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// ──────────────────────────────────────────────────────────────────────────
// COLUMN 1 — Introduction + Aims
// ──────────────────────────────────────────────────────────────────────────
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  { text: "Bone mineral density (BMD) is a key indicator of skeletal health and fracture risk. Weight-bearing and resistance exercise are among the most effective non-pharmacological strategies for maintaining and improving BMD across the lifespan.", options: { breakLine: true } },
  { text: "\n", options: { breakLine: true } },
  { text: "Bone density peaks at approximately 30 years of age; thereafter, net bone loss begins, with women experiencing accelerated resorption following the menopause due to declining oestrogen levels (Rizzoli, Bianchi, Garabédian, McKay and Moreno, 2010). Osteoporosis affects an estimated 200 million women worldwide and is a leading cause of fragility fractures (Kanis, Cooper, Rizzoli and Reginster, 2019).", options: { breakLine: true } },
  { text: "\n", options: { breakLine: true } },
  { text: "Exercise — particularly the combination of resistance and high-impact loading — has been shown to attenuate bone loss and in some cases increase BMD, even in postmenopausal women with low bone mass (Watson, Weeks, Weis, Harding, Horan and Beck, 2018). However, the relative magnitude of response by age and sex group remains incompletely characterised.", options: {} }
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  { text: " To investigate the effect of a combined resistance and impact exercise programme on BMD across four age and gender groups over 12 months.", options: { breakLine: true } },
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  { text: "Hypotheses:", options: { bold: true, breakLine: true } },
  { text: "H1: Combined exercise will significantly increase BMD at the hip and lumbar spine compared with baseline across all groups.", options: { bullet: true, breakLine: true } },
  { text: "H2: Pre-menopausal women and younger adult males (30–40 yrs) will show the greatest BMD gains (~1–2%).", options: { bullet: true, breakLine: true } },
  { text: "H3: Post-menopausal women will show a smaller but statistically significant improvement in BMD compared with older males.", options: { bullet: true } }
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const ethicsText = [
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  { text: "Full ethical approval will be sought from the Birmingham City University Health, Education and Life Sciences (HELS) Faculty Ethics Committee prior to data collection. All participants will receive a detailed participant information sheet at least 48 hours before enrolment. Written informed consent will be obtained from every individual, who will retain the right to withdraw at any time without penalty. Participant data will be stored securely, anonymised, and destroyed after five years in accordance with the General Data Protection Regulation (GDPR, 2018).", options: { breakLine: true } },
  { text: "\n", options: { breakLine: true } },
  { text: "Inclusion/Exclusion:", options: { bold: true, breakLine: true } },
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// ──────────────────────────────────────────────────────────────────────────
// COLUMN 2 — Method
// ──────────────────────────────────────────────────────────────────────────
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  { text: "A 12-month prospective longitudinal randomised controlled study will be conducted. One hundred and twenty sedentary volunteers, recruited from community churches, will be randomly allocated to four groups of 30:", options: { breakLine: true } },
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  { text: " — Post-menopausal women, 40–50 yrs", options: { breakLine: true } },
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  { text: " — Younger adult males, 30–40 yrs", options: { breakLine: true } },
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  { text: "BMD Measurement (Primary Outcome):", options: { bold: true, breakLine: true } },
  { text: "Dual-energy X-ray absorptiometry (DXA) will be used to measure BMD at the lumbar spine and total hip at baseline (T0), 6 months (T6), and 12 months (T12). DXA employs two low-dose X-ray beams at differing energy levels to calculate bone mineral content and density; it is the clinical gold standard for diagnosing osteoporosis (Kanis et al., 2019). Potential interpretation limitations, including soft-tissue artefact and body composition effects, will be standardised across measurement time-points (Albano, Messina, Vitale and Maffei, 2020).", options: {} }
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  { text: "Exercise Intervention:", options: { bold: true, breakLine: true } },
  { text: "All groups will follow an identical periodised programme combining resistance and impact modalities, consistent with evidence that multi-modal loading optimises osteogenic adaptation (Mohebbi, Shojaa, Kohl, von Stengel, Jakob and Kerschan-Schindl, 2023):", options: { breakLine: true } },
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  { text: "Resistance training", options: { bold: true, breakLine: false } },
  { text: " (3×/week): bilateral squats, lunges, and deadlifts progressing from 60% to ≥85% of one repetition maximum.", options: { breakLine: true } },
  { text: "Impact training", options: { bold: true, breakLine: false } },
  { text: " (2×/week): hopping, drop-jumps, and countermovement jumps targeting ground reaction forces >3× body weight (Hinton, Nigh and Thyfault, 2015).", options: { breakLine: true } },
  { text: "\n", options: { breakLine: true } },
  { text: "Nutritional Standardisation:", options: { bold: true, breakLine: true } },
  { text: "All participants will receive 1,000 mg calcium and 800 IU vitamin D daily throughout the study; dietary calcium intake will be monitored via 3-day food diaries at baseline, T6, and T12 to control for confounding nutritional variables (Weaver, Gordon, Janz, Kalkwarf, Lappe, Lewis, O'Karma, Wallace and Zemel, 2015).", options: { breakLine: true } },
  { text: "\n", options: { breakLine: true } },
  { text: "Statistical Analysis:", options: { bold: true, breakLine: true } },
  { text: "A two-way repeated-measures ANOVA (group × time) will compare BMD changes. Tukey's HSD post hoc test will identify pairwise group differences to ensure accuracy and reliability of findings.", options: {} }
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// ──────────────────────────────────────────────────────────────────────────
// COLUMN 3 — Safety / Risk Assessment + Expected Results
// ──────────────────────────────────────────────────────────────────────────
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  { text: "\n", options: { breakLine: true } },
  { text: "Cardiovascular events:", options: { bold: true, breakLine: true } },
  { text: "Risk: low. Mitigation: pre-participation health screening using the PAR-Q+; GP medical clearance required for all participants ≥40 years; defibrillator available on-site.", options: { breakLine: true } },
  { text: "\n", options: { breakLine: true } },
  { text: "Fall/impact injury (plyometric training):", options: { bold: true, breakLine: true } },
  { text: "Risk: low–moderate. Mitigation: non-slip flooring, appropriate footwear, and a structured warm-up; progressions introduced only after demonstrated landing technique competency.", options: { breakLine: true } },
  { text: "\n", options: { breakLine: true } },
  { text: "Radiation exposure (DXA):", options: { bold: true, breakLine: true } },
  { text: "Risk: minimal. Each DXA scan delivers <10 µSv — substantially below annual background exposure. Three scans total per participant. Pregnant participants will be excluded.", options: { breakLine: true } },
  { text: "\n", options: { breakLine: true } },
  { text: "Adverse events will be recorded in an incident log. A Data Safety Monitoring Board will review safety data at the T6 interim analysis.", options: {} }
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  { text: "Pre-menopausal women (Group 1) and younger adult males (Group 3) are expected to show the greatest BMD gains (~1–2%) at lumbar spine and total hip, reflecting higher baseline bone turnover capacity and oestrogen/testosterone support.", options: { breakLine: true } },
  { text: "\n", options: { breakLine: true } },
  { text: "Post-menopausal women (Group 2) and older males (Group 4) are anticipated to show attenuated but clinically meaningful gains, consistent with meta-analytic data demonstrating positive exercise effects on BMD regardless of menopausal or bone status (Mohebbi et al., 2023).", options: { breakLine: true } },
  { text: "\n", options: { breakLine: true } },
  { text: "These findings would underline the importance of initiating regular load-bearing exercise before peak bone mass declines, while also confirming benefit at older ages.", options: {} }
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// ──────────────────────────────────────────────────────────────────────────
// COLUMN 4 — Ethical concerns (additional) + References
// ──────────────────────────────────────────────────────────────────────────
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  { text: "Vulnerability considerations:", options: { bold: true, breakLine: true } },
  { text: "Post-menopausal women with potential undiagnosed osteoporosis represent a vulnerable sub-group. Pre-study DXA screening will identify individuals with T-scores below −2.5; these participants will be referred to their GP prior to inclusion. Exercise intensity will be individually tailored where clinically indicated.", options: { breakLine: true } },
  { text: "\n", options: { breakLine: true } },
  { text: "Data governance:", options: { bold: true, breakLine: true } },
  { text: "All personal and health data will be pseudonymised. Data will be held on a password-protected, encrypted university server. Access will be restricted to the principal investigator and supervisor. Raw data will be permanently deleted five years post-publication in line with BCU data retention policy and GDPR (2018).", options: { breakLine: true } },
  { text: "\n", options: { breakLine: true } },
  { text: "Conflict of interest:", options: { bold: true, breakLine: true } },
  { text: "The study receives no commercial funding. Calcium and vitamin D supplements will be sourced from an independent supplier with no financial relationship to the research team.", options: { breakLine: true } },
  { text: "\n", options: { breakLine: true } },
  { text: "Animal/biological material:", options: { bold: true, breakLine: true } },
  { text: "No animal tissue or biological specimens are used in this study. All data are derived from human participants who have given informed consent.", options: {} }
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sectionHeader(slide, col4X, y, COL_W, "REFERENCES");
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const refsText = [
  { text: "Albano, D., Messina, C., Vitale, J. and Maffei, E. (2020) 'Imaging of the hip: which technique and when', ", options: { breakLine: false } },
  { text: "RMD Open", options: { italic: true, breakLine: false } },
  { text: ", 6(1), p. e001012.", options: { breakLine: true } },

  { text: "\nCleveland Clinic (2020) ", options: { breakLine: false } },
  { text: "Bone Density Scan (DEXA, DXA)", options: { italic: true, breakLine: false } },
  { text: ". Available at: https://my.clevelandclinic.org/health/diagnostics/10683-dexa-scan [Accessed: 3 May 2026].", options: { breakLine: true } },

  { text: "\nGarg, M.K. and Kharb, S. (2013) 'Dual energy X-ray absorptiometry: pitfalls in measurement and interpretation of bone mineral density', ", options: { breakLine: false } },
  { text: "Indian Journal of Endocrinology and Metabolism", options: { italic: true, breakLine: false } },
  { text: ", 17(2), pp. 203–210.", options: { breakLine: true } },

  { text: "\nHinton, P.S., Nigh, P. and Thyfault, J. (2015) 'Effectiveness of resistance training or jumping-exercise to increase bone mineral density in men with low bone mass', ", options: { breakLine: false } },
  { text: "Journal of Osteoporosis", options: { italic: true, breakLine: false } },
  { text: ", 2015, pp. 1–12.", options: { breakLine: true } },

  { text: "\nKanis, J.A., Cooper, C., Rizzoli, R. and Reginster, J-Y. (2019) 'European guidance for the diagnosis and management of osteoporosis in postmenopausal women', ", options: { breakLine: false } },
  { text: "Osteoporosis International", options: { italic: true, breakLine: false } },
  { text: ", 30(1), pp. 3–44.", options: { breakLine: true } },

  { text: "\nMohebbi, R., Shojaa, M., Kohl, M., von Stengel, S., Jakob, F. and Kerschan-Schindl, K. (2023) 'Exercise training and bone mineral density in postmenopausal women', ", options: { breakLine: false } },
  { text: "Osteoporosis International", options: { italic: true, breakLine: false } },
  { text: ", 34(7), pp. 1131–1157.", options: { breakLine: true } },

  { text: "\nRizzoli, R., Bianchi, M.L., Garabédian, M., McKay, H.A. and Moreno, L.A. (2010) 'Maximizing bone mineral mass gain during growth for the prevention of fractures in the adolescents and the elderly', ", options: { breakLine: false } },
  { text: "Bone", options: { italic: true, breakLine: false } },
  { text: ", 46(2), pp. 294–305.", options: { breakLine: true } },

  { text: "\nWatson, S.L., Weeks, B.K., Weis, L.J., Harding, A.T., Horan, S.A. and Beck, B.R. (2018) 'High-intensity resistance and impact training improves bone mineral density and physical function in postmenopausal women with osteopenia and osteoporosis', ", options: { breakLine: false } },
  { text: "Journal of Bone and Mineral Research", options: { italic: true, breakLine: false } },
  { text: ", 33(2), pp. 211–220.", options: { breakLine: true } },

  { text: "\nWeaver, C.M., Gordon, C.M., Janz, K.F., Kalkwarf, H.J., Lappe, J.M., Lewis, R., O'Karma, M., Wallace, T.C. and Zemel, B.S. (2015) 'The National Osteoporosis Foundation's position statement on peak bone mass development and lifestyle factors', ", options: { breakLine: false } },
  { text: "Osteoporosis International", options: { italic: true, breakLine: false } },
  { text: ", 27(4), pp. 1281–1386.", options: {} }
];
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// ══════════════════════════════════════════════════════════════════════════
// COLUMN 1 — Introduction  |  Aims & Hypotheses  |  Ethics (part 1)
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  n("Bone mineral density (BMD) is a critical determinant of skeletal strength and fracture risk throughout the lifespan. BMD peaks at approximately 30 years of age, after which net bone loss begins; women experience a particularly sharp acceleration in bone resorption following the menopause due to declining oestrogen (Rizzoli, Bianchi, Garabédian, McKay and Moreno, 2010).", true),
  sp(),
  n("Osteoporosis is a systemic skeletal disease characterised by low BMD and micro-architectural deterioration leading to increased fragility and fracture risk. The Royal Osteoporosis Society (no date) emphasises that both impact and muscle-strengthening exercises are among the most evidence-based strategies to preserve and improve bone strength across the lifespan.", true),
  sp(),
  n("DXA (dual-energy X-ray absorptiometry) is the clinical gold standard for measuring BMD, using two low-dose X-ray beams at different energy levels to determine bone mineral content relative to soft tissue. It is quick, painless, and widely used to diagnose osteoporosis and monitor treatment response. However, operator-related errors and interpretation pitfalls must be carefully managed (Albano, Agnollitto, Petrini, Biacca, Ulivieri, Sconfienza and Messina, 2020; Garg and Kharb, 2013; Cleveland Clinic, 2020).", false)
], 6.6);
y += 1.64;

hdr(col1X, y, COL_W, "AIMS & HYPOTHESES");
y += 0.245;

box(col1X, y, COL_W, 1.10, [
  b("Aim: ", false), n("To investigate the effect of a 12-month combined resistance and impact exercise programme on BMD across four age and gender groups.", true),
  sp(),
  b("Hypotheses:", true),
  { text: "H\u2081: Combined exercise will significantly increase BMD at the hip and lumbar spine across all four groups.", options: { bullet: true, breakLine: true } },
  { text: "H\u2082: Pre-menopausal women and younger adult males (30\u201340 yrs) will show the greatest BMD gains (~1\u20132%).", options: { bullet: true, breakLine: true } },
  { text: "H\u2083: Post-menopausal women and older males (40\u201350 yrs) will show smaller but statistically significant BMD improvements.", options: { bullet: true } }
], 6.7);
y += 1.12;

hdr(col1X, y, COL_W, "ETHICAL & LEGAL CONCERNS");
y += 0.245;

box(col1X, y, COL_W, 1.53, [
  b("Ethics application:", true),
  n("Full ethical approval will be sought from the BCU Health, Education and Life Sciences (HELS) Faculty Ethics Committee before any data collection. All participants will receive a detailed information sheet at least 48 hours before enrolment and must provide written informed consent. Participants retain the right to withdraw at any time without penalty or detriment to their ongoing involvement.", true),
  sp(),
  b("Data governance:", true),
  n("All personal and health data will be pseudonymised, stored on a password-protected encrypted university server, and accessible only to the principal investigator and supervisor. Raw data will be permanently deleted five years post-publication in line with BCU data retention policy and the General Data Protection Regulation (GDPR, 2018).", false)
], 6.5);

// ══════════════════════════════════════════════════════════════════════════
// COLUMN 2 — Method  |  Method Cont.
// ══════════════════════════════════════════════════════════════════════════
y = COL_Y;

hdr(col2X, y, COL_W, "METHOD");
y += 0.245;

box(col2X, y, COL_W, 2.52, [
  b("Study design:", true),
  n("A 12-month prospective longitudinal study. One hundred and twenty sedentary volunteers, recruited from community churches via random selection, will be allocated to four groups of 30:", true),
  sp(),
  b("Group 1", false), n(" — Pre-menopausal women, 30–40 yrs", true),
  b("Group 2", false), n(" — Post-menopausal women, 40–50 yrs", true),
  b("Group 3", false), n(" — Younger adult males, 30–40 yrs", true),
  b("Group 4", false), n(" — Older adult males, 40–50 yrs", true),
  sp(),
  b("Participants:", true),
  n("All volunteers must be generally healthy and currently sedentary. Exclusion criteria include musculoskeletal conditions, metabolic bone disease, and medications known to affect bone metabolism.", true),
  sp(),
  b("Primary outcome — BMD measurement:", true),
  n("BMD will be measured at the lumbar spine and total hip using DXA scans at baseline (T0), 6 months (T6), and 12 months (T12). DXA employs two low-dose X-ray beams at differing energy levels to calculate bone mineral content and density from the differential absorption by bone versus soft tissue. It is the clinical gold standard and most widely used hospital method for diagnosing osteoporosis (Cleveland Clinic, 2020). All scans will be conducted by a trained radiographer to minimise operator-related errors and pitfalls in measurement (Albano et al., 2020; Garg and Kharb, 2013).", true),
  sp(),
  b("Nutritional standardisation:", true),
  n("To prevent diet from confounding BMD results, all participants will supplement with 1,000 mg calcium and 800 IU vitamin D daily throughout the study. Dietary intake will be monitored at T0, T6, and T12 via 3-day food diaries (Weaver, Gordon, Janz, Kalkwarf, Lappe, Lewis, O'Karma, Wallace and Zemel, 2015).", false)
], 6.6);
y += 2.54;

hdr(col2X, y, COL_W, "METHOD CONT.");
y += 0.245;

box(col2X, y, COL_W, 2.20, [
  b("Exercise intervention:", true),
  n("All groups follow an identical periodised programme combining resistance and impact loading, in line with guidance on safe and effective exercise for bone health (Royal Osteoporosis Society, no date; Giangregorio et al., 2014):", true),
  sp(),
  b("Resistance training (3×/week): ", false),
  n("Bilateral squats, lunges, and deadlifts. Load will progress from 60% to ≥85% of one repetition maximum (1RM). This modality targets muscle-strengthening and bone-loading principles supported by the Royal Osteoporosis Society (no date).", true),
  sp(),
  b("Impact training (2×/week): ", false),
  n("Hopping, drop-jumps, and countermovement jumps producing ground reaction forces >3× body weight. Impact exercise applies mechanical strain to bone, stimulating osteogenic adaptation (Hinton, Nigh and Thyfault, 2015).", true),
  sp(),
  b("Statistical analysis:", true),
  n("A two-way repeated-measures ANOVA (group × time) will assess BMD changes between and within groups. ANOVA determines whether significant differences exist across multiple group means simultaneously (Qualtrics, 2023). Tukey's Honestly Significant Difference (HSD) post hoc test will then identify exactly which group pairs differ significantly. Tukey's HSD is most appropriate when comparing all possible group pairings with equal sample sizes, controlling the family-wise error rate at α = 0.05 (Frost, 2019; Abdi and Williams, 2010). P-values will be interpreted as the probability of observing results at least as extreme as those found, assuming the null hypothesis is true (Nahm, 2017).", false)
], 6.6);

// ══════════════════════════════════════════════════════════════════════════
// COLUMN 3 — Risk Assessment  |  Expected Results
// ══════════════════════════════════════════════════════════════════════════
y = COL_Y;

hdr(col3X, y, COL_W, "RISK ASSESSMENT & SAFETY");
y += 0.245;

box(col3X, y, COL_W, 3.10, [
  n("All exercise sessions will be supervised by qualified fitness professionals. Risks identified during the risk assessment process are as follows:", true),
  sp(),
  b("1. Musculoskeletal injury (resistance training)", true),
  n("Risk level: Moderate. Mitigation: structured progressive overload beginning at 60% 1RM; technique assessed each session; session stopped immediately if pain exceeds 3/10 on the Numeric Rating Scale. Evidence supports the safety of high-intensity resistance training in low-bone-mass populations under qualified supervision (Giangregorio et al., 2014).", true),
  sp(),
  b("2. Cardiovascular event", true),
  n("Risk level: Low. Mitigation: pre-participation health screening using the PAR-Q+; GP medical clearance required for all participants aged ≥40 years; automated external defibrillator available on-site at all sessions.", true),
  sp(),
  b("3. Fall or impact injury (plyometric training)", true),
  n("Risk level: Low–Moderate. Mitigation: non-slip flooring; appropriate footwear required; structured warm-up preceding every session; plyometric progressions introduced only after demonstrated landing technique competency. The Royal Osteoporosis Society (no date) confirms moderate-impact exercise is generally safe, even for individuals with osteoporosis.", true),
  sp(),
  b("4. Radiation exposure (DXA)", true),
  n("Risk level: Minimal. Each DXA scan delivers <10 µSv — considerably below annual background radiation exposure. Three scans per participant over 12 months. Pregnant participants will be excluded prior to enrolment (Cleveland Clinic, 2020).", true),
  sp(),
  b("5. Adverse event monitoring", true),
  n("All adverse events will be recorded in a standardised incident log. A Data Safety Monitoring Board will review participant safety data at the T6 interim analysis point.", false)
], 6.5);
y += 3.12;

hdr(col3X, y, COL_W, "EXPECTED RESULTS");
y += 0.245;

box(col3X, y, COL_W, 1.42, [
  n("Pre-menopausal women (Group 1) and younger adult males (Group 3) are expected to show the greatest BMD gains (~1–2%) at the lumbar spine and total hip, reflecting higher baseline bone turnover capacity supported by sex hormone levels.", true),
  sp(),
  n("Post-menopausal women (Group 2) and older males (Group 4) are anticipated to show smaller but clinically meaningful improvements, consistent with current evidence that exercise positively affects BMD regardless of menopausal or bone status (Mohebbi et al., 2023 as cited in poster references).", true),
  sp(),
  n("These findings would highlight the importance of beginning load-bearing exercise before peak bone mass begins to decline with age, whilst confirming that exercise benefit extends to older populations.", false)
], 6.6);

// ══════════════════════════════════════════════════════════════════════════
// COLUMN 4 — Ethics cont.  |  References
// ══════════════════════════════════════════════════════════════════════════
y = COL_Y;

hdr(col4X, y, COL_W, "ETHICAL & LEGAL CONCERNS (CONT.)");
y += 0.245;

box(col4X, y, COL_W, 2.12, [
  b("Vulnerability considerations:", true),
  n("Post-menopausal women may have undiagnosed osteoporosis and represent a vulnerable sub-group. Baseline DXA screening will identify participants with a T-score below −2.5; these individuals will be referred to their GP before being permitted to commence the exercise programme. Exercise intensity will be individually adjusted where clinically indicated, following evidence-based safety guidelines (Giangregorio et al., 2014).", true),
  sp(),
  b("Inclusion and exclusion criteria:", true),
  n("All participants must be: (i) generally healthy and currently sedentary; (ii) free of musculoskeletal conditions, metabolic bone disease, or fracture within the preceding 12 months; (iii) not taking medications known to affect bone metabolism (e.g. corticosteroids, bisphosphonates). Pregnancy is an exclusion criterion due to DXA radiation exposure.", true),
  sp(),
  b("Conflict of interest:", true),
  n("The study receives no commercial funding. Calcium and vitamin D supplements will be sourced from an independent supplier with no financial relationship to the research team.", true),
  sp(),
  b("Animal and biological material:", true),
  n("No animal tissue or biological specimens are used. All data are derived from human participants who have given full informed consent.", false)
], 6.5);
y += 2.14;

hdr(col4X, y, COL_W, "REFERENCES");
y += 0.245;

const refsArr = [
  n("Abdi, H. and Williams, L. (2010) "),
  i("Encyclopedia of Research Design."),
  n(" Available at: https://personal.utdallas.edu/~herve/abdi-NewmanKeuls2010-pretty.pdf (Accessed: 28 April 2026).", true),

  n("\nAlbano, D., Agnollitto, P.M., Petrini, M., Biacca, A., Ulivieri, F.M., Sconfienza, L.M. and Messina, C. (2020) 'Operator-related errors and pitfalls in dual energy X-ray absorptiometry: How to recognise and avoid them', "),
  i("Academic Radiology."),
  n(" doi: 10.1016/j.acra.2020.07.028.", true),

  n("\nCleveland Clinic (2020) "),
  i("DEXA scan (DXA): Bone density test, what is it and how it's done."),
  n(" Available at: https://my.clevelandclinic.org/health/diagnostics/10683-dexa-dxa-scan-bone-density-test (Accessed: 28 April 2026).", true),

  n("\nFrost, J. (2019) "),
  i("Using post hoc tests with ANOVA."),
  n(" Available at: https://statisticsbyjim.com/anova/post-hoc-tests-anova/ (Accessed: 17 April 2026).", true),

  n("\nGarg, M. and Kharb, S. (2013) 'Dual energy X-ray absorptiometry: Pitfalls in measurement and interpretation of bone mineral density', "),
  i("Indian Journal of Endocrinology and Metabolism,"),
  n(" 17(2), p.203. doi: 10.4103/2230-8210.109659.", true),

  n("\nGiangregorio, L. et al. (2014) 'Too fit to fracture: Exercise recommendations for individuals with osteoporosis or osteoporotic vertebral fracture', "),
  i("Osteoporosis International,"),
  n(" 25(3), pp.821–835. doi: 10.1007/s00198-013-2523-2.", true),

  n("\nHinton, P.S., Nigh, P. and Thyfault, J. (2015) 'Effectiveness of resistance training or jumping-exercise to increase bone mineral density in men with low bone mass: A 12-month randomized clinical trial', "),
  i("Bone,"),
  n(" 79, pp.203–212. doi: 10.1016/j.bone.2015.06.008.", true),

  n("\nLewiecki, E.M. and Lane, N.E. (2008) 'Common mistakes in the clinical use of bone mineral density testing', "),
  i("Nature Clinical Practice Rheumatology,"),
  n(" 4(12), pp.667–674. doi: 10.1038/ncprheum0928.", true),

  n("\nNahm, F.S. (2017) 'What the P values really tell us', "),
  i("Korean Journal of Pain,"),
  n(" 30(4), p.241. doi: 10.3344/kjp.2017.30.4.241.", true),

  n("\nQualtrics (2023) "),
  i("What is ANOVA (analysis of variance) testing?"),
  n(" Available at: https://www.qualtrics.com/articles/strategy-research/anova/ (Accessed: 28 April 2026).", true),

  n("\nRizzoli, R., Bianchi, M.L., Garabédian, M., McKay, H.A. and Moreno, L.A. (2010) 'Maximizing bone mineral mass gain during growth for the prevention of fractures in the adolescents and the elderly', "),
  i("Bone,"),
  n(" 46(2), pp.294–305.", true),

  n("\nRoyal Osteoporosis Society (no date) "),
  i("Exercise for bones."),
  n(" Available at: https://theros.org.uk/information-and-support/bone-health/exercise-for-bones/ (Accessed: 17 April 2026).", true),

  n("\nWeaver, C.M. et al. (2015) 'Calcium plus vitamin D supplementation and risk of fractures: An updated meta-analysis from the National Osteoporosis Foundation', "),
  i("Osteoporosis International,"),
  n(" 27(1), pp.367–376. doi: 10.1007/s00198-015-3386-5.", false)
];

box(col4X, y, COL_W, 3.01, refsArr, 5.45);

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