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NIH Consensus Development Panel on Osteoporosis Prevention, Diagnosis, and Therapy. Osteoporosis prevention, diagnosis, and therapy. <i>JAMA<\/i>. 2001;285(6):785\u2013795.","DOI":"10.1001\/jama.285.6.785"},{"key":"2","doi-asserted-by":"crossref","unstructured":"2. Peeters CMM, Visser E, Van De Ree CLP, Gosens T, Den Oudsten BL, De Vries J. Quality of life after hip fracture in the elderly: a systematic literature review. <i>Injury<\/i>. 2016;47(7):1369\u20131382.","DOI":"10.1016\/j.injury.2016.04.018"},{"key":"3","doi-asserted-by":"crossref","unstructured":"3. Katsoulis M, Benetou V, Karapetyan T, et\u00a0al. Excess mortality after hip fracture in elderly persons from Europe and the USA: the CHANCES project. <i>J Intern Med<\/i>. 2017;281(3):300\u2013310.","DOI":"10.1111\/joim.12586"},{"key":"4","doi-asserted-by":"crossref","unstructured":"4. Burge R, Dawson-Hughes B, Solomon DH, Wong JB, King A, Tosteson A. Incidence and economic burden of osteoporosis-related fractures in the United States, 2005\u20132025. <i>J Bone Miner Res<\/i>. 2007;22(3):465\u2013475.","DOI":"10.1359\/jbmr.061113"},{"key":"5","doi-asserted-by":"crossref","unstructured":"5. Taguchi Y, Inoue Y, Kido T, Arai N. Treatment costs and cost drivers among osteoporotic fracture patients in Japan: a retrospective database analysis. <i>Arch Osteoporos<\/i>. 2018;13(1):45.","DOI":"10.1007\/s11657-018-0456-2"},{"key":"6","doi-asserted-by":"crossref","unstructured":"6. Kyu HH, Bachman VF, Alexander LT, et\u00a0al. Physical activity and risk of breast cancer, colon cancer, diabetes, ischemic heart disease, and ischemic stroke events: systematic review and dose-response meta-analysis for the Global Burden of Disease Study 2013. <i>BMJ<\/i>. 2016;354:i3857.","DOI":"10.1136\/bmj.i3857"},{"key":"7","doi-asserted-by":"crossref","unstructured":"7. Qu X, Zhang X, Zhai Z, et\u00a0al. 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Association of physical activity and fracture risk among postmenopausal women. <i>JAMA Netw Open<\/i>. 2019;2(10):e1914084.","DOI":"10.1001\/jamanetworkopen.2019.14084"},{"key":"11","doi-asserted-by":"crossref","unstructured":"11. Han S, Choi S, Jang HD, et\u00a0al. The impact of regular physical activity on vertebral fractures: Korean nationwide population-based cohort study. <i>BMC Musculoskelet Disord<\/i>. 2025;26(1):78.","DOI":"10.1186\/s12891-024-08179-2"},{"key":"12","doi-asserted-by":"crossref","unstructured":"12. Nakamura K, Kitamura K, Inoue M, Sawada N, Tsugane S; Japan Public Health Center-based Prospective Study Group. Physical activity and 10-year incidence of self-reported vertebral fractures in Japanese women: the Japan Public Health Center-based Prospective Study. <i>Osteoporos Int<\/i>. 2014;25(11):2565\u20132571.","DOI":"10.1007\/s00198-014-2770-x"},{"key":"13","doi-asserted-by":"crossref","unstructured":"13. Mikkil\u00e4 S, Calogiuri G, Emaus N, Morseth B. A cross-sectional and 6-year follow-up study of associations between leisure time physical activity and vertebral fracture in adults. <i>BMC Musculoskelet Disord<\/i>. 2019;20(1):435.","DOI":"10.1186\/s12891-019-2821-8"},{"key":"14","doi-asserted-by":"crossref","unstructured":"14. Nakamura K, Takachi R, Kitamura K, et\u00a0al. The Murakami Cohort Study of vitamin D for the prevention of musculoskeletal and other age-related diseases: a study protocol. <i>Environ Health Prev Med<\/i>. 2018;23(1):28.","DOI":"10.1186\/s12199-018-0715-2"},{"key":"15","doi-asserted-by":"crossref","unstructured":"15. Kikuchi H, Inoue S, Odagiri Y, et\u00a0al. Intensity-specific validity and reliability of the Japan Public Health Center-based prospective study-physical activity questionnaire. <i>Prev Med Rep<\/i>. 2020;20:101169.","DOI":"10.1016\/j.pmedr.2020.101169"},{"key":"16","unstructured":"16. World Health Organization. <i>WHO Guidelines on Physical Activity and Sedentary Behaviour<\/i>. World Health Organization; 2020."},{"key":"17","doi-asserted-by":"crossref","unstructured":"17. Yokoyama Y, Takachi R, Ishihara J, et\u00a0al. Validity of short and long self-administered food frequency questionnaires in ranking dietary intake in middle-aged and elderly Japanese in the Japan Public Health Center-Based Prospective Study for the Next Generation (JPHC-NEXT) protocol area. <i>J Epidemiol<\/i>. 2016;26(8):420\u2013432.","DOI":"10.2188\/jea.JE20150064"},{"key":"18","unstructured":"18. Kanis J. <i>Textbook of Osteoporosis<\/i>. Blackwell Science; 1996."},{"key":"19","doi-asserted-by":"crossref","unstructured":"19. Soen S, Fukunaga M, Sugimoto T, et\u00a0al; Japanese Society for Bone and Mineral Research and Japan Osteoporosis Society Joint Review Committee for the Revision of the Diagnostic Criteria for Primary Osteoporosis. Diagnostic criteria for primary osteoporosis: year 2012 revision. <i>J Bone Miner Metab<\/i>. 2013;31(3):247\u2013257.","DOI":"10.1007\/s00774-013-0447-8"},{"key":"20","doi-asserted-by":"crossref","unstructured":"20. Platonova K, Kitamura K, Watanabe Y, et\u00a0al. Dietary calcium and vitamin K are associated with osteoporotic fracture risk in middle-aged and elderly Japanese women, but not men: the Murakami Cohort Study. <i>Br J Nutr<\/i>. 2021;125(3):319\u2013328.","DOI":"10.1017\/S0007114520001567"},{"key":"21","unstructured":"21. World Health Organization. Prevention and management of osteoporosis. <i>World Health Organ Tech Rep Ser<\/i>. 2003;921:1\u2013164, back cover."},{"key":"22","doi-asserted-by":"crossref","unstructured":"22. Yao P, Parish S, Bennett DA, et\u00a0al; China Kadoorie Biobank Collaborative Group. Gender differences in modifiable risk factors for hip fracture: 10-year follow-up of a prospective study of 0.5 million Chinese adults. <i>J Intern Med<\/i>. 2022;291(4):481\u2013492.","DOI":"10.1111\/joim.13429"},{"key":"23","doi-asserted-by":"crossref","unstructured":"23. Micha\u00eblsson K, Olofsson H, Jensevik K, et\u00a0al. Leisure physical activity and the risk of fracture in men. <i>PLoS Med<\/i>. 2007;4(6):e199.","DOI":"10.1371\/journal.pmed.0040199"},{"key":"24","doi-asserted-by":"crossref","unstructured":"24. Morseth B, Ahmed LA, Bj\u00f8rnerem \u00c5, et\u00a0al. Leisure time physical activity and risk of non-vertebral fracture in men and women aged 55 years and older: the Troms\u00f8 Study. <i>Eur J Epidemiol<\/i>. 2012;27(6):463\u2013471.","DOI":"10.1007\/s10654-012-9665-y"},{"key":"25","doi-asserted-by":"crossref","unstructured":"25. Sherrington C, Fairhall NJ, Wallbank GK, et\u00a0al. Exercise for preventing falls in older people living in the community. <i>Cochrane Database Syst Rev<\/i>. 2019;1(1):CD012424.","DOI":"10.1002\/14651858.CD012424.pub2"},{"key":"26","doi-asserted-by":"crossref","unstructured":"26. Hejazi K, Askari R, Hofmeister M. Effects of physical exercise on bone mineral density in older postmenopausal women: a systematic review and meta-analysis of randomized controlled trials. <i>Arch Osteoporos<\/i>. 2022;17(1):102.","DOI":"10.1007\/s11657-022-01140-7"},{"key":"27","doi-asserted-by":"crossref","unstructured":"27. Rico H, Gonz\u00e1lez-Riola J, Revilla M, Villa LF, G\u00f3mez-Castresana F, Escribano J. Cortical versus trabecular bone mass: influence of activity on both bone components. <i>Calcif Tissue Int<\/i>. 1994;54(6):470\u2013472.","DOI":"10.1007\/BF00334325"},{"key":"28","doi-asserted-by":"crossref","unstructured":"28. Appleby PN, Allen NE, Roddam AW, Key TJ. Physical activity and fracture risk: a prospective study of 1898 incident fractures among 34,696 British men and women. <i>J Bone Miner Metab<\/i>. 2008;26(2):191\u2013198.","DOI":"10.1007\/s00774-007-0806-4"},{"key":"29","doi-asserted-by":"crossref","unstructured":"29. Langsetmo L, Hitchcock CL, Kingwell EJ, et\u00a0al; Canadian Multicentre Osteoporosis Study Research Group. Physical activity, body mass index and bone mineral density-associations in a prospective population-based cohort of women and men: the Canadian Multicentre Osteoporosis Study (CaMos). <i>Bone<\/i>. 2012;50(1):401\u2013408.","DOI":"10.1016\/j.bone.2011.11.009"},{"key":"30","doi-asserted-by":"crossref","unstructured":"30. Muir JM, Ye C, Bhandari M, Adachi JD, Thabane L. The effect of regular physical activity on bone mineral density in post-menopausal women aged 75 and over: a retrospective analysis from the Canadian multicentre osteoporosis study. <i>BMC Musculoskelet Disord<\/i>. 2013;14:253.","DOI":"10.1186\/1471-2474-14-253"},{"key":"31","doi-asserted-by":"crossref","unstructured":"31. Shi V, Morgan EF. Estrogen and estrogen receptors mediate the mechanobiology of bone disease and repair. <i>Bone<\/i>. 2024;188:117220.","DOI":"10.1016\/j.bone.2024.117220"},{"key":"32","doi-asserted-by":"crossref","unstructured":"32. Schlacht TZ, Haque I, Skelton DA. What are the effects of exercise on trabecular microarchitecture in older adults? A systematic review and meta-analysis of HR-pQCT studies. <i>Calcif Tissue Int<\/i>. 2023;113(4):359\u2013382.","DOI":"10.1007\/s00223-023-01127-7"},{"key":"33","doi-asserted-by":"crossref","unstructured":"33. Myers ER, Wilson SE. Biomechanics of osteoporosis and vertebral fracture. <i>Spine (Phila Pa 1976)<\/i>. 1997;22(24 Suppl):25S\u201331S.","DOI":"10.1097\/00007632-199712151-00005"},{"key":"34","doi-asserted-by":"crossref","unstructured":"34. Silva MJ. Biomechanics of osteoporotic fractures. <i>Injury<\/i>. 2007;38(Suppl 3):S69\u2013S76.","DOI":"10.1016\/j.injury.2007.08.014"},{"key":"35","doi-asserted-by":"crossref","unstructured":"35. Adams MA, Dolan P. Biomechanics of vertebral compression fractures and clinical application. <i>Arch Orthop Trauma Surg<\/i>. 2011;131(12):1703\u20131710.","DOI":"10.1007\/s00402-011-1355-9"},{"key":"36","doi-asserted-by":"crossref","unstructured":"36. Jackman TM, Hussein AI, Curtiss C, et\u00a0al. Quantitative, 3D visualization of the initiation and progression of vertebral fractures under compression and anterior flexion. <i>J Bone Miner Res<\/i>. 2016;31(4):777\u2013788.","DOI":"10.1002\/jbmr.2749"},{"key":"37","doi-asserted-by":"crossref","unstructured":"37. Kamimura S, Iida T, Watanabe Y, et\u00a0al. Physical activity and recurrent fall risk in community-dwelling Japanese people aged 40\u201374 years: the Murakami cohort study. <i>Eur Rev Aging Phys Act<\/i>. 2022;19(1):20.","DOI":"10.1186\/s11556-022-00300-5"},{"key":"38","doi-asserted-by":"crossref","unstructured":"38. Hanyuda A, Sawada N, Uchino M, et\u00a0al; JPHC-NEXT Study Group. Physical inactivity, prolonged sedentary behaviors, and use of visual display terminals as potential risk factors for dry eye disease: JPHC-NEXT study. <i>Ocul Surf<\/i>. 2020;18(1):56\u201363.","DOI":"10.1016\/j.jtos.2019.09.007"},{"key":"39","doi-asserted-by":"crossref","unstructured":"39. Holtermann A, Krause N, Van Der Beek AJ, Straker L. 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