{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T22:04:48Z","timestamp":1790373888501,"version":"4.1.0"},"reference-count":48,"publisher":"Oxford University Press (OUP)","issue":"9","license":[{"start":{"date-parts":[[2015,3,5]],"date-time":"2015-03-05T00:00:00Z","timestamp":1425513600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2015,9,1]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n               <jats:sec>\n                  <jats:title>\u2003<\/jats:title>\n                  <jats:p>Regular exercisers have lower fracture risk, despite modest effects of exercise on bone mineral content (BMC). Exercise may produce localized cortical and trabecular bone changes that affect bone strength independently of BMC. We previously demonstrated that brief, daily unilateral hopping exercises increased femoral neck BMC in the exercise leg versus the control leg of older men. This study evaluated the effects of these exercises on cortical and trabecular bone and its 3D distribution across the proximal femur, using clinical CT. Fifty healthy men had pelvic CT scans before and after the exercise intervention. We used hip QCT analysis to quantify BMC in traditional regions of interest and estimate biomechanical variables. Cortical bone mapping localized cortical mass surface density and endocortical trabecular density changes across each proximal femur, which involved registration to a canonical proximal femur model. Following statistical parametric mapping, we visualized and quantified statistically significant changes of variables over time in both legs, and significant differences between legs. Thirty-four men aged mean (SD) 70 (4) years exercised for 12-months, attending 92% of prescribed sessions. In traditional regions of interest, cortical and trabecular BMC increased over time in both legs. Cortical BMC at the trochanter increased more in the exercise than control leg, whereas femoral neck buckling ratio declined more in the exercise than control leg. Across the entire proximal femur, cortical mass surface density increased significantly with exercise (2.7%; p\u2009&amp;lt;\u20090.001), with larger changes (&amp;gt;\u20096%) at anterior and posterior aspects of the femoral neck and anterior shaft. Endocortical trabecular density also increased (6.4%; p\u2009&amp;lt;\u20090.001), with localized changes of\u2009&amp;gt;\u200912% at the anterior femoral neck, trochanter, and inferior femoral head. Odd impact exercise increased cortical mass surface density and endocortical trabecular density, at regions that may be important to structural integrity. These exercise-induced changes were localized rather than being evenly distributed across the proximal femur. \u00a9 2015 American Society for Bone and Mineral Research.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1002\/jbmr.2499","type":"journal-article","created":{"date-parts":[[2015,3,5]],"date-time":"2015-03-05T12:00:26Z","timestamp":1425556826000},"page":"1709-1716","source":"Crossref","is-referenced-by-count":100,"title":["The Influence of High-Impact Exercise on Cortical and Trabecular Bone Mineral Content and 3D Distribution Across the Proximal Femur in Older Men: A Randomized Controlled Unilateral Intervention"],"prefix":"10.1093","volume":"30","author":[{"given":"Sarah J","family":"Allison","sequence":"first","affiliation":[{"name":"School of SportExercise and Health SciencesLoughborough UniversityLeicestershireUK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenneth E S","family":"Poole","sequence":"additional","affiliation":[{"name":"Department of MedicineUniversity of CambridgeCambridgeUK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Graham M","family":"Treece","sequence":"additional","affiliation":[{"name":"Department of EngineeringUniversity of Cambridge"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew H","family":"Gee","sequence":"additional","affiliation":[{"name":"Department of EngineeringUniversity of Cambridge"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carol","family":"Tonkin","sequence":"additional","affiliation":[{"name":"Department of MedicineUniversity of CambridgeCambridgeUK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Winston J","family":"Rennie","sequence":"additional","affiliation":[{"name":"Department of RadiologyUniversity Hospitals of LeicesterLeicesterUK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan P","family":"Folland","sequence":"additional","affiliation":[{"name":"School of SportExercise and Health SciencesLoughborough UniversityLeicestershireUK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gregory D","family":"Summers","sequence":"additional","affiliation":[{"name":"Department of RheumatologyDerby Hospitals NHS Foundation TrustDerbyUK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katherine","family":"Brooke-Wavell","sequence":"additional","affiliation":[{"name":"School of SportExercise and Health SciencesLoughborough UniversityLeicestershireUK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2015,3,5]]},"reference":[{"key":"2024020319035470600_jbmr2499-bib-0001","doi-asserted-by":"crossref","first-page":"99","DOI":"10.3111\/13696998.2010.547967","article-title":"Study of the incremental cost and clinical burden of hip fracture in postmenopausal women in the United Kingdom","volume":"14","author":"Guti\u00e9rrez","year":"2011","journal-title":"J Med Econ"},{"key":"2024020319035470600_jbmr2499-bib-0002","doi-asserted-by":"crossref","first-page":"1889","DOI":"10.1001\/jama.288.15.1889","article-title":"Clinical use of bone densitometry: scientific review","volume":"288","author":"Cummings","year":"2002","journal-title":"JAMA"},{"key":"2024020319035470600_jbmr2499-bib-0003","doi-asserted-by":"crossref","first-page":"72","DOI":"10.1016\/0140-6736(93)92555-8","article-title":"Bone density at various sites for prediction of hip fractures. The Study of Osteoporotic Fractures Research Group","volume":"341","author":"Cummings","year":"1993","journal-title":"Lancet"},{"key":"2024020319035470600_jbmr2499-bib-0004","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1359\/jbmr.1999.14.1.111","article-title":"Structure of the femoral neck in hip fracture: cortical bone loss in the inferoanterior to superoposterior axis","volume":"14","author":"Bell","year":"1999","journal-title":"J Bone Miner Res"},{"key":"2024020319035470600_jbmr2499-bib-0005","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1016\/S8756-3282(98)00143-4","article-title":"Regional differences in cortical porosity in the fractured femoral neck","volume":"24","author":"Bell","year":"1999","journal-title":"Bone"},{"key":"2024020319035470600_jbmr2499-bib-0006","doi-asserted-by":"crossref","first-page":"1318","DOI":"10.1359\/jbmr.2001.16.7.1318","article-title":"Intracapsular hip fracture and the region-specific loss of cortical bone: analysis by peripheral quantitative computed tomography","volume":"16","author":"Crabtree","year":"2001","journal-title":"J Bone Miner Res"},{"key":"2024020319035470600_jbmr2499-bib-0007","doi-asserted-by":"crossref","first-page":"1917","DOI":"10.1016\/j.jbiomech.2009.05.001","article-title":"During sideways falls proximal femur fractures initiate in the superolateral cortex: evidence from high-speed video of simulated fractures","volume":"42","author":"de Bakker","year":"2009","journal-title":"J Biomech"},{"key":"2024020319035470600_jbmr2499-bib-0008","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1016\/S0140-6736(05)66870-5","article-title":"Relation between age, femoral neck cortical stability, and hip fracture risk","volume":"366","author":"Mayhew","year":"2005","journal-title":"Lancet"},{"key":"2024020319035470600_jbmr2499-bib-0009","doi-asserted-by":"crossref","first-page":"482","DOI":"10.1359\/jbmr.090734","article-title":"Changing structure of the femoral neck across the adult female lifespan","volume":"25","author":"Poole","year":"2010","journal-title":"J Bone Miner Res"},{"key":"2024020319035470600_jbmr2499-bib-0010","doi-asserted-by":"crossref","first-page":"2165","DOI":"10.1002\/jbmr.1960","article-title":"Similarities and differences between sexes in regional loss of cortical and trabecular bone in the mid-femoral neck: The AGES-Reykjavik Longitudinal Study","volume":"28","author":"J\u00f3hannesd\u00f3ttir","year":"2013","journal-title":"J Bone Miner Res"},{"issue":"1","key":"2024020319035470600_jbmr2499-bib-0011","first-page":"69","article-title":"Asymmetric femoral neck trabecular bone loss with ageing: relative preservation of the inferior region","volume":"93","author":"Mayhew","year":"2011","journal-title":"J Bone Joint Surg Br"},{"key":"2024020319035470600_jbmr2499-bib-0012","doi-asserted-by":"crossref","first-page":"1808","DOI":"10.1359\/jbmr.090504","article-title":"Femoral neck trabecular bone: loss with aging and role in preventing fracture","volume":"24","author":"Thomas","year":"2009","journal-title":"J Bone Miner Res"},{"key":"2024020319035470600_jbmr2499-bib-0013","doi-asserted-by":"crossref","first-page":"1268","DOI":"10.1016\/j.bone.2011.03.776","article-title":"Distribution of cortical bone in the femoral neck and hip fracture: a prospective case-control analysis of 143 incident hip fractures; the AGES-REYKJAVIK Study","volume":"48","author":"J\u00f3hannesd\u00f3ttir","year":"2011","journal-title":"Bone"},{"key":"2024020319035470600_jbmr2499-bib-0014","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1016\/j.bone.2011.09.044","article-title":"Micro-structural basis for particular vulnerability of the superolateral neck trabecular bone in the postmenopausal women with hip fractures","volume":"50","author":"Milovanovic","year":"2012","journal-title":"Bone"},{"key":"2024020319035470600_jbmr2499-bib-0015","doi-asserted-by":"crossref","first-page":"1784","DOI":"10.1016\/j.jbiomech.2014.03.036","article-title":"Strain energy in the femoral neck during exercise","volume":"47","author":"Martelli","year":"2014","journal-title":"J Biomech"},{"key":"2024020319035470600_jbmr2499-bib-0016","doi-asserted-by":"crossref","first-page":"1634","DOI":"10.1359\/jbmr.1999.14.9.1634","article-title":"Have the DXA-based exercise studies seriously underestimated the effects of mechanical loading on bone","volume":"14","author":"Jarvinen","year":"1999","journal-title":"J Bone Miner Res"},{"key":"2024020319035470600_jbmr2499-bib-0017","doi-asserted-by":"crossref","first-page":"1475","DOI":"10.1359\/jbmr.1998.13.9.1475","article-title":"Randomized controlled study of effects of sudden impact loading on rat femur","volume":"13","author":"J\u00e4rvinen","year":"1998","journal-title":"J Bone Miner Res"},{"key":"2024020319035470600_jbmr2499-bib-0018","doi-asserted-by":"crossref","first-page":"1545","DOI":"10.1359\/jbmr.2002.17.8.1545","article-title":"Improved bone structure and strength after long-term mechanical loading is greatest if loading is separated into short bouts","volume":"17","author":"Robling","year":"2002","journal-title":"J Bone Miner Res"},{"key":"2024020319035470600_jbmr2499-bib-0019","doi-asserted-by":"crossref","first-page":"809","DOI":"10.1359\/JBMR.041222","article-title":"Bone adaptation to a mechanical loading program significantly increases skeletal fatigue resistance","volume":"20","author":"Warden","year":"2005","journal-title":"J Bone Miner Res"},{"key":"2024020319035470600_jbmr2499-bib-0020","doi-asserted-by":"crossref","first-page":"1321","DOI":"10.1007\/s00198-008-0785-x","article-title":"Targeted exercises against hip fragility","volume":"20","author":"Nikander","year":"2009","journal-title":"Osteoporos Int"},{"key":"2024020319035470600_jbmr2499-bib-0021","doi-asserted-by":"crossref","first-page":"120","DOI":"10.1359\/jbmr.1999.14.1.120","article-title":"Site specific effects of strength training on bone structure and geometry of ultradistal radius in post-menopausal women","volume":"14","author":"Adami","year":"1999","journal-title":"J Bone Miner Res"},{"key":"2024020319035470600_jbmr2499-bib-0022","doi-asserted-by":"crossref","first-page":"132","DOI":"10.1016\/S8756-3282(03)00082-6","article-title":"Effect of alendronate and exercise on bone and physical performance of postmenopausal women: a randomized controlled trial","volume":"33","author":"Uusi-Rasi","year":"2003","journal-title":"Bone"},{"key":"2024020319035470600_jbmr2499-bib-0023","doi-asserted-by":"crossref","first-page":"1337","DOI":"10.1002\/jbmr.2155","article-title":"Spatial heterogeneity in the response of the proximal femur to two lower-body resistance exercise regimens","volume":"29","author":"Lang","year":"2014","journal-title":"J Bone Miner Res"},{"key":"2024020319035470600_jbmr2499-bib-0024","doi-asserted-by":"crossref","first-page":"321","DOI":"10.1016\/j.bone.2012.12.045","article-title":"Brooke-Wavell K. High impact exercise increased femoral neck bone mineral density in older men: a randomised unilateral intervention","volume":"53","author":"Allison","year":"2013","journal-title":"Bone"},{"key":"2024020319035470600_jbmr2499-bib-0025","doi-asserted-by":"crossref","first-page":"1043","DOI":"10.1016\/j.bone.2009.12.001","article-title":"Optimum frequency of exercise for bone health: randomised controlled trial of a high-impact unilateral intervention","volume":"46","author":"Bailey","year":"2010","journal-title":"Bone"},{"issue":"11\u201312","key":"2024020319035470600_jbmr2499-bib-0026","doi-asserted-by":"crossref","first-page":"1083","DOI":"10.1016\/0021-9290(87)90026-1","article-title":"Functional strain in bone tissue as an objective, and controlling stimulus for adaptive bone remodelling","volume":"20","author":"Lanyon","year":"1987","journal-title":"J Biomech"},{"key":"2024020319035470600_jbmr2499-bib-0027","doi-asserted-by":"crossref","first-page":"313","DOI":"10.1016\/S8756-3282(98)00113-6","article-title":"Strain rate as a controlling influence on adaptive modeling in response to dynamic loading of the ulna in growing male rats","volume":"23","author":"Mosley","year":"1998","journal-title":"Bone"},{"key":"2024020319035470600_jbmr2499-bib-0028","doi-asserted-by":"crossref","first-page":"411","DOI":"10.1007\/BF02553711","article-title":"Regulation of bone mass by mechanical strain magnitude","volume":"37","author":"Rubin","year":"1985","journal-title":"Calcif Tissue Int"},{"key":"2024020319035470600_jbmr2499-bib-0029","doi-asserted-by":"crossref","first-page":"952","DOI":"10.1016\/j.media.2012.02.008","article-title":"Imaging the femoral cortex: thickness, density and mass from clinical CT","volume":"16","author":"Treece","year":"2012","journal-title":"Med Image Anal"},{"key":"2024020319035470600_jbmr2499-bib-0030","doi-asserted-by":"crossref","first-page":"e38466","DOI":"10.1371\/journal.pone.0038466","article-title":"Cortical thickness mapping to identify focal osteoporosis in patients with hip fracture","volume":"7","author":"Poole","year":"2012","journal-title":"PLoS One"},{"key":"2024020319035470600_jbmr2499-bib-0031","doi-asserted-by":"crossref","first-page":"46","DOI":"10.1002\/jbmr.2325","article-title":"Denosumab rapidly increases cortical bone in key locations of the femur: a 3D bone mapping study in women with osteoporosis","volume":"30","author":"Poole","year":"2015","journal-title":"J Bone Miner Res"},{"key":"2024020319035470600_jbmr2499-bib-0032","volume-title":"Technical report CUED\/F-INFENG\/TR691","author":"Treece","year":"2014"},{"key":"2024020319035470600_jbmr2499-bib-0033","first-page":"S102","volume-title":"Presented at: Organization for Human Brain Mapping 2009 Annual Meeting","author":"Worsley","year":"2009"},{"key":"2024020319035470600_jbmr2499-bib-0034","doi-asserted-by":"crossref","first-page":"453","DOI":"10.1016\/j.bone.2009.08.059","article-title":"Analysis of hip geometry by clinical CT for the assessment of hip fracture risk in elderly Japanese women","volume":"46","author":"Ito","year":"2010","journal-title":"Bone"},{"key":"2024020319035470600_jbmr2499-bib-0035","doi-asserted-by":"crossref","first-page":"252","DOI":"10.1007\/BF01774015","article-title":"Stress distributions within the proximal femur during gait and falls: Implications for osteoporotic fracture","volume":"5","author":"Lotz","year":"1995","journal-title":"Osteoporosis Int"},{"key":"2024020319035470600_jbmr2499-bib-0036","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1016\/j.bone.2007.08.039","article-title":"Load distribution in the healthy and osteoporotic human proximal femur during a fall to the side","volume":"42","author":"Verhulp","year":"2008","journal-title":"Bone"},{"issue":"2","key":"2024020319035470600_jbmr2499-bib-0037","first-page":"114","article-title":"Effect of calcar femoral upon the strength of proximal end of the femur: modelling with finite element method","volume":"4","author":"Glinkowski","year":"1998","journal-title":"Med Sci Monit"},{"key":"2024020319035470600_jbmr2499-bib-0038","doi-asserted-by":"crossref","first-page":"311","DOI":"10.1111\/j.1757-7861.2009.00053.x","article-title":"The role of the calcar femorale in stress distribution in the proximal femur","volume":"1","author":"Zhang","year":"2009","journal-title":"Orthop Surg"},{"issue":"1","key":"2024020319035470600_jbmr2499-bib-0039","first-page":"157","article-title":"Calcar femorale influences the fracture site of osteoporotic proximal femur","volume":"6","author":"Glinkowski","year":"1999","journal-title":"Osteoporos Int"},{"key":"2024020319035470600_jbmr2499-bib-0040","doi-asserted-by":"crossref","first-page":"881","DOI":"10.1002\/jbmr.270","article-title":"In vivo discrimination of hip fracture with quantitative computed tomography: results from the prospective European Femur Fracture Study (EFFECT)","volume":"26","author":"Bousson","year":"2011","journal-title":"J Bone Miner Res"},{"key":"2024020319035470600_jbmr2499-bib-0041","doi-asserted-by":"crossref","first-page":"537","DOI":"10.1002\/jbmr.1802","article-title":"Proximal femoral density distribution and structure in relation to age and hip fracture risk in women","volume":"28","author":"Carballido-Gamio","year":"2013","journal-title":"J Bone Miner Res"},{"key":"2024020319035470600_jbmr2499-bib-0042","doi-asserted-by":"crossref","first-page":"346","DOI":"10.4248\/BR201304005","article-title":"Trabecular plate loss and deteriorating elastic modulus of femoral trabecular bone in intertrochanteric hip fractures","volume":"1","author":"Wang","year":"2013","journal-title":"Bone Res"},{"key":"2024020319035470600_jbmr2499-bib-0043","doi-asserted-by":"crossref","first-page":"101","DOI":"10.1016\/0169-6009(91)90039-3","article-title":"A reconstruction of the remodelling cycle in normal human cortical iliac bone","volume":"12","author":"Agerbaek","year":"1991","journal-title":"Bone Miner"},{"key":"2024020319035470600_jbmr2499-bib-0044","doi-asserted-by":"crossref","first-page":"1081","DOI":"10.1002\/ar.a.10119","article-title":"Bone's mechanostat: a 2003 update","volume":"275","author":"Frost","year":"2003","journal-title":"Anat Rec"},{"key":"2024020319035470600_jbmr2499-bib-0045","doi-asserted-by":"crossref","first-page":"783","DOI":"10.1016\/j.clinbiomech.2013.06.010","article-title":"Comparison of gluteal and hamstring activation during five commonly used plyometric exercises","volume":"28","author":"Struminger","year":"2013","journal-title":"Clin Biomech"},{"key":"2024020319035470600_jbmr2499-bib-0046","doi-asserted-by":"crossref","first-page":"827","DOI":"10.1016\/j.annepidem.2008.08.007","article-title":"The association between physical activity and osteoporotic fractures: a review of the evidence and implications for future research","volume":"18","author":"Moayyeri","year":"2008","journal-title":"Ann Epidemiol"},{"key":"2024020319035470600_jbmr2499-bib-0047","doi-asserted-by":"crossref","first-page":"1985","DOI":"10.1249\/01.MSS.0000142662.21767.58","article-title":"American College of Sports Medicine Position Stand: physical activity and bone health","volume":"36","author":"Kohrt","year":"2004","journal-title":"Med Sci Sports Exerc"},{"key":"2024020319035470600_jbmr2499-bib-0048","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1007\/s00198-009-0967-1","article-title":"The effects of exercise and physical activity participation on bone mass and geometry in postmenopausal women: a systematic review of pQCT studies","volume":"21","author":"Hamilton","year":"2010","journal-title":"Osteoporos Int"}],"container-title":["Journal of Bone and Mineral Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1002%2Fjbmr.2499","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1002%2Fjbmr.2499","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/jbmr.2499","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/jbmr.2499","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/academic.oup.com\/jbmr\/article-pdf\/30\/9\/1709\/56567667\/jbmr2499.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/jbmr\/article-pdf\/30\/9\/1709\/56567667\/jbmr2499.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,3,13]],"date-time":"2024-03-13T14:54:01Z","timestamp":1710341641000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/jbmr\/article\/30\/9\/1709-1716\/7599188"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2015,3,5]]},"references-count":48,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2015,3,5]]},"published-print":{"date-parts":[[2015,9,1]]}},"URL":"https:\/\/doi.org\/10.1002\/jbmr.2499","relation":{},"ISSN":["0884-0431","1523-4681"],"issn-type":[{"value":"0884-0431","type":"print"},{"value":"1523-4681","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2015,9,1]]},"published":{"date-parts":[[2015,3,5]]}}}