Cited by 366Bone health and osteoporosis researchPhysical Activity and HealthBalance, Gait, and Falls Prevention

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Exercise and Sports Science Australia (ESSA) position statement on exercise prescription for the prevention and management of osteoporosis

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Beck, Belinda R., Daly, Robin M., Singh, Maria A. Fiatarone, Taaffe, Dennis R.·2017·Journal of Science and Medicine in Sport

DOI 10.1016/j.jsams.2016.10.001

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Abstract

Objectives Osteoporotic fractures are associated with substantial morbidity and mortality. Although exercise has long been recommended for the prevention and management of osteoporosis, existing guidelines are often non-specific and do not account for individual differences in bone health, fracture risk and functional capacity. The aim of the current position statement is to provide health practitioners with specific, evidence-based guidelines for safe and effective exercise prescription for the prevention or management of osteoporosis, accommodating a range of potential comorbidities.Design Position statement.Methods Interpretation and application of research reports describing the effects of exercise interventions for the prevention and management of low bone mass, osteoporosis and osteoporotic fracture.Results Evidence from animal and human trials indicates that bone responds positively to impact activities and high intensity progressive resistance training. Furthermore, the optimisation of muscle strength, balance and mobility minimises the risk of falls (and thereby fracture), which is particularly relevant for individuals with limited functional capacity and/or a very high risk of osteoporotic fracture. It is important that all exercise programs be accompanied by sufficient calcium and vitamin D, and address issues of comorbidity and safety. For example, loaded spine flexion is not recommended, and impact activities may require modification in the presence of osteoarthritis or frailty.Conclusions Specific guidelines for safe and effective exercise for bone health are presented. Individual exercise prescription must take into account existing bone health status, co-morbidities, and functional or clinical risk factors for falls and fracture.

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II Consenso Colombiano para el Manejo de la Osteoporosis Posmenopáusica
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Background
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Self-citation
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Effects of supervised high-intensity hardstyle kettlebell training on grip strength and health-related physical fitness in insufficiently active older adults: the BELL pragmatic controlled trial
Meigh, N. J., Keogh, J., Schram, B. L., Hing, W. A., & Rathbone, E. N. (2022) · BMC Geriatrics · doi:10.1186/s12877-022-02958-z · Cited by 22
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Self-citation
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Background
Effect of Yi Jin Jing exercise plus Elastic Band Resistance exercise on overall bone mineral density in postmenopausal women
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“In vivo experimental findings confirm that appropriate intensity of exercise alleviated the loss of BMD. Studies have shown that moderate ‐ intensity resistance training prevents BMD loss in postmenopausal women effectively (Beck et al., 2017; Watson et al., 2018).”
Background
The effect of magnetic therapy and moderate aerobic exercise on osteoporotic patients
Marwa Mahmoud, E. I. D., El-Gendy, A. M., Abdelbasset, W. K., Elkholi, S. M. A., & Abdel-fattah, M. S. (2021) · Medicine · doi:10.1097/md.0000000000027379 · Cited by 14
“which result from osteoporosis represents major health, social, and economic burden.([5]) Recently, increased awareness of side effects of the main osteoporosis drug, bisphosphonates, led to decreased adherence to pharmacotherapy regimes, which has been highlighted as “a crisis in the treatment of osteoporosis”.”
Background
Bone health in women with breast cancer
Ramchand, S. K., Cheung, Y.-M. M., & Grossmann, M. (2019) · Climacteric · doi:10.1080/13697137.2019.1580257 · Cited by 14
Objectively-measured sedentary time, habitual physical activity and bone strength in adults aged 62 years: the Newcastle Thousand Families Study.
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One year of Football Fitness improves L1–L4 BMD, postural balance, and muscle strength in women treated for breast cancer
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The Impact of an Adapted Physical Activity Program on Bone Turnover, Physical Performance and Fear of Falling in Osteoporotic Women with Vertebral Fractures: A Quasi-Experimental Pilot Study
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Result
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“In this regard, high-intensity resistance exercise training (i.e., ≥ 80% one-repetition maximum) and impact exercise (i.e., jumping, kicking, punching) are often considered the preferred exercise modes (Beck et al., 2017; Kohrt et al., 2004).”
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“However, evidence that high bone mineral density is linked to physical activity is mostly misinterpreted as evidence that any physical activity will lead to increased BMD [11].”
Background
Exercise in the Prevention of Osteoporosis-Related Fractures
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Self-citation
A protocol for a randomised controlled trial of the bone response to impact loading or resistance training in young women with lower than average bone mass: the OPTIMA-Ex trial
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Self-citation
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Perceptions of fracture and fall risk and of the benefits and barriers to exercise in adults with diabetes
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Effects of an mHealth physical activity intervention to prevent osteoporosis in premenopausal women. A randomized controlled trial
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Recommended Musculoskeletal and Sports Medicine Curriculum for Internal Medicine Residency Training
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Exercise and Musculoskeletal Health in Men With Low Bone Mineral Density: A Systematic Review
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“12,13 In healthy individuals, the mechanical loading and straining from dynamic exercises stimulates site-speci ﬁ c osteogenic responses, such that new bone tissue replaces damaged tissue.”
Background
Rehabilitative good clinical practice in the treatment of osteoporosis: a comprehensive review of clinical evidences
Agostini, F., Alessandro de, S. I. R. E., Sveva, V., Finamore, N., Savina, A., Fisicaro, A., Bernetti, A., Santilli, V., Mangone, M., & Paoloni, M. (2024) · Disability and Rehabilitation · doi:10.1080/09638288.2024.2440142 · Cited by 9
“…exercises and physical therapy in older adults with osteoporosis, based on the T-score definition of osteoporosis, without differences in gender, age, comorbidities, and past fractures [1,21,22,27,29,31,32], in which only one guideline have been stratified for fracture risk, based on T-score [22].”
Geometry and bone mineral density determinants of femoral neck strength changes following exercise
O’Rourke, D., Beck, B. R., Harding, A. T., Watson, S. L., Pivonka, P., & Martelli, S. (2022) · Biomechanics and Modeling in Mechanobiology · doi:10.1007/s10237-022-01642-w · Cited by 8
“As such, exercise prescription should consider the equivalence of the HiRIT and IAC exercise programmes for promoting femoral neck strength reported here with caution and in conjunction with broader considerations of general health of participants (Beck et al. 2017).”
BackgroundSelf-citation
Skeletal effects of eccentric strengthening exercise: a scoping review
Singh, H., Moore, B. A., Rathore, R., Reed, W. R., Thompson, W. R., Fisher, G., Lein, D. H., & Hunter, G. R. (2023) · BMC Musculoskeletal Disorders · doi:10.1186/s12891-023-06739-6 · Cited by 8
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Background
Diagnose und Therapie der Osteoporose bei Patienten mit chronischer Niereninsuffizienz
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Background
The Exercise and Sports Science Australia position statement: Exercise medicine in cancer management
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“Regular exercise is recommended to counteract bone fragility because of the mechanical stimulation and benefits to bone health that are associated with exercise (14).”
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Chen, H., Lou, Y., Fei, S., Luo, J., Man, F., Zhang, L., Guo, L., & Pan, Q. (2024) · Osteoporosis International · doi:10.1007/s00198-024-07280-5 · Cited by 7
“The resistance, impact, and balance exercises recommended in osteoporosis treat-ment guidelines are excellent [6] but may pose challenges for some individuals.”
Effects of combined protein and exercise interventions on bone health in middle-aged and older adults — A systematic literature review and meta-analysis of randomized controlled trials
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“Moreover, the adaptation to treatment is thought to vary by region, as bones subjected to the stress and strains of training are more likely to exhibit increased density [12].”
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Bettariga, F., Newton, R. U., Bishop, C. J., Maestroni, L., Borsati, A., Avancini, A., Pilotto, S., Taaffe, D. R., Galvao, D. A., & Haff, G. G. (2025) · Sports Medicine · doi:10.1007/s40279-025-02311-5 · Cited by 10
Self-citation
The Effect of Exercise on Body Composition and Physical Performance in Prostate Cancer Patients Undergoing Androgen Deprivation Therapy (ADT): A Narrative Synthesis
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The effect of fibroblast growth factor receptor inhibition on resistance exercise training-induced adaptation of bone and muscle quality in mice
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Peres-Ueno, M. J., Capato, L. L., Porto, J. M., Adão, I. F., Maciel, J. G., Herrero, C. F. P. D. S., Nogueira‐Barbosa, M. H., de Paula, F. J. A., Ferrioli, E., & de Abreu, D. C. C. (2022) · Annals of Physical and Rehabilitation Medicine · doi:10.1016/j.rehab.2022.101680 · Cited by 7
Bone marrow metabolism is affected by body weight and response to exercise training varies according to anatomical location
Ojala, R., Hentilä, J., Lietzén, M. S., Arponen, M., Heiskanen, M. A., Honkala, S. M., Virtanen, H., Koskensalo, K., Lautamäki, R., Löyttyniemi, E., et al. (2023) · Diabetes, obesity and metabolism · doi:10.1111/dom.15311 · Cited by 7
“39 While the benefits of weight-bearing exercise on bone are well established, 5,40 the effects of exercise are mostly explained by base-line BMD level.”
Background
Development and Validation of India-specific Hindi Version of Osteoporosis Knowledge Assessment Tool
Barik, S., Raj, V., Munshi, B. D., Rajput, O., Prajapati, S., Prasad, S. G., & Kumar, A. (2023) · Journal of Mid-life Health · doi:10.4103/jmh.jmh_219_22 · Cited by 7
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Background
A combination of routine blood analytes predicts fitness decrement in elderly endurance athletes
Haslacher, H., Ratzinger, F., Perkmann, T., Batmyagmar, D., Nistler, S., Scherzer, T. M., Ponocny‐Seliger, E., Pilger, A., Gerner, M. C., Scheichenberger, V., et al. (2017) · PLoS ONE · doi:10.1371/journal.pone.0177174 · Cited by 7
Managing Menopausal Symptoms in Young Women With Breast Cancer: When Medicine Is Not All. The Take Care Project
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Assessment of mechanical variables best describing bone remodelling responses based on their correlation with bone density
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The Effects of Whole-Body Vibration Exercise Combined With an Isocaloric High-Fructose Diet on Osteoporosis and Immunomodulation in Ovariectomized Mice
Tsai, S.-H., Tseng, Y.-H., Chiou, W., Chen, S.-M., Chung, Y., Wei, W., & Huang, W.-C. (2022) · Frontiers in Nutrition · doi:10.3389/fnut.2022.915483 · Cited by 6
“Exercise regimens have been shown to be an effective method of ameliorating osteoporosis, and progressive resistance training provides the additional benefit of minimizing the risk of falls and fractures (11).”
Method
The applied study to improve the treatment of knee sports injuries in ultimate frisbee players based on personalized exercise prescription: a randomized controlled trial
Chen, S., Du, L., Gao, Y., Li, H., Zheng, Y., Xie, L., & Zhong, Z. (2024) · Frontiers in Public Health · doi:10.3389/fpubh.2024.1441790 · Cited by 6
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“There is no contraindication for physical activity or targeted training; it only needs to be adapted to the corresponding needs or health status (e.g., musculoskeletal problems, cardiovascular or cognitive limitations) [88].”
Bilateral multidirectional jumps with reactive jump-landings achieve osteogenic thresholds with and without instruction in premenopausal women
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“It may be that a fall hazard identification program is not enough to reduce the number of falls, and it is necessary to pair with other falls prevention programs such as strength training and balance training.(62) The lack of effect reported in this study may be due to limitations of the primary studies.”
Background
Rethinking of osteoporosis through a sex- and gender-informed approach in the COVID-19 era
VIOLI, A., FORTUNATO, V., D’Amuri, A., Zuliani, G., Basili, S., Passaro, A., Corica, B., & Raparelli, V. (2021) · Minerva Obstetrics and Gynecology · doi:10.23736/s2724-606x.21.04893-4 · Cited by 6
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Xu, W., Zhao, X., Zeng, M., Wu, S., He, Y., & Zhou, M. (2024) · Frontiers in Medicine · doi:10.3389/fmed.2024.1341336 · Cited by 6
“Progressive resistance exercise or in combination with other interventions (protein, calcium and vitamin D supplementation) is optimal for improving muscle and bone density in old adults (12, 13).”
Background
Bone-Targeted High-Intensity Training Does Not Reduce Quality of Life Related to Pelvic Floor Dysfunction: The MEDEX-OP Randomized Controlled Trial
Kistler-Fischbacher, M., Weeks, B. K., & Beck, B. R. (2025) · International Urogynecology Journal · doi:10.1007/s00192-025-06187-x · Cited by 8
Self-citation
A clinician's guide to the management of geriatric musculoskeletal disease: Part 1 - Osteoporosis
Feehan, J., Tripodi, N., Fleischmann, M., Zanker, J., & Duque, G. (2021) · International journal of osteopathic medicine · doi:10.1016/j.ijosm.2021.12.003 · Cited by 5
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Ng, C., Scott, D. S., Sim, M., Zhu, K., Siafarikas, A., Hart, N., Tan, J., & Chivers, P. (2022) · Archives of Osteoporosis · doi:10.1007/s11657-022-01100-1 · Cited by 4
“Participants who achieved this may have had more varied physical activity types with greater diversification of loading favourable for osteogenesis [38].”
Background
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Jiménez, S. S., Viñolo-Gil, M. J., Carmona-Barrientos, I., Martín-Vega, F. J., García‐Muñoz, C., Vargas, A. R. G., & González-Medina, G. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph192316196 · Cited by 5
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Fleay, B., Singh, F., Saunders, C. M., Taaffe, D. R., Galvao, D. A., Newton, R. U., & Fox‐Harding, C. (2023) · Women s Health · doi:10.1177/17455057231161483 · Cited by 6
Self-citation
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Karanasios, E., Ryan‐Stewart, H., & Faulkner, J. (2023) · Journal of Trainology · doi:10.17338/trainology.12.1_5 · Cited by 5
“…documented to improve cardiorespiratory fitness and reduce AS. 5 Similarly, resistance training (RT) improves bone health and insulin sensitivity 6,7 , is associated with decreased mortality and CVD risk 8 , and may elicit comparable or superior benefits to AE in the treatment of hypertension 9 .”
Association of combined healthy lifestyle factors with incident osteoporosis in patients with and without type 2 diabetes
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“Although there is guidance from the USA [34], Australia [19], and Canada [35] regarding safe and effective exercise and physical activity for bone health, some important questions are still unsettled.”
Regular physical activity improves physical function and health-related quality of life among middle-aged and older women who suffered a fragility fracture—a population-based cohort
Barcelos, A., Lopes, D. G., Mazeda, C., Canhão, H. M., Branco, J., & Rodrigues, A. M. (2024) · Osteoporosis International · doi:10.1007/s00198-024-07265-4 · Cited by 7
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Defeudis, G., Cardinali, L., Eftekhariranjbar, S., Massari, M. C., & Migliaccio, S. (2024) · Journal of Endocrinological Investigation · doi:10.1007/s40618-024-02517-w · Cited by 5
“According to recent guidelines [54] multi-component exercise prescription must include a personalised approach that takes into account the individual’s BMD, functional and clinical risk factors for falls and fractures, and individual preferences and interests in order to maximise exercise adherence…”
The impact of Tai Chi on osteoporosis and osteopenia in middle-aged and elderly adults: a systematic review and meta-analysis of randomized controlled trial
Guo, X., Wang, J., Wang, Y., & Sun, Q. (2026) · Osteoporosis International · doi:10.1007/s00198-026-07910-0 · Cited by 4
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Menopausal Women: Recognition, Exercise Benefits, Considerations, and Programming Needs
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“(c) Conditions in which exercise would require monitoring on an individual basis include cardiomyopathy, valvular heart disease, complex ventricular ectopy, uncontrolled elevated blood pressure, uncontrolled metabolic disease, spinal compression fractures, hip or pelvic fractures, and severe balance disturbances shoul…”
BackgroundInfluential
Using Raw Accelerometer Data to Predict High-Impact Mechanical Loading
Veras, L., Diniz‐Sousa, F., Boppre, G., Devezas, V., Sousa, H. S., Preto, J. R., Vilas‐Boas, J. P., Machado, L. J., de Oliveira, J. J. F., & Fonseca, H. (2023) · Sensors · doi:10.3390/s23042246 · Cited by 5
“The results of our study provide new mechanical loading prediction models for jumping, which is noteworthy because jumping is one of the most popular and effective exercises prescribed for bone health improvement [41], but also one that could increase the risk of fracture in patients with severe osteoporosis and bone…”
Result
High versus Low-Intensity Resistance Training on Bone Mineral Density and Content Acquisition by Postmenopausal Women with Osteopenia: A Randomized Controlled Trial
Eslamipour, F., Gheitasi, M., Hovanloo, F., & Yaghoubitajani, Z. (2023) · Medical Journal of the Islamic Republic of Iran · doi:10.47176/mjiri.37.126 · Cited by 12
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BackgroundInfluential
Effects of 12-week power training on bone in mobility-limited older adults: randomised controlled trial
Muollo, V., Hvid, L. G., Shanbhogue, V. V., Steinhauser, V., Caporossi, D., Dimauro, I., Andersen, M., Fantini, C., Grazioli, E., Strotmeyer, E. S., et al. (2024) · Archives of Osteoporosis · doi:10.1007/s11657-024-01487-z · Cited by 4
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Kamil‐Rosenberg, S., Greaney, M. L., & Garber, C. E. (2020) · Sport Sciences for Health · doi:10.1007/s11332-020-00674-y · Cited by 4
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The role of the Dual X-Ray Absorptiometry investigation in the design of personalized training programs for women with postmenopausal osteopenia / osteoporosis
Holubiac, I. Ș., & Leuciuc, F. V. (2023) · Balneo and PRM Research Journal · doi:10.12680/balneo.2023.598 · Cited by 4
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The Role of Artificial Intelligence and Professional Expertise in Adapted Physical Activity Prescription for Orthopedic Rehabilitation
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“In osteoporosis, differences were especially evident in safety and effectiveness, consistent with consensus statements highlighting the need for carefully dosed loading strategies that maximize musculoskeletal benefits while minimizing fracture risk [26,27].”

Authors: Beck, B. R., Daly, R. M., Singh, M. A. F., & Taaffe, D. R.
Affiliations: Griffith University (AU)
Deakin University (AU)
The University of Sydney (AU)
Edith Cowan University (AU)
Corresponding author: Beck, Belinda R.
ORCID: Beck, Belinda R.
Daly, Robin M.
Taaffe, Dennis R.
Venue: Journal of Science and Medicine in Sport
Publisher: Elsevier BV
Published: 2017-05
Volume: 20
Issue: 5
Pages: 438-445
ISSN: 1440-2440 (ISSN-L)
DOI: 10.1016/j.jsams.2016.10.001
OpenAlex: W2548243806
Cited by: 366
References: 80
Citations by year: 2026: 37 · 2025: 34 · 2024: 41 · 2023: 51 · 2022: 62 · 2021: 40 · 2020: 44 · 2019: 26 · 2018: 17 · 2017: 14
FWCI: 23.13
Type: journal article
Language: en
Open access: bronze
doi.org
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations: Journal of science and medicine in sport (publishedVersion)
PubMed (publishedVersion)
Research Online (Edith Cowan University) (submittedVersion)
Figshare (submittedVersion, cc-by)
Griffith Research Online (submittedVersion, cc-by-nc-nd)
Topics: Health Sciences › Medicine › Orthopedics and Sports Medicine › Bone health and osteoporosis research
Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Physical Activity and Health
Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Balance, Gait, and Falls Prevention
Keywords: exercise prescription, osteoporosis, osteoporotic fracture prevention, osteopenia, resistance training, fall risk, balance and mobility, muscle strength, calcium and vitamin D supplementation, comorbidities, osteoarthritis, frailty, spinal loading
MeSH terms: Accidental Falls, Animals, Australia, Calcium, Dietary, Exercise Therapy, Female, Humans, Male, Osteoporosis, Risk Factors, Vitamin D, Exercise, Bone Density, Consensus, Resistance Training, Osteoporotic Fractures

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Exercise and Sports Science Australia (ESSA) position statement on exercise prescription for the prevention and management of osteoporosis

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