga, love, and light. Bring your own yoga mats or mats will be available for purchase.
The event is FREE and open to the public. RSVP requested by calling 631-828-4818.
Tara Salay at her studio in Setauket. Photo by Rita J. Egan
Tara Salay is a big believer in the natural healing aspects of yoga.
Tara Salay at her studio in Setauket. Photo by Rita J. Egan
The former physical therapist turned yoga instructor specializes in teaching yoga to those with chronic pain and pelvic health issues. Recently, she opened a business in Setauket.
The St. James resident said working as a physical therapist for five years she regularly advised patients with chronic pain and pelvic issues to take yoga classes. Unfortunately, many patients couldn’t find a class that helped them. Before the pandemic, she began to think about opening a yoga studio that would cater to these individuals, but as businesses had to shut their doors due to state mandates, Salay took to the virtual classroom to introduce her business.
“It was the push that I needed in a way because I had all the plans before, and then I was, like, I have the time now let me just do it,” she said.
With COVID-19 restrictions being lifted, Salay eventually was able to rent a space part-time and then a month ago began renting full-time and opened up her studio in the Port Jefferson Chiropractic building on Route 25A near Washington Street. Right now, she doesn’t have a name for the studio and operates under her name. Her goal is “to bring awareness of how yoga can help people who are dealing with chronic conditions.”
Chronic pain and pelvic issues are common. Salay said issues in the pelvic area range from problems for both women and men with the bladder, actual pain in the pelvis, sexual dysfunction or even bowel issues. She added some people will go to physical therapy with pelvic pain and will feel better, but then will face a stressful situation and the issues will return.
“That’s why yoga is really great for it, because it works on the mind-body connection and teaches them how to relax those muscles so they’re not tensing up every time that they’re stressed out,” she said.
“My teacher training was just so transformational for me personally that I just wanted to transition. I just want to dedicate myself to doing yoga. I’ll use my knowledge as a PT but this is what I’m doing now.”
— Tara Salay
The instructor said yoga is more than different poses but also about breathwork and meditation, and many are hesitant because they think they can’t handle the poses, which sometimes look difficult.
“We can make it work for your body,” Salay said. “There’s more to yoga that I think people aren’t aware of, and they think that you have to have a certain body type or be flexible or be able to get into these crazy positions to do yoga, and that’s definitely not true at all.”
With her physical therapy experience, she said she has a deep understanding of the body, and she can guide her clients to help keep them safe. Salay has been practicing yoga for more than 10 years, and when she decided she wanted to open a yoga studio took the classes to become a teacher. Originally, she thought she would incorporate her yoga training into her physical therapy, but the reverse happened.
“My teacher training was just so transformational for me personally that I just wanted to transition,” Salay said. “I just want to dedicate myself to doing yoga. I’ll use my knowledge as a PT but this is what I’m doing now.”
In addition to opening a yoga business, the 30-year-old is planning her wedding to her fiancé, Scott, later this year. She said to balance everything she has some help with planning the wedding that she is keeping on the small side, and she meditates every morning to center herself for the day and stay positive. For those trying to open a new business while juggling life’s responsibilities, she has advice.
“Take one step at a time and have a set schedule and try your best not to overwhelm yourself,” she said. “I was trying to do two blogs a week. I had to do one a week. It was setting my priorities on where I really needed to spend my time and making that clear.”
Currently, Salay offers private lessons or classes for small groups by appointment only. She said, as her clientele grows, she would like to offer set classes targeted toward certain conditions such as pelvic pain or osteoporosis.
The studio is located at 416 Main St., Setauket. Classes are still available online for those who may not be comfortable practicing in public just yet or may not live nearby. For more information, visit her website: drtarasalay.com.
Save the date! Suffolk County Vanderbilt Museum, 180 Little Neck Road, Centerport hosts a Sunset Yoga Flow event on Friday, May 28 from 7 to 8 p.m. Kick off your weekend with a beautiful view on the Great Lawn overlooking Northport Harbor. All props and mats will be provided upon request. Check in begins at 6:30 p.m. Tickets are $30 adults, $15 children. To register, visit www.vanderbiltmuseum.org.
Sonny Stancarone will be hosting a new piano relaxation program in Port Jefferson. Photo by Julianne Mosher
What do you get when you combine meditation, mindfulness, yoga and pianos? A new piano relaxation center in Upper Port.
Vic “Sonny” Stancarone, owner of Sonny’s Pianos at 1500 Main St., decided to open another spot right across from his store, that will be beneficial to the community — especially after a stressful 2020.
On Friday, April 30, a dozen people gathered at his new Piano Relaxation Center, now located at 6 North Country Road. The idea behind it, he said, was to give people a new space to learn piano in a stress-free way.
He said that this has been something he’s wanted to do “forever.”
“I love buying and selling pianos,” he said. “But I love working with people and now I circle back to doing what I’ve always wanted.”
Photo by Julianne Mosher
At his other shop, Stancarone buys and sells refurbished pianos. From Steinways to Young Changs, he cleans them up, tunes them and helps them find new homes. He is also known for his art case collection — often vintage pianos with decorative artwork painted throughout the instrument.
But on top of selling pianos at wholesale prices, he had an extensive career in health, fitness and wellness — while also being a piano performer.
Stancarone is a former health and fitness director for big-name corporations, adjunct professor and yoga practitioner. He said learning breathing exercises, relaxation and meditation techniques, yoga and marital arts helped cure him of crippling childhood asthma at 11 years old. That experience always stuck with him and, with whatever career path he followed, he always tried to help others the way he was helped, before.
His piano playing and teaching methods are based on breathing with the diaphragm, relaxing with emphasis on enjoying the playing rather than playing perfectly. He calls his method “piano yoga.”
“I feel that piano playing is wonderful, creative, therapeutic, life-enhancing, stress-reducing vehicle that everyone can enjoy,” he said. “The biggest problem with the piano is that people are intimidated by it, they think, ‘Oh, I don’t have talent,’ or ‘I can’t play it,’ but it has nothing to do with talent.”
He added that interested people just need to sit down and try. The way to success is approaching the keys like one would for meditation or mindfulness.
“I want them to read, relax and clear their heads of everything,” Stancarone said. “To just kind of connect to what I call the musician with them, so that they could just get into the flow.”
So, the new relaxation center is a new way for people to learn piano, learn how to decompress or just jam out.
“People are looking to get out of the house,” he said. “They’ve all been cooped up. So, something like this is very nonthreatening. It’s very relaxing. It’s very easy and my approach is just now sitting down to play.”
The main thing is just to relax and enjoy the instrument.
Sonny Stancarone instructing two piano players at his new space. Photo by Julianne Mosher
“My mission is to let people see that everyone can do this,” he said. “And show someone that the piano is the most accessible of all instruments — you can just sit down and you’re making music.”
The space will offer classes of 10 people — each receiving their own spot at a piano.
“I teach them breathing techniques, stress management techniques, relaxation techniques,” Stancarone said. “We do a little sitting chair yoga … so, it really incorporates a lot of different things.”
Yoga can improve balance and strength, which are risk factors for falls. METRO photo
Fear of falling can lead to greater risk
By David Dunaief, M.D.
Dr. David Dunaief
Earlier in life, falls usually do not result in significant consequences. However, once we reach middle age, falls become more substantial. Even without icy steps and walkways, falls can be a serious concern for older patients, where consequences can be devastating. They can include brain injuries, hip fractures, a decrease in functional ability and a decline in physical and social activities (1). Ultimately, a fall can lead to loss of independence (2).
Contributors to fall risk
Many factors contribute to fall risk. A personal history of falling in the recent past is the most prevalent. But there are many other significant factors, such as age and medication use. Some medications, like antihypertensive medications used to treat high blood pressure and psychotropic medications used to treat anxiety, depression and insomnia, are of particular concern. Chronic diseases can also contribute.
Circumstances that predispose us to falls also involve weakness in upper and lower body strength, decreased vision, hearing disorders and psychological issues, such as anxiety and depression (3).
Simple fall prevention tips
Of the utmost importance is exercise. But what do we mean by “exercise”? Exercises involving balance, strength, movement, flexibility and endurance all play significant roles in fall prevention (4).
Many of us in the Northeast are also low in vitamin D, which may strengthen muscle and bone. This is an easy fix with supplementation. Footwear also needs to be addressed. Nonslip shoes are crucial indoors, and outside in winter, footwear that prevents sliding on ice is a must. Inexpensive changes in the home, like securing area rugs, can also make a big difference.
Medication side-effects
There are a number of medications that may heighten fall risk. As I mentioned, psychotropic drugs top the list. But what other drugs might have an impact?
High blood pressure medications have been investigated. A propensity-matched sample study (a notch below a randomized control trial in terms of quality) showed an increase in fall risk in those who were taking high blood pressure medication (5). Those on moderate doses of blood pressure medication had the greatest risk of serious injuries from falls, a 40 percent increase.
While blood pressure medications may contribute to fall risk, they have significant benefits in reducing the risks of cardiovascular disease and events. Thus, we need to weigh the risk-benefit ratio in older patients before considering stopping a medication. When it comes to treating high blood pressure, lifestyle modifications may also play a significant role in treating this disease (6).
How exercise helps
All exercise has value. A meta-analysis of a group of 17 trials showed that exercise significantly reduced the risk of a fall (7). If the categories are broken down, exercise led to a 37 percent reduction in falls that resulted in injury and a 30 percent reduction in those falls requiring medical attention. Even more impressive was a 61 percent reduction in fracture risk.
Remember, the lower the fracture risk, the more likely you are to remain physically independent. Thus, the author summarized that exercise not only helps to prevent falls but also fall injuries.
Unfortunately, those who have fallen before, even without injury, often develop a fear that causes them to limit their activities. This leads to a dangerous cycle of reduced balance and increased gait disorders, ultimately resulting in an increased risk of falling (8).
What types of exercise?
Tai chi, yoga and aquatic exercise have been shown to have benefits in preventing falls and injuries from falls.
A randomized controlled trial showed that those who did an aquatic exercise program had a significant improvement in the risk of falls (9). The aim of the aquatic exercise was to improve balance, strength and mobility. Results showed a reduction in the number of falls from a mean of 2.00 to a fraction of this level — a mean of 0.29. There was also a 44 percent decline in the number of exercising patients who fell during the six-month trial, with no change in the control group.
If you don’t have a pool available, Tai Chi, which requires no equipment, was also shown to reduce both fall risk and fear of falling in older adults in a randomized control trial of 60 male and female participants (10).
Another pilot study used modified chair yoga classes with a small assisted living population (11). Participants were those over 65 who had experienced a recent fall and had a resulting fear of falling. While the intention was to assess exercise safety, researchers found that participants had less reliance on assistive devices and three of the 16 participants were able to eliminate their use of mobility assistance devices.
Thus, our best line of defense against fall risk is prevention. Does this mean stopping medications? Not necessarily. But for those 65 and older, or for those who have arthritis and are at least 45 years old, it may mean reviewing your medication list with your doctor. Before considering changing your blood pressure medications, review the risk-to-benefit ratio with your physician.
Dr. David Dunaief is a speaker, author and local lifestyle medicine physician focusing on the integration of medicine, nutrition, fitness and stress management. For further information, visit www.medicalcompassmd.com.
Coco Teodoro, owner of Cocomotion yoga studio in Miller Place, has hosted free online yoga classes during hte pandemic, but is concerned about his business.
Photo by Julianne Moser
They went from selling out classes several times a day, to having one person in a class.
Coco Teodoro, owner of Miller Place and Patchogue-based Cocomotion Yoga + Movement Space, said that the virus has hit his industry just as hard as others.
“Our business, just like rock concerts, musicals, they’re in the business of bringing people together,” he said. “And that’s the one thing we can’t do. So, our entire business model is toast because if you’re good at bringing people together, then what are you good at after that?”
Teodoro said that because of the pandemic, he has lost 90% of his business — just one of many things that hit him hard in 2020.
“I kept telling everybody that this is the year of loss for me,” he said. “I lost my mom just a few months ago, then lost my job [at an advertising firm in Manhattan] of 17 years, and then I could end up losing my business.”
But Teodoro tries not to be negative. There’s hope and he sees a silver lining, despite the hardships he and his colleagues are facing because of the coronavirus.
“I always felt that as long as I can teach, I can always make it in this world,” he said.
Teodoro, a certified instructor, has been practicing yoga for more than 20 years. He opened his first location in Miller Place five years ago and added a second space on the South Shore in 2017.
In March 2020, he was all ready to open up his third location on top of that in East Setauket. He took over the second floor of the Country Corner Bar on Route 25A and then the virus hit.
The front of Cocomotion in Miller Place. Photo by Julianne Mosher
While they are still renting out the other two locations, they haven’t been able to use their Patchogue and new Setauket spaces yet.
Teodoro said they are focusing on maintaining their flagship spot in Miller Place because it’s the largest out of the three. They just recently opened up to in-person classes, where they marked spots on the floor six-feet apart. A class that once held nearly three-dozen people can now only hold eight.
“We feel like this is the safest place to practice,” he said.
And it’s been hard, he said. Early on in the pandemic, Teodoro had more than 20 instructors on his payroll, now he has just two — who are doing their classes for free. Since March, he and partner Jane Irvine were putting out over 500 yoga classes online for no charge.
“We’re actually going out of business and working at the same time,” he said. “We’re literally staying here so we can hold on to the community that we built.”
And that community has become their family.
“We know every single person,” Irvine said. “We know what’s going on in their lives. We know their children, we know what’s happening. So, we’re here, and we say that we love this family. This is our family.”
Irvine said the community has been as supportive as they could be during this difficult time, and while the business is struggling, the teachers at Cocomotion just want to make others feel better because they know of the impacts stress can cause someone.
“Pre-COVID, people would have multiple memberships,” Teodoro said. “They’d have a membership at the local gym, then they’d have a membership at the yoga studio, and then they might have a psychiatrist, as well.”
That’s how this studio is different than the rest, adding, “We decided to squeeze all three of those in.”
Irvine said that now more than ever, people need a ritual.
“People need something to devote their time to, otherwise the mind is just going to go crazy,” she said. “It gives you a focus, a point in your day to do something to take care of yourself.”
Cocomotion’s free classes are still available on their social media platforms, including Facebook and Instagram, but he’s encouraging people to take advantage of the sacred space he worked half a decade on in Miller Place.
“Everything that we’ve built is our dream,” he said. “So yes, we’re going to struggle — everybody’s struggling at this moment in time. But ultimately, we still get to wake up and have this community that we love and do what we love to do.”
In 2014, Andrea Petterson was in a dark place. The Sound Beach resident had recently left her job as a landscape manager at Stony Brook University, just months after she accused her supervisor of sexual harassment and discrimination. At the time, she was in the beginning stages of filing a lawsuit against the school.
“I was at my lowest,” Petterson said, looking back. “That job was my life, my identity and everything I was. Suddenly, I felt very unsafe.”
Andrea Petterson with one of the ornaments she made and sold. Photo from Christne Cirolli
That was, she said, until she found herself inside Gentle Strength Yoga studio, after a friend suggested she try and heal herself there. Owned and operated by John T. Mather Memorial Hospital nurse Christine Cirolli, the yoga studio opened in Mount Sinai in 2013, and moved permanently to Route 25A in Rocky Point in 2016.
Aside from offering regular classes, acupunctures and massages, the studio was designed to be a community-oriented refuge where “people can band together to help each other,” according to Cirolli.
“The second I stepped in, it just felt like home,” said Petterson, who was a student for two years before graduating from Long Island Yoga School in Great Neck and eventually becoming an instructor at the studio. “Christine really gave me an opportunity here to learn more about myself. She was the one that told me that ‘helping heals’ and that has stuck with me.”
This past Christmas, Petterson raised close to $3,400 by making and selling holiday ornaments in the studio, and then donated the funds to several families in need. She routinely teaches classes at Joseph A. Edgar Immediate School in Rocky Point and within Shoreham-Wading River school district.
She also said the studio has motivated her to start an organization that helps to empower young women.
Melissa McMullan, a longtime regular at the studio and a teacher in the Comsewogue School District, said the holiday fundraiser at the studio helped provide a happy holiday for one of her students, whose family lives in poverty. She referred to the studio as “a special place.”
“Christine really gave me an opportunity here to learn more about myself.”
— Andrea Petterson
“It’s the kind of place where people can come in and talk about what’s going on physically or mentally and everybody sort of works together to help each other,” she said. “At the studio, we learn that yoga is really the beginning of a lifelong practice of being connected with, and kind to members of our community.”
Cirolli, a Queens native and Suffolk Community College graduate, said she has been practicing yoga on and off since she was in high school, and always aimed for her studio to be inclusive for everybody.
“I feel blessed that people would trust me, that they are here in a place of caring and love,” Cirolli said.
She added that Gentle Strength hosts a free 12-step recovery yoga program for those affected by alcohol addiction.
“It’s just providing people with another tool to help in their recovery,” she said of the program. “It doesn’t require anyone to sign up or register, either, so if they wanted to come here and be completely anonymous, they can. I thought that was a really nice way to try and welcome people in here who might otherwise be steered away.”
How do we protect one of our most valued assets, our infrastructure? Not roads and bridges, but our bones. When we think of bone fractures as a child or young adult, we think of short-term pain and inconvenience, but usually we recover without long-term consequences.
However, as we get older, fractures can be a lot more significant, with potentially life-altering or life-ending consequences. Osteoporosis is a silent disease that affects millions of patients, most commonly, but by no means exclusively, postmenopausal women. The trend is for low bone mass and osteoporosis diagnoses to increase by 29 percent from 2010 to 2030.
Osteoporosis is where there is bone loss, weakening of the bones and small deleterious changes in the architecture of the bone over time that may result in fractures with serious consequences (1).
One way to measure osteoporosis is with a dual-energy X-ray absorptiometry (DXA) scan for bone mineral density. Osteopenia is a slightly milder form that may be a precursor to osteoporosis. However, we should not rely on the DXA scan alone; risk factors are important, such as a family or personal history of fractures as we age. The Fracture Risk Assessment Tool (FRAX) is more thorough for determining the 10-year fracture risk. Those who have a risk of fracture that is 3 percent or more should consider treatment with medications. A link to the FRAX tool can be found at www.shef.ac.uk/FRAX.
Most of us have been told since we were young that we need more calcium to make sure we have strong bones. In fact, the National Osteoporosis Foundation recommends that we get 1,000 to 1,200 mg per day of calcium if we are over 50 years old (2). Recommendations vary by sex and age. This would be mostly from diet but also from supplements. However, the latest research suggests that calcium for osteoporosis prevention may not be as helpful as we thought.
The under/overmedication treatment paradox
Depending on the population, we could be overtreating or undertreating osteoporosis. In the elderly population that has been diagnosed with osteoporosis, there is undertreatment. One study showed that only 28 percent of patients who are candidates for osteoporosis drugs are taking the medication within the first year of diagnosis (3). The reason most were reluctant was that they had experienced a recent gastrointestinal event and did not want to induce another with osteoporosis medications, such as bisphosphonates. The data were taken from Medicare records of patients who were at least 66 years old.
On the other hand, as many as 66 percent of the women receiving osteoporosis medications may not have needed it, according to a retrospective study (4). This is the overtreatment population, with half these patients younger, between the ages of 40 and 64, and without any risk factors to indicate the need for a DXA scan. This younger population included many who had osteopenia, not osteoporosis.
Also, the DXA scan may have shown osteoporosis at what the researchers described as nonmain sites in one-third of patients diagnosed with the disease. Main sites, according to the International Society for Clinical Densitometry recommendations, would be the anterior-posterior spine, hip and femoral neck. A nonmain site in this review was the lateral lumbar spine. Before you get a DXA scan, make sure you have sufficient risk factors, such as family or personal history of fracture, age and smoking history. When the DXA scan is done, make sure it is interpreted at the main sites. If you are not sure, have another physician consult on the results.
We all need calcium to prevent osteoporosis, right?
Calcium has always been the forefront of prevention and treatment of osteoporosis. However, two studies would have us question this approach. Results of one meta-analysis of a group of 59 randomized controlled trials showed that dietary calcium and calcium supplements with or without vitamin D did increase the bone density significantly in most places in the body, including the femoral neck, spine and hip (5). Yet the changes were so small that they would not have much clinical benefit in terms of fracture prevention.
Another meta-analysis of a group of 44 observational dietary trials and 26 randomized controlled trials did not show a benefit with dietary or supplemental calcium with or without vitamin D (6). There was a slight reduction in nonsignificant vertebral fractures, but not in other places, such as the hip and forearm. Dietary calcium and supplements disappointed in these two trials.
Does this mean calcium is not useful? Not so fast!
In some individual studies that were part of the meta-analyses, the researchers mentioned that dairy, specifically milk, was the dietary source on record, and we know milk is not necessarily good for bones. But in many of the studies, the researcher did not differentiate between the sources of dietary calcium. This is a very important nuance. Calcium from animal products may increase inflammation and the acidity of the body and may actually leach calcium from the bone, while calcium from vegetable-rich, nutrient-dense sources may be better absorbed, providing more of an alkaline and anti-inflammatory approach. This would be a good follow-up study, comparing the effects of calcium from animal and plant-based dietary sources.
What can be done to improve the situation?
Studies have shown that yoga can help prevent osteoporosis by improving mobility, posture and strength.
Yoga used to be on the fringe of society. Now, it has become more prevalent and part of mainstream exercise. This is a good trend since this type of exercise may have a big impact on prevention and treatment of osteoporosis. In a small pilot study, the results showed that those who practiced yoga had an increase in their spine and hip bone density compared to those who did not (7). There were 18 participants in this trial.
The researchers were encouraged by these results, so they increased the number of participants in another study. The results showed that 12 minutes of yoga daily or every other day significantly increased the bone density from the start of the study in both the spine and femur, the thigh bone (8). There was also an increase in hip bone density, but this was not significant. The strength of the study includes its 10-year duration. However, one weakness was that this trial did not include a control group.
Another was that 741 participants started the trial, but only 227 finished, less than one-third. Of those, 202 were women. Significantly, prior to the study there were 109 fractures in the participants, most of whom had osteoporosis or osteopenia, but none had yoga-related fractures by the end of the trial. The “side effects” of yoga include improved mobility, posture, strength and a reduction in anxiety. The researchers gave a nice road map of specific beneficial poses. Before starting a program, consult your doctor.
The moral of the story is that exercise is beneficial. Yoga may be another simple addition to this exercise regimen. Calcium may be good or bad, depending on its dietary source. Be cautious with supplemental calcium; it does have side effects, including kidney stones, cardiovascular events and gastrointestinal symptoms, and consult with your doctor to assess whether you might be in an overtreatment or undertreatment group when it comes to medication.
Dr. Dunaief is a speaker, author and local lifestyle medicine physician focusing on the integration of medicine, nutrition, fitness and stress management. For further information, visit www.medicalcompassmd.com or consult your personal physician.
