Why Flamingoes Don't Get Osteoperosis

There is a surprising new therapy to increase bone density that may decrease the odds of fracturing a femur or hip as one gets older. Recall the movie, Karate Kid, and download from your memory the image of the kid, balancing on one foot on a log at the beach, seagulls flying overhead. Now imagine an older person in a nursing home, slowly moving about with the aid of a walker doing an imitation of the Karate Kid. What you've got is Dynamic Flamingo Therapy, the invention of researcher, Keizo Sakamoto from Tokyo, and likely the least expensive and least intrusive intervention ever described in the medical literature for preventing hip fractures.

In October 2006, writing in the Journal of Orthopedic Science, Sakamoto described the effect of what he called “unipedal standing” on the frequency of falls and hip fractures in an elderly population. His unipedal standing balance exercise was simple. Stand on one leg for a minute (alternating legs) with your eyes open three times a day. If you need to, hang onto something so you don’t tip over.

Bone density and bone strength is improved by mild stress to the bone, that’s why we make all the fuss about weight bearing exercise. By Sakamoto’s calculations, standing on one foot for a minute would have an effect on bone density equivalent to walking 53 minutes.

Repeating his exercise three times a day would be equivalent to taking three almost hour long walks a day. For older people who are not that mobile, unipedal standing is an interesting option. It improves balance enough that it decreases spontaneous falls by about a third. It also puts mild strain on the bone, strengthening it and decreasing the chance of fracture if the person does fall.

In his first experiment, Sakamoto recruited subjects, averaging 82 years old, and randomized them, some to serve as controls and some to “exercise.” Falls and hip fractures for a sixmonth period were counted. Data was collected for 315 unipedal standers and 212 control subjects that presumably rarely stood on one foot.

The 315 subjects in the exercise group recorded 118 falls in the six-month test period. The 212 control subjects recorded 121 falls. There was one hip fracture in each group. The difference in number of falls was statistically significant, but the number of fractures weren’t enough to generate accurate statistics.

A more recent paper was published by Sakamoto in the November 2008 issue of Clinical Calcium that lends greater weight to unipedal standing; only the treatment has been renamed. No longer is standing on one foot called unipedal standing, now it is “Dynamic Flamingo Therapy.”

In this paper, Sakamoto describes a group of women doing his exercise for a period of ten years. Starting in 1993, he recruited 86 women to do his flamingo exercise, the same standing on one foot at a time for a minute three times a day. The women were tested regularly to evaluate bone density. At the start of the program, the average age was just under 68. Sakamoto summarized the results as the percentage of participants showing increased bone mineral density (BMD) compared to their levels when they enrolled in the study.

After three months 63 percent of the study participants had increased bone density. This isn’t as exciting as it sounds, as there is a seasonal variation in bone density, increasing over the summer months as production of vitamin D increases with greater sun exposure. But after six months 41 percent still had denser bones than when they started; after one year the number increased to 58 percent. This is exciting. There was a drop at the three year mark, down to 32 percent. This increased after five years back to 54 percent. After 10 years of performing this exercise, 33 percent of the women still had increased bone density compared to their initial scan.

There was no control group but increasing bone density as a woman ages from 68 to 78 is clearly unexpected. None of the women who continued the exercises fractured a hip during the ten year period. This also stands out.

For people too frail for rigorous workouts or even walking to build bone density, this therapy offers an alternative ‘exercise.’ Even for those of us who do exercise routinely, a few minutes on one foot may still provide added advantage.