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  1. Article: Am I big boned? Bone length scaled reference data for HRpQCT measures of the radial and tibial diaphysis in White adults.

    Warden, Stuart J / Fuchs, Robyn K / Liu, Ziyue / Toloday, Katelynn R / Surowiec, Rachel / Moe, Sharon M

    Bone reports

    2024  Volume 20, Page(s) 101735

    Abstract: Cross-sectional size of a long bone shaft influences its mechanical properties. We recently used high-resolution peripheral quantitative computed tomography (HRpQCT) to create reference data for size measures of the radial and tibial diaphyses. However, ... ...

    Abstract Cross-sectional size of a long bone shaft influences its mechanical properties. We recently used high-resolution peripheral quantitative computed tomography (HRpQCT) to create reference data for size measures of the radial and tibial diaphyses. However, data did not take into account the impact of bone length. Human bone exhibits relatively isometric allometry whereby cross-sectional area increases proportionally with bone length. The consequence is that taller than average individuals will generally have larger z-scores for bone size outcomes when length is not considered. The goal of the current work was to develop a means of determining whether an individual's cross-sectional bone size is suitable for their bone length. HRpQCT scans performed at 30 % of bone length proximal from the distal end of the radius and tibia were acquired from 1034 White females (age = 18.0 to 85.3 y) and 392 White males (age = 18.4 to 83.6 y). Positive relationships were confirmed between bone length and cross-sectional areas and estimated mechanical properties. Scaling factors were calculated and used to scale HRpQCT outcomes to bone length. Centile curves were generated for both raw and bone length scaled HRpQCT data using the LMS approach. Excel-based calculators are provided to facilitate calculation of z-scores for both raw and bone length scaled HRpQCT outcomes. The raw z-scores indicate the magnitude that an individual's HRpQCT outcomes differ relative to expected sex- and age-specific values, with the scaled z-scores also considering bone length. The latter enables it to be determined whether an individual or population of interest has normal sized bones for their length, which may have implications for injury risk. In addition to providing a means of expressing HRpQCT bone size outcomes relative to bone length, the current study also provides centile curves for outcomes previously without reference data, including tissue mineral density and moments of inertia.
    Language English
    Publishing date 2024-01-06
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2821774-3
    ISSN 2352-1872
    ISSN 2352-1872
    DOI 10.1016/j.bonr.2024.101735
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: Characteristics of Interventions to Improve Bone Health in Children With Cerebral Palsy: A Systematic Review.

    Liquori, Brianna M / Gannotti, Mary E / Thorpe, Deborah E / Fuchs, Robyn K

    Pediatric physical therapy : the official publication of the Section on Pediatrics of the American Physical Therapy Association

    2022  Volume 34, Issue 2, Page(s) 163–170

    Abstract: Purpose: A systematic review evaluated exercise parameters and ages that produced the most improvement in bone among individuals with cerebral palsy (CP) ages 3 to 21 years.: Methods: PubMed, Scopus, Ebscohost, and Web of Science identified potential ...

    Abstract Purpose: A systematic review evaluated exercise parameters and ages that produced the most improvement in bone among individuals with cerebral palsy (CP) ages 3 to 21 years.
    Methods: PubMed, Scopus, Ebscohost, and Web of Science identified potential articles. Covidence was used to identify eligible citations and assess bias. The osteogenic index (OI) was used to evaluate intervention parameters.
    Results: The database search identified 312 citations. Twelve full-text articles were included. A 1-hour calisthenic exercise program performed 2 to 3 times a week for 8 months targeting each body region had the highest effect size and a substantial OI. Most of the interventions reviewed had low OIs. Activities of longer duration and greater intensity had greater OIs and prepubertal age-enhanced treatment effects.
    Conclusion: Bone interventions for individuals with CP have low OIs, and principles of mechanostat theory should be applied to exercise dosing.
    MeSH term(s) Adolescent ; Adult ; Bone Density ; Cerebral Palsy/rehabilitation ; Child ; Child, Preschool ; Exercise ; Humans ; Young Adult
    Language English
    Publishing date 2022-04-06
    Publishing country United States
    Document type Journal Article ; Systematic Review ; Research Support, Non-U.S. Gov't
    ZDB-ID 1036679-9
    ISSN 1538-005X ; 0898-5669
    ISSN (online) 1538-005X
    ISSN 0898-5669
    DOI 10.1097/PEP.0000000000000878
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article ; Online: Enhanced Bone Size, Microarchitecture, and Strength in Female Runners with a History of Playing Multidirectional Sports.

    Warden, Stuart J / Sventeckis, Austin M / Surowiec, Rachel K / Fuchs, Robyn K

    Medicine and science in sports and exercise

    2022  Volume 54, Issue 12, Page(s) 2020–2030

    Abstract: Purpose: Female runners have high rates of bone stress injuries (BSIs), including stress reactions and fractures. The current study explored multidirectional sports (MDS) played when younger as a potential means of building stronger bones to reduce BSI ... ...

    Abstract Purpose: Female runners have high rates of bone stress injuries (BSIs), including stress reactions and fractures. The current study explored multidirectional sports (MDS) played when younger as a potential means of building stronger bones to reduce BSI risk in these athletes.
    Methods: Female collegiate-level cross-country runners were recruited into groups: 1) RUN, history of training and/or competing in cross-country, recreational running/jogging, swimming, and/or cycling only, and 2) RUN + MDS, additional history of training and/or competing in soccer or basketball. High-resolution peripheral quantitative computed tomography was used to assess the distal tibia, common BSI sites (diaphysis of the tibia, fibula, and second metatarsal), and high-risk BSI sites (base of the second metatarsal, navicular, and proximal diaphysis of the fifth metatarsal). Scans of the radius were used as control sites.
    Results: At the distal tibia, RUN + MDS ( n = 18) had enhanced cortical area (+17.1%) and thickness (+15.8%), and greater trabecular bone volume fraction (+14.6%) and thickness (+8.3%) compared with RUN ( n = 14; all P < 0.005). Failure load was 19.5% higher in RUN + MDS ( P < 0.001). The fibula diaphysis in RUN + MDS had an 11.6% greater total area and a 11.1% greater failure load (all P ≤ 0.03). At the second metatarsal diaphysis, total area in RUN + MDS was 10.4% larger with greater cortical area and thickness and 18.6% greater failure load (all P < 0.05). RUN + MDS had greater trabecular thickness at the base of the second metatarsal and navicular and greater cortical area and thickness at the proximal diaphysis of the fifth metatarsal (all P ≤ 0.02). No differences were observed at the tibial diaphysis or radius.
    Conclusions: These findings support recommendations that athletes delay specialization in running and play MDS when younger to build a more robust skeleton and potentially prevent BSIs.
    MeSH term(s) Humans ; Female ; Bone Density ; Bone and Bones ; Radius ; Tibia/diagnostic imaging ; Running
    Language English
    Publishing date 2022-08-06
    Publishing country United States
    Document type Journal Article ; Research Support, N.I.H., Extramural
    ZDB-ID 603994-7
    ISSN 1530-0315 ; 0195-9131 ; 0025-7990
    ISSN (online) 1530-0315
    ISSN 0195-9131 ; 0025-7990
    DOI 10.1249/MSS.0000000000003016
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article ; Online: Bone Microarchitecture and Strength Adaptation to Physical Activity: A Within-Subject Controlled HRpQCT Study.

    Warden, Stuart J / Wright, Christian S / Fuchs, Robyn K

    Medicine and science in sports and exercise

    2021  Volume 53, Issue 6, Page(s) 1179–1187

    Abstract: Purpose: Physical activity benefits bone mass and cortical bone size. The current study assessed the impact of chronic (≥10 yr) physical activity on trabecular microarchitectural properties and microfinite element analyses of estimated bone strength.: ...

    Abstract Purpose: Physical activity benefits bone mass and cortical bone size. The current study assessed the impact of chronic (≥10 yr) physical activity on trabecular microarchitectural properties and microfinite element analyses of estimated bone strength.
    Methods: Female collegiate-level tennis players (n = 15; age = 20.3 ± 0.9 yr) were used as a within-subject controlled model of chronic unilateral upper-extremity physical activity. Racquet-to-nonracquet arm differences at the distal radius and radial diaphysis were assessed using high-resolution peripheral quantitative computed tomography. The distal tibia and the tibial diaphysis in both legs were also assessed, and cross-country runners (n = 15; age = 20.8 ± 1.2 yr) included as controls.
    Results: The distal radius of the racquet arm had 11.8% (95% confidence interval [CI] = 7.9% to 15.7%) greater trabecular bone volume/tissue volume, with trabeculae that were greater in number, thickness, connectivity, and proximity to each other than that in the nonracquet arm (all P < 0.01). Combined with enhanced cortical bone properties, the microarchitectural advantages at the distal radius contributed a 18.7% (95% CI = 13.0% to 24.4%) racquet-to-nonracquet arm difference in predicted load before failure. At the radial diaphysis, predicted load to failure was 9.6% (95% CI = 6.7% to 12.6%) greater in the racquet versus nonracquet arm. There were fewer and smaller side-to-side differences at the distal tibia; however, the tibial diaphysis in the leg opposite the racquet arm was larger with a thicker cortex and had 4.4% (95% CI = 1.7% to 7.1%) greater strength than the contralateral leg.
    Conclusion: Chronically elevated physical activity enhances trabecular microarchitecture and microfinite element estimated strength, furthering observations from short-term longitudinal studies. The data also demonstrate that tennis players exhibit crossed symmetry wherein the leg opposite the racquet arm possesses enhanced tibial properties compared with in the contralateral leg.
    MeSH term(s) Absorptiometry, Photon ; Adaptation, Physiological ; Bone Density ; Cortical Bone/anatomy & histology ; Cortical Bone/physiology ; Cross-Sectional Studies ; Diaphyses/anatomy & histology ; Diaphyses/diagnostic imaging ; Diaphyses/physiology ; Female ; Humans ; Radius/anatomy & histology ; Radius/diagnostic imaging ; Radius/physiology ; Running/physiology ; Tennis/physiology ; Tibia/anatomy & histology ; Tibia/diagnostic imaging ; Tibia/physiology ; Tomography, X-Ray Computed ; Young Adult
    Language English
    Publishing date 2021-01-03
    Publishing country United States
    Document type Journal Article ; Research Support, N.I.H., Extramural
    ZDB-ID 603994-7
    ISSN 1530-0315 ; 0195-9131 ; 0025-7990
    ISSN (online) 1530-0315
    ISSN 0195-9131 ; 0025-7990
    DOI 10.1249/MSS.0000000000002571
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  5. Article ; Online: Designing Exercise to Improve Bone Health Among Individuals With Cerebral Palsy.

    Gannotti, Mary E / Liquori, Brianna M / Thorpe, Deborah E / Fuchs, Robyn K

    Pediatric physical therapy : the official publication of the Section on Pediatrics of the American Physical Therapy Association

    2020  Volume 33, Issue 1, Page(s) 50–56

    Abstract: Purpose: Individuals with cerebral palsy (CP), ambulatory or not, have less bone strength and density than their peers. Aging individuals with CP are at a higher risk for nontraumatic fractures, progressive deformity, pain, and spinal stenosis. Critical ...

    Abstract Purpose: Individuals with cerebral palsy (CP), ambulatory or not, have less bone strength and density than their peers. Aging individuals with CP are at a higher risk for nontraumatic fractures, progressive deformity, pain, and spinal stenosis. Critical periods for skeletal formation are during prepuberty and adolescence. Applying mechanostat theory to exercise design for individuals with CP may be beneficial.
    Methods: Principles of mechanostat theory, particularly the osteogenic index, is applied to guide the design of exercise programs based on varying levels of physical capacity.
    Results: Recommendations are made for optimizing dosing of a variety of interventions for improving bone health among individuals with CP based on mechanostat theory with specific type, number of repetitions, and frequency.
    Conclusions: Researchers and clinicians are called to action to consider the role of exercise throughout the lifespan for all individuals with CP, regardless of level of severity.
    MeSH term(s) Adolescent ; Adult ; Aging ; Bone Density/physiology ; Cerebral Palsy/rehabilitation ; Exercise Therapy/methods ; Humans ; Male
    Language English
    Publishing date 2020-12-03
    Publishing country United States
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 1036679-9
    ISSN 1538-005X ; 0898-5669
    ISSN (online) 1538-005X
    ISSN 0898-5669
    DOI 10.1097/PEP.0000000000000765
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  6. Article ; Online: Do Selective Serotonin Reuptake Inhibitors (SSRIs) Cause Fractures?

    Warden, Stuart J / Fuchs, Robyn K

    Current osteoporosis reports

    2016  Volume 14, Issue 5, Page(s) 211–218

    Abstract: Recent meta-analyses report a 70 % increase in fracture risk in selective serotonin reuptake inhibitor (SSRI) users compared to non-users; however, included studies were observational and limited in their ability to establish causality. Here, we use the ... ...

    Abstract Recent meta-analyses report a 70 % increase in fracture risk in selective serotonin reuptake inhibitor (SSRI) users compared to non-users; however, included studies were observational and limited in their ability to establish causality. Here, we use the Bradford Hill criteria to explore causality between SSRIs and fractures. We found a strong, consistent, and temporal relationship between SSRIs and fractures, which appears to follow a biological gradient. However, specificity and biological plausibility remain concerns. In terms of specificity, the majority of available data have limitations due to either confounding by indication or channeling bias. Self-controlled case series address some of these limitations and provide relatively strong observational evidence for a causal relationship between SSRIs and fracture. In doing so, they suggest that falls contribute to fractures in SSRI users. Whether there are also underlying changes in skeletal properties remains unresolved. Initial studies provide some evidence for skeletal effects of SSRIs; however, the pathways involved need to be established before biological plausibility can be accepted. As the link between SSRIs and fractures is based on observational data and not evidence from prospective trials, there is insufficient evidence to definitively determine a causal relationship and it appears premature to label SSRIs as a secondary cause of osteoporosis. SSRIs appear to contribute to fracture-inducing falls, and addressing any fall risk associated with SSRIs may be an efficient approach to reducing SSRI-related fractures. As fractures stemming from SSRI-induced falls are more likely in individuals with compromised bone health, it is worth considering bone density testing and intervention for those presenting with risk factors for osteoporosis.
    Language English
    Publishing date 2016-10
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 2186581-4
    ISSN 1544-2241 ; 1544-1873
    ISSN (online) 1544-2241
    ISSN 1544-1873
    DOI 10.1007/s11914-016-0322-3
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  7. Article ; Online: Physical activity induced adaptation can increase proximal femur strength under loading from a fall onto the greater trochanter.

    Fuchs, Robyn K / Carballido-Gamio, Julio / Keyak, Joyce H / Kersh, Mariana E / Warden, Stuart J

    Bone

    2021  Volume 152, Page(s) 116090

    Abstract: Physical activity enhances proximal femur bone mass, but it remains unclear whether the benefits translate into an enhanced ability to resist fracture related loading. We recently used baseball pitchers as a within-subject controlled model to demonstrate ...

    Abstract Physical activity enhances proximal femur bone mass, but it remains unclear whether the benefits translate into an enhanced ability to resist fracture related loading. We recently used baseball pitchers as a within-subject controlled model to demonstrate physical activity induced proximal femur adaptation in regions associated with weight bearing and increased strength under single-leg stance loading. However, there was no measurable benefit to resisting common injurious loading (e.g. a fall onto the greater trochanter). A lack of power and a small physical activity effect size may have contributed to the latter null finding. Softball pitchers represent an alternative within-subject controlled model to explore adaptation of the proximal femur to physical activity, exhibiting greater dominant-to-nondominant (D-to-ND) leg differences than baseball pitchers. The current study used quantitative computed tomography, statistical parametric mapping, and subject-specific finite element (FE) modeling to explore adaptation of the proximal femur to physical activity in female softball pitchers (n = 25). Female cross-country runners (n = 15) were included as symmetrically loaded controls, showing very limited D-to-ND leg differences. Softball pitchers had D-to-ND leg differences in proximal femur, femoral neck, and trochanteric volumetric bone mineral density and content, and femoral neck volume. Voxel-based morphometry analyses and cortical bone mapping showed D-to-ND leg differences within a large region connecting the superior femoral head, inferior femoral neck and medial intertrochanteric region, and within the greater trochanter. FE modeling revealed pitchers had 19.4% (95%CI, 15.0 to 23.9%) and 4.9% (95%CI, 1.7 to 8.2%) D-to-ND leg differences in predicted ultimate strength under single-leg stance loading and a fall onto the greater trochanter, respectively. These data affirm the spatial and strength adaptation of the proximal femur to weight bearing directed loading and demonstrate that the changes can also have benefits, albeit smaller, on resisting loads associated with a sideways fall onto the greater trochanter.
    MeSH term(s) Accidental Falls ; Bone Density ; Exercise ; Female ; Femur/diagnostic imaging ; Femur Neck/diagnostic imaging ; Finite Element Analysis ; Humans
    Language English
    Publishing date 2021-06-25
    Publishing country United States
    Document type Journal Article ; Research Support, N.I.H., Extramural
    ZDB-ID 632515-4
    ISSN 1873-2763 ; 8756-3282
    ISSN (online) 1873-2763
    ISSN 8756-3282
    DOI 10.1016/j.bone.2021.116090
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  8. Article ; Online: Physical Therapist Management of Patients With Suspected or Confirmed Osteoporosis: A Clinical Practice Guideline From the Academy of Geriatric Physical Therapy.

    Hartley, Gregory W / Roach, Kathryn E / Nithman, Robert W / Betz, Sherri R / Lindsey, Carleen / Fuchs, Robyn K / Avin, Keith G

    Journal of geriatric physical therapy (2001)

    2022  Volume 44, Issue 2, Page(s) 80

    Abstract: A clinical practice guideline on physical therapist management of patients with suspected or confirmed osteoporosis was developed by a volunteer guideline development group (GDG) that was appointed by the Academy of Geriatric Physical Therapy (APTA ... ...

    Abstract A clinical practice guideline on physical therapist management of patients with suspected or confirmed osteoporosis was developed by a volunteer guideline development group (GDG) that was appointed by the Academy of Geriatric Physical Therapy (APTA Geriatrics). The GDG consisted of an exercise physiologist and 6 physical therapists with clinical and methodological expertise. The guideline was based on a systematic review of existing clinical practice guidelines, followed by application of the ADAPTE methodological process described by Guidelines International Network for adapting guidelines for cultural and professional utility. The recommendations contained in this guideline are derived from the 2021 Scottish Intercollegiate Guideline Network (SIGN) document: Management of Osteoporosis and the Prevention of Fragility Fractures. These guidelines are intended to assist physical therapists practicing in the United States, and implementation in the context of the US health care system is discussed.
    MeSH term(s) Aged ; Exercise ; Humans ; Osteoporosis ; Physical Therapists ; Physical Therapy Modalities
    Language English
    Publishing date 2022-04-03
    Publishing country United States
    Document type Journal Article ; Systematic Review
    ZDB-ID 2250801-6
    ISSN 2152-0895 ; 1539-8412
    ISSN (online) 2152-0895
    ISSN 1539-8412
    DOI 10.1519/JPT.0000000000000357
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  9. Article ; Online: Physical Therapist Management of Patients With Suspected or Confirmed Osteoporosis: A Clinical Practice Guideline From the Academy of Geriatric Physical Therapy.

    Hartley, Gregory W / Roach, Kathryn E / Nithman, Robert W / Betz, Sherri R / Lindsey, Carleen / Fuchs, Robyn K / Avin, Keith G

    Journal of geriatric physical therapy (2001)

    2022  Volume 44, Issue 2, Page(s) E106–E119

    Abstract: A clinical practice guideline on physical therapist management of patients with suspected or confirmed osteoporosis was developed by a volunteer guideline development group (GDG) that was appointed by the Academy of Geriatric Physical Therapy (APTA ... ...

    Abstract A clinical practice guideline on physical therapist management of patients with suspected or confirmed osteoporosis was developed by a volunteer guideline development group (GDG) that was appointed by the Academy of Geriatric Physical Therapy (APTA Geriatrics). The GDG consisted of an exercise physiologist and 6 physical therapists with clinical and methodological expertise. The guideline was based on a systematic review of existing clinical practice guidelines, followed by application of the ADAPTE methodological process described by Guidelines International Network for adapting guidelines for cultural and professional utility. The recommendations contained in this guideline are derived from the 2021 Scottish Intercollegiate Guideline Network (SIGN) document: Management of Osteoporosis and the Prevention of Fragility Fractures. These guidelines are intended to assist physical therapists practicing in the United States, and implementation in the context of the US health care system is discussed.
    MeSH term(s) Aged ; Exercise ; Humans ; Osteoporosis ; Physical Therapists ; Physical Therapy Modalities
    Language English
    Publishing date 2022-04-03
    Publishing country United States
    Document type Journal Article ; Systematic Review ; Research Support, Non-U.S. Gov't
    ZDB-ID 2250801-6
    ISSN 2152-0895 ; 1539-8412
    ISSN (online) 2152-0895
    ISSN 1539-8412
    DOI 10.1519/JPT.0000000000000346
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  10. Article ; Online: Baseball and Softball Pitchers are Distinct Within-Subject Controlled Models for Exploring Proximal Femur Adaptation to Physical Activity.

    Fuchs, Robyn K / Thompson, William R / Weatherholt, Alyssa M / Warden, Stuart J

    Calcified tissue international

    2019  Volume 104, Issue 4, Page(s) 373–381

    Abstract: Within-subject controlled models in individuals who preferentially load one side of the body enable efficient exploration of the skeletal benefits of physical activity. There is no established model of physical activity-induced side-to-side differences ( ... ...

    Abstract Within-subject controlled models in individuals who preferentially load one side of the body enable efficient exploration of the skeletal benefits of physical activity. There is no established model of physical activity-induced side-to-side differences (i.e., asymmetry) at the proximal femur. Proximal femur asymmetry was assessed via dual-energy X-ray absorptiometry in male jumping athletes (JMP, n = 16), male baseball pitchers (BB, n = 21), female fast-pitch softball pitchers (SB, n = 22), and controls (CON, n = 42). The jumping leg was the dominant leg in JMP, whereas in BB, SB and CON the dominant leg was contralateral to the dominant/throwing arm. BB and SB had 5.5% (95% CI 3.9-7.0%) and 6.5% (95% CI 4.8-8.2%) dominant-to-nondominant leg differences for total hip areal bone mineral density (aBMD), with the asymmetry being greater than both CON and JMP (p < 0.05). BB and SB also possessed dominant-to-nondominant leg differences in femoral neck and trochanteric aBMD (p < 0.001). SB had 9.7% (95% CI 6.4-13.0%) dominant-to-nondominant leg differences in femoral neck bone mineral content, which was larger than any other group (p ≤ 0.006). At the narrow neck, SB had large (> 8%) dominant-to-nondominant leg differences in cross-sectional area, cross-sectional moment of inertia and section modulus, which were larger than any other group (p ≤ 0.02). Male baseball and female softball pitchers are distinct within-subject controlled models for exploring adaptation of the proximal femur to physical activity. They exhibit adaptation in their dominant/landing leg (i.e., leg contralateral to the throwing arm), but the pattern differs with softball pitchers exhibiting greater femoral neck adaptation.
    MeSH term(s) Absorptiometry, Photon/methods ; Adaptation, Physiological/physiology ; Adult ; Athletes ; Baseball ; Bone Density/physiology ; Exercise/physiology ; Female ; Femur/physiology ; Femur Neck/physiology ; Humans ; Male
    Language English
    Publishing date 2019-01-21
    Publishing country United States
    Document type Journal Article ; Research Support, N.I.H., Extramural
    ZDB-ID 304266-2
    ISSN 1432-0827 ; 0944-0747 ; 0008-0594 ; 0171-967X
    ISSN (online) 1432-0827
    ISSN 0944-0747 ; 0008-0594 ; 0171-967X
    DOI 10.1007/s00223-019-00519-y
    Database MEDical Literature Analysis and Retrieval System OnLINE

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