Prevention and Impacts of Osteoporosis in Ageing Population

This paper discusses the definition, causes, impacts, and prevention measures of osteoporosis in ageing population. It also includes a research study on early prevention measures. The importance of physical exercises and population-intervention strategies are discussed. The subject is related to ageing and health. The course code, course name, and college/university are not mentioned.

Ageing 1
AGEING
By (Name of student)
The Name of Class (Course)
Professor (Tutor)
The Name of the School (University)
The City and State
The Date

Ageing 2
Executive Summary
This paper first begins with the definition of osteoporosis which is low bone strength condition
causing high risks of broken legs or fracture before looking into more fact on osteoporosis such
as how common it is, its causes and who is most affected by osteoporosis? As well as its impacts.
Osteoporosis has had its fair share of terrorizing the aged, but some prevention measures have
been discovered to control the condition. Preventive measures such as population-intervention
strategies on the importance of physical exercises among others are discussed in this paper
before getting into one research done on the prevention of osteoporosis. The research is from the
National Bone Health Campaign, and it studies proper ways of preventing osteoporosis by
educating the public on early prevention measures such as alerting the young population.

Ageing 3
Introduction
Defining Osteoporosis
Osteoporosis is an illness characterized by low bone strength causing high risks of broken legs or
fracture. Bone strength consists of two elements: bone quality and amount of bone (bone mass).
Osteoporosis is the main underlying factor leading to fractures in women at postmenopausal and
the aged. Fracture more often happen in hip bones, wrist and spine although any bone could be
affected. Fractures especially occurring in the hip bone may disable permanently.1 Hence, there
is the need for studying and looking for preventive measures to the condition that affects the
ageing.
Body
How common it is
After 35 years of age, the difference in the bone mass which is removed and the laid down bone
mass begins to get imbalanced due to the process of aging slightly. Hence, there is a beginning in
the reduction of the overall quantity of bone mass. This condition is widely known as ‘bone
thinning' ‘bone loss.' However, this doesn't mean that the bones would look different from the
outside, but the inside has the cortical thins and as well as the struts that make up the bone's inner
structure reduce in its thickness or sometimes breaking down. Therefore, there is a result being
holes identical to honeycomb structures. The structure becomes larger thus leading to
osteoporosis that means porous bones. The quality change in bones is significantly likely to
increase its rate as one grows older thereby explaining the reason for bones increasing their
fragility and a higher percentage of fractures.

Ageing 4
Causes
The leading cause in bone loss in women in their later lives is the decrease in produced estrogen
once one hits menopause. Estrogen is the sex hormone that has an essential role in maintaining
and building bones. A reduction in estrogen could lead to loss of bones and ultimate
osteoporosis. Past menopause, the bone loss rate increases since the produced amount of
estrogen by the ovaries of women falls dramatically. There is a rapid loss of bone in the
beginning years past menopause but continues to the postmenopausal year.2
In men, the level of sex hormones reduces at the middle age, and the reduction is usually gradual.
Also, the reduction in hormone levels leads to the bone loss in men past years.
Osteoporosis could come from the bone loss that could arise with a variety of eating disorders,
disease conditions, specific medical and medication treatments. For example, osteoporosis could
come from prolonged use of ant seizure medications as well as glucocorticoid medications.
Numerous individuals think that osteoporosis comes naturally and cannot be avoided since it is
part of aging. On the other hand, the medical professionals believe in the prevention of
osteoporosis. Additionally, people who have already succumbed to osteoporosis could slow
down or prevent an increase in the osteoporosis effects thereby reducing the risk of fracture.
Although osteoporosis was one of primary viewed disease relating to old age, at the moment, the
condition is recognized as a disease that could have begun due to lesser optimal growth in bones
during adolescence childhood other than the bone loss in the later stages of life.

Ageing 5
Who is most affected
1. Women
Women are the most likely to develop osteoporosis since their bone loss has a rapid rate of
reduction several years past menopause, where there is a reduced level in the hormone.
Additionally, women are usually small boned than men generally in their life, combining this
with the rapid bone loss, there is a higher rate of bone fracture in women.3
2. Men
Usually, people think osteoporosis only affects women. Men have the majority believing that
osteoporosis will not affect them as it does to women. There is the fact that one in five men break
bones once past 50 years due to low strength in the bones. The men having osteoporosis show
that such a small percentage in men ads to the confusion of immunity to osteoporosis that may
increase the difficulty to seek medical support or help.
3. Younger women and men
In younger women and men, osteoporosis could lead to but not sure to cause fractures. There
mostly exists an underlying reason or condition in the identification, but mostly one doesn't find
the cause. Hence the ‘idiopathic' word. If one is a healthy youth who regularly breaks bones, this
would be distressing. Treating and diagnosing osteoporosis. In young women, men and in
children is complex involving referral to general specialists in hospitals.4
Impact
Although sufficient forces such as falling from high places or movement at high speed may lead
to the breaking of bones, if one is diagnosed with osteoporosis, there is a higher chance of bones
breaking from simple falls. If one has established osteoporosis, means the condition has been

Ageing 6
noted using a scan, and there may fracture due to osteoporosis. The bone that is engulfed in
osteoporosis is not painful, but pain may come to the bones that break and cause other problems.
The following are the impacts of osteoporosis:
1. Broken wrists
When one is prone to breaking the wrists, there is a high possibility that these breakings could be
due to osteoporosis. Women wrist fracture often occur just after passing menopause and mostly
happen due to falls since most people tend to put out their arms to break their fall. Healthy bones
have to withstand simple falls. Therefore, having broken bones in these circumstances in the
absence of any disease may be an indication of osteoporosis hints.6

Ageing 7
Wrist Fracture
Total Yes No
p-value
160,930 8,792 152,138
N (%) N (%) N (%)
Age, years
Men +- SD 63.2 (7.2) 64.6 (7.2) 63.2 (7.2) <0.001
<55 21,430 (13.3) 860 (9.8) 20,570 (13.5) <0.001
55-59 31,804 (19.8) 1,479 (16.8) 30,325 (19.9)
60-64 37,016 (23.0) 1,853 (21.1) 35,163 (23.1)
65-69 35,227 (21.9) 2,214 (25.2) 33,013 (21.7)
70-74 24,781 (15.4) 1,606 (18.3) 23,175 (15.2)
75-79 10,672 (6.6) 780 (8.9) 9,892 (6.5)
Ethnicity
Unknown 1,830 (1.1) 89 (1.0) 1,741 (1.1) <0.001
Pacific or Asian islander 4,158 (2.6) 144 (1.6) 4,014 (2.6)
Latino/Hispanic 6,329 (3.9) 221 (2.5) 6,108 (4.0)
African-American or
Black
14,469 (9.0) 310 (3.5) 14,159 (9.3)
White 133,032
(82.9)
7,973 (90.9) 125,059
(82.4)
Missing 409 21 388
Alaskan Native or
American Indian
703 (0.4) 34 (0.4) 669 (0.4)
Education
College degree or higher 63,151 (39.5) 3,668 (42.0) 59,483 (39.4) <0.001
Missing 1,207 54 1,153
Some vocational/college
school
60,610 (37.9) 3,292 (37.7) 57,318 (38.0)
<High school diploma 35,962 (22.5) 1,778 (20.3) 34,184 (22.6)
Clinical Trial
Participants
Yes 67,881 (42.2) 3,724 (42.4) 64,157 (42.2) 0.731
No 93,049 (57.8) 5,068 (57.6) 87,981 (57.8)
Body Mass Index (kg/m)
Mean ± SD 28.0 (5.9) 27.3 (5.5) 28.0 (6.0) <0.001
Normal (18.5 – 24.9) 54,697 (34.3) 3,254 (37.4) 51,443 (34.1) <0.001
Underweight (< 18.5) 1,390 (0.9) 83 (1.0) 1,307 (0.9)
Overweight (25.0 – 29.9) 55,419 (34.7) 3,154 (36.2) 52,265 (34.7)
Obesity II (35.0 – 39.9) 12,089 (7.6) 537 (6.2) 11,552 (7.7)
Obesity I (30.0 – 34.9)
Missing 1,411 1,327

Ageing 8
Extreme Obesity III (>=
40)
6,377 (4.0) 243 (2.8) 6,134 (4.1)
Smoking Status
Past smoker 66,783 (42.0) 3,746 (43.2) 63,037 (42.0) 0.004
[5] Current smoker 11,048 (7.0) 536 (6.2) 10,512 (7.0)
Never smoked 81,007 (51.0) 4,395 (50.7) 76,612 (51.0)
Missing 2,092 79 1,128
Supplementary calcium
(mg)
Mean ± SD 354.9 (569.9) 379.4 (542.7) 353.5 (571.4) <0.001
Missing 2 0 2
Supplemental Vitamin D
(IU)
Mean ± SD 196 (248) 209 (249) 195 (247) <0.001
None 83,741 (52.0) 4,337 (49.3) 79,404 (52.2) <0.001
<400 IU 16,227 (10.1) 923 (10.5) 15,304 (10.1)
400 IU 45,427 (28.2) 2,574 (29.3) 42,853 (28.2)
>400 IU 15,533 (9.7) 958 (10.9) 14,575 (9.6)
Missing 2 0 2
2. Broken Hips
The primary site in breaking hips occurs at the thigh bone's top, at the femur's neck. If one breaks
the hip due to osteoporosis, then the individual is highly likely to be in the late eighties or
seventies. Developing this kind of hip fracturing may be due to resulting falls. Having a broken
hip becomes a leading source of pain hence interrupting the day-to-day activities. Most broken
hips require admission and operation.8
If one has a fit body before the hips breaking, one has to be able to look one has to expect
independent living with qualified physiotherapy and social service help if need be. Once age
starts catching up, there is a possibility of coping with different medical conditions. Hence
making a recovery from an operated broken hip back to normal lifestyle may be difficult.
Therefore it is vital to try preventing any hip fracture occurrence.

Ageing 9
3. Spinal Fracture
Fractures that occur due to osteoporosis in the spine bones usually happen in the lumbar if not
the thoracic spinal areas. They are mostly known as vertebral or spinal fractures. The bones
become compressed and squashed due to their reduced strength. Therefore, the fracture may be
referred to as collapsed, crush or wedge fractures. Depending on the part of the affected vertebra.
One way of describing the fractures is through compression fractures. Back pain is the main
symptom in the spinal fracture. However, the level of pain would vary in various people, with
others not having any symptom. There is no clarity to such variations. Most people go through
the spinal fractures and heal in about 11 weeks, and the back pain tends to decrease. However,
this back pain may persist for longer durations especially if there were numerous fractures.9
Approaches in Prevention
1. Exercises
There should be a regular exercising level. Exercise makes the muscles and bones stronger and
helps in the prevention of bone loss. Additionally, exercise aids in keeping one mobile and
active. Weight-bearing exercise performed at about three times in one week is the best method in
preventing osteoporosis. Exercise such as playing tennis, jogging, walking and are some of the
preferred weight-bearing exercises. Additionally, balance and strength exercises could be
influential in helping one avoid falls, thereby reducing the falling chances.10
2. Eating foods with high calcium content
Amassing calcium throughout the life helps in building and keeping strong bones it is a
recommendation that calcium is availed to the 31- 50 aged individuals at 1,200mg in one day.
Individuals past 50 should be taking 1,500 mg calcium every day. Excellent calcium sources

Ageing 10
include the dairy products such as milk, various seafood such as sardine, dark green leafy
vegetables that include broccoli, kale, collard, and fortified calcium flour.
3. Supplements
If one thinks that there is a need for calcium to attain enough content then first, a doctor should
be consulted. Calcium citrate and calcium carbonate are the best forms of the supplements. One
should avoid taking up to 2,000 mg in one day. Such high amounts could lead to kidney
problems.11
4. Vitamin D
The body makes use of vitamin D in absorbing calcium. Being exposed to the sun for about 20
minutes in a day inclines the body to absorb the calcium from enough vitamin D. vitamin D can
also come from eggs. Cereal, milk and fatty acids other than using supplements. However, an
excess of 10,000 IU in vitamin D every day could cause harm to the body. It could cause bone
loss or injury to the liver. First, the doctor should be contacted.12
Population-level Public Health prevention policies
1. Population-based intervention to raise the physical activity
Doing physical exercises, regularly, is associated with better health and lower risk of mortality.
Fitness and physical activity have many benefits leading to healthy bones. Hence, there is a
reduction in the risk of fractures and osteoporosis or any fall-related injuries.13
Strong or sufficient evidence shows the effectiveness of some of the six interventions that
encourage physical exercises. They include campaigns on multi-component information, point-
out-decision prompts encouraging the use of stairs, physical education in school and change
programs that adapt to individual health-behavior.14

Ageing 11
2. A population-based intervention that decreases Tobacco use
Bones could be profoundly affected by smocking. Hence, tobacco control and prevention efforts
might have a positive effect on the health of bones.15 More widely, such tobacco awareness
programs have the best way of providing an understanding of the methods of assessment,
translation, and application of evidence that relies on population intervention.16
The systems in health care may be the most critical systems for setting up population
interventions. Programs and policies implemented by the networks in health care or enormous
employers or any other entity that uses health care systems in large masses of people can target
both the providers and patients. A broad multi-component effort has an acknowledgment that
tobacco reduction requires a population intervention that changes the attitude together with
behaviors of individuals. The advocates in bone health can benefit from the multifaceted
examination programs used in the tobacco interventions in the community.17
The research
The National Bone Health Campaign
The campaign demonstrates both ability and need to apply population-based means in the early
life in an attempt to lower the chances of getting the bone illness later. It also demonstrates how
a particular audience, that is, girls aged 9-12 may be targeted ones with the program of
prevention.18
Background
The National Bone Health Campaign is a national campaign established by congressional
mandate in 1998. It is controlled in partnership with the Department of Health and Human
Services, centers Disease Control and Prevention CDC, National Osteoporosis Foundation and

Ageing 12
the office on Women's Health. This campaign applies the approach of social marketing to create
awareness to girls before adolescence, other adults, and parents who have an influence on the
behaviors which can be helpful to prevent reduced bone density thereupon lowering the
osteoporosis risks at advanced stages of life.19
Before the materials for the campaign were designed, a formative study was done to find out a
comprehensive understanding on how data regarding the consumption of calcium and physical
activities are more likely to be portrayed effectively by individuals in this age bracket. A topic
which was understood poorly. Ethnic-and racial-specific groups of focus were the primary
technique used for this study, together with daughters and parents baseline survey. The outcome
showed that was neither an understanding of the healthy bone nor was it a vital consideration by
parents and girls.20
The study also indicated that parents and girls needed messages of motivation, information,
handle the surroundings which result in desired habits and offer action procedures. Girls equally
want information available to be in the context of power, fun and social interaction.21
The Intervention
The ultimate aim of the campaign generally is to encourage and educate girls on how to build
long-lasting healthy habits specifically high consumption of calcium and physical exercises that
maintain and build strong bones. In summary, the campaign aims at increasing the knowledge of
parents and girls on how physical exercises and intake of calcium correspond with bone health.
Over an extended period, the concern will drift to improving on this high knowledge to attain
behavioral change.22
In order to achieve the aims, the campaign created six important messages:

Ageing 13
a) Frequent physical exercises and foods rich in calcium to build strong bones.
b) Being very active physically is fun and gives fitness, energy, social interaction, and
health.
c) Bone health is a crucial segment in regards to power, fitness, and strength.
d) There are various fun and easy ways of doing physical exercises every day.
e) Proper nutrition enables one to stay active and fit.
Every material for the campaign is developed to portray easy means for taking part in weight-
bearing physical exercises and consuming 1,300mg of calcium every day. To appeal to the desire
of girls in gaining internal strength, all the messages are together held by the tagline of the
campaign: powerful Bones. Powerful Girls. The poster below illustrates.23
The campaigns cornerstone is through a website that enables girls to appreciate how physical
exercises and bearing weight and consuming calcium can be an exciting, crucial part of their
lives every day. The site stresses the important bone-healthy habits. It also talks about interactive
quizzes and games, hints on how to access weight-bearing exercises and recipes for delicious
calcium contained foods.24

Ageing 14
It is essential to take note that the campaign website creates awareness to girls before
adolescence about weight-bearing physical exercises and sufficient intake of calcium.
The campaign applies various means to find girls among them paying for advertisements in
youth and children magazines which includes Nickelodeon, print materials which provides fact
sheets, calendar stickers and presentations, radio media tour and radio advertisements whereby
434 radio advertisements played in 2001 in July and December.
Four major themes are persistently applied in the campaign for parents:
a) Calcium-rich foods are a very vital segment of a balanced diet that is healthy.
b) Developing an atmosphere that will encourage their daughter's consumption of calcium
and physical exercises with ease to secure their daughters future.
c) Parent’s acts have an impact and taking part in their daughter’s sports programs or
activities actively or as a spectator is one way of taking part and shows support to their
daughter’s healthy lifestyle journey.
d) It is crucial for the parent to ensure daughters have strong bones from childhood as a way
of being part of their daughter's future and development.
These messages are spread through checklists, tip sheets and shopping lists which includes
particular action steps made for parents. Paid advertisements were printed and put in women’s
magazines which include Ladies’ Home Journal, Essence and Family Circle. A website to
enforce these important messages has been created.
Partners
Various organizations that directly work with girls have tendered the NBHC materials to the
girl's needs. Girls scout created a videotape, troop activity cards; Girls Inc. developed facilitator

Ageing 15
manuals and activity guide, and a bone health patch. The National Association of Schools Nurses
created materials to be used in schools. Additionally, NBHC partners together with nonprofit
organizations, state, local and Federal agencies.
Evaluation, Results, and Challenges
The concern on the campaign evaluation lately has been making a follow up on “process
measures” that weigh the level at which individuals access the new messages and materials. The
campaign in 2004 during spring had over 122 million mentions in print media and over 3.1
million visits on the website. The plan underway is to increase the target of girl's age to 18 years
to emphasize messages previously introduced to the young girls.25
From the campaign the following evaluation was made based on challenges and results:
 Target population illiteracy.
Many participants were noted to have limited access to the knowledge on osteoporosis.
Most have never accessed writing or reading materials hence creating challenges in
stumping out the condition. In resolving this barrier, there were simple structured short
content materials that could be fast and easily read by the participants. Additionally,
some outreach programs were extended for the aim of educating the both the elderly and
the young on the relatives about osteoporosis.
 Duration of audience and presentation.
Feedback suggests that seminars regarding such health matters should be shorter when
the audience mainly consists of the elderly (above 75 years of age). Taking note of this
feedback, it is approximated that a 0-minute presentation would suffice for the elderly
audience rather than making a 4-hour presentation.
 Delivery importance

Ageing 16
The style in delivery would make an enormous difference regarding how well the
information was received and understood. For example, most participants would fail to
understand the important messages when taken to a well-known doctor who makes use
of the difficult-to-grasp terminologies in medicine.
Conclusion
Osteoporosis is an illness that mainly affects women at postmenopausal stages and the aged,
possibly leading to fractures more often happen in hip bones, wrist, and spine although any bone
could be affected. Preventing osteoporosis requires one to participate in exercises, eat foods
containing calcium and vitamin D and taking supplements. The significant number of occurrence
of osteoporosis has led to the development of population-interventions such as health campaigns
that could reduce the number of affected individuals. This brings out the research under study in
this paper courtesy of the National Bone Health Campaign that focusses on educating the young
on the condition before it is too late. Hence The National Bone Health Campaign advises using
proper methods of delivering information about osteoporosis and targeting a specific population
as ways of preventing osteoporosis.

Ageing 17
References
1. Schweser K, Crist B. Osteoporosis: a discussion on the past 5 years. Current reviews in
musculoskeletal medicine. 2017;10(2);265-274.
2. Woods G, Huang M, Cawthon P, McDaniels-Davidson C, Fink H, Kado D. Study of
Osteoporotic Fractures (SOF) Research Group. Patterns of menopausal hormone therapy
use and hyperkyphosis in older women. Menopause. 2018;(25)7;738-743.
3. Stanghelle B, Bentzen H, Giangregorio L, Pripp A, Bergland A. Effect of a resistance and
balance exercise programme for women with osteoporosis and vertebral fracture: study
protocol for a randomized controlled trial. BMC musculoskeletal disorders.
2018;19(1);100.
4. Gruber‐Baldini A, Hosseini M, Orwig D, Grattan L, Chiles S, Hochberg M, Magaziner
Jl . Cognitive Differences between Men and Women who Fracture their Hip and Impact
on Six‐Month Survival. Journal of the American Geriatrics Society, 2017;65(3);64-69.
5. Cosman F, Hattersley G, Hu M, Williams G, Fitzpatrick L, Black D. Effects of
abaloparatide‐SC on fractures and bone mineral density in subgroups of postmenopausal
women with osteoporosis and varying baseline risk factors. Journal of Bone and Mineral
Research. 2017;3(1);17-23.
6. Galli S, Stocchero M, Andersson M, Karlsson J, He W, Lilin T, Wennerberg A, Jimbo R.
Correction to: The effect of magnesium on early osseointegration in osteoporotic bone: a
histological and gene expression investigation. Osteoporosis international: a journal
established as result of cooperation between the European Foundation for Osteoporosis

Ageing 18
and the National Osteoporosis Foundation of the USA. 2018;29(8);1931.
7. Puth MT, Klaschik M, Schmid M, Weckbecker K, Münster E. Prevalence and
comorbidity of osteoporosis–a cross-sectional analysis on 10,660 adults aged 50 years
and older in Germany. BMC musculoskeletal disorders. 2018;19(1);144
8. Atkinson H, Moyer, R, Yacoub D, Coughlin D. Birmingham TB. Effects of recombinant
human growth hormone for osteoporosis: systematic review and meta-analysis. Canadian
Journal on Aging/La Revue canadienne du vieillissement. 2017;36(1);41-54.
9. Cosman F, Nieves J, Dempster D. Treatment sequence matters: anabolic and
antiresorptive therapy for osteoporosis. Journal of Bone and Mineral Research.
2017;32(2);198-202.
10. Miko I, Szerb I, Szerb A, Bender T, Poor G. Effect of a balance-training programme on
postural balance, aerobic capacity and frequency of falls in women with osteoporosis: a
randomized controlled trial. Journal of rehabilitation medicine. 2017;50(6);542-527.
11. Ridge A, Devine A, Lyons-Wall P, Conlon J, Lo J. The impact of whey protein
supplementation in older adults on nutrient intakes and satiety over an 11-week exercise
intervention. Food Quality and Preference. 2018;68(1);72-79.
12. Bouillon R. How much vitamin D is needed for healthy bones?. Journal of internal
medicine. 2017;177(282);461-464.
13. Cronholm F, Rosengren B, Karlsson C, Karlsson M. A physical activity intervention
program in school is also accompanied by higher leisure-time physical activity: a
prospective controlled 3-year study in 194 prepubertal children. Journal of Physical

Ageing 19
Activity and Health. 2017;14(4);301-307.
14. Wu F, Wills K, Laslett L, Oldenburg B, Jones G, Winzenberg T. Moderate‐to‐vigorous
physical activity but not sedentary time is associated with musculoskeletal health
outcomes in a cohort of Australian middle‐aged women. Journal of Bone and Mineral
Research. 2017;32(4);708-715.
15. Stuart A, Pasco J, Jacka, F, Berk M, Williams L. Falls and depression in men: a
population-based study. American journal of men's health. 2018;12(1);14-18
16. Sattari M, Cauley J, Johnson GC, Li W, Limacher M, Manini T, Sarto G, Sullivan S,
Wactawski-Wende J. Osteoporosis in the Women's Health Initiative: Another Treatment
Gap?. The American journal of medicine. 2017;130(8);937-948.
17. Nguyen V. Community health programs and services for osteoporosis and osteoporotic
fracture prevention: A population health perspective. International Journal of Healthcare
Management. 2017;28(1);1-3.
18. Larsen M, Nielsen C, Helge E, Madsen M, Manniche V, Hansen L, Hansen L, Bangsbo,
J, Krustrup P. Positive effects on bone mineralisation and muscular fitness after 10
months of intense school-based physical training for children aged 8–10 years: the FIT
FIRST randomised controlled trial. Br J Sports Med. 2018;52(4);254-260.
19. Jeihooni A, Askari A, Kashfi S, Khiyali Z, Kashfi S, Safari O, Rastegarimehr B,
Mansourian M. Application of health belief model in prevention of osteoporosis among
primary school girl students. International Journal of Pediatrics. 2017;5(11);6017-6029.
20. Knabe C, Mele A, Kann P, Peleska B, Adel-Khattab D, Renz H, Reuss A, Bohner M,

Ageing 20
Stiller M. Effect of sex-hormone levels, sex, body mass index and other host factors on
human craniofacial bone regeneration with bioactive tricalcium phosphate grafts.
Biomaterials. 2017;123(1);48-62.
21. Krustrup P, Helge E, Hansen P, Aagaard P, Hagman, M, Randers M, de SM, Mohr M.
Effects of recreational football on women’s fitness and health: adaptations and
mechanisms. European journal of applied physiology. 2018;115(1);11-32.
22. Duran I, Martakis K, Hamacher S, Stark C, Semler O, Schoenau E. Are there effects of
age, gender, height, and body fat on the functional muscle-bone unit in children and
adults. Osteoporosis International. 2018;29(5);1069-1079.
23. Chan C, Mohamed N, Ima-Nirwana S, Chin K. A Review of Knowledge, Belief and
Practice Regarding Osteoporosis among Adolescents and Young Adults. International
journal of environmental research and public health. 2018;15(8);1727.
24. Darabi L, Shokravi A, Ghaffari M. Comparison of Two Methods of Direct and Indirect
Education on Osteoporosis Preventive Behaviors among Female Students. International
Journal of Pediatrics. 2017;5(8);5483-92.
25. McDonald E, Mack K, Shields W, Lee R, Gielen A. Primary care opportunities to prevent
unintentional home injuries: a focus on children and older adults. American journal of
lifestyle medicine. 2018;43(1);96-106.