Physical activity and weight-bearing exercises have been shown to increase BMD in different pathological conditions, as well as in health (51,52). Of course the type, quantity and quality of physical activity must be tailored on the basis of sex, age, and primary disease. Children physically active at a younger age show a higher periosteal bone formation, resulting in a greater diameter of the long bones, with an increased BMC. On the contrary, those who started regular activity after puberty tend to have bone mass increases as the result of endocortical formation. The periosteal growth of the former potentially results in a lifelong larger skeleton, providing greater resistance to fractures and periosteal remodeling.
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