Impact loading exercise induced osteogenesis from childhood to early adulthood in tennis players aged 8-30 years

Osteogenesis with impact-loading exercise is often assessed by the extra bone growth induced in the loaded arm of tennis players. We used PRISMA to explore % bone mineral content (BMC) and area (BA) asymmetry in players 8-30 years according to weekly training hours, age, sex, maturity, and bone segment. Proper statistics for 70 groups were extracted by two reviewers from 18 eligible studies of low risk of bias (< 35, STROBE) and good quality (> 70%). The quality of the review was high (AMSTAR, 81%). Using "random effects" we tested moderation-specific meta-comparisons and meta-regressions. The loaded bones % hypertrophy was higher in BMC (19%) than BA (10%), and, with BMC and BA merged, in boys (17%) than girls (13%), in humerus (19%) than radius-ulna (14%), and in pubertal (19%) players. Weekly training hours were more important (43%) than sex (17%), puberty (14%) and bone (15%) in BMC, and puberty (48%) was more important than weekly training hours (19%), sex (12%), and radius-ulna (5%) in BA. The loaded bones % hypertrophy correlated with weekly training hours highly (> 0.60) in all maturity groups for BMC and BA, and moderately (0.41) in early adults for BA; it also correlated with age (≥ 0.60) in children and peripubertal players, but not (0.037) with starting age. Impact loading exercise favors mineralization twice than bone expansion, while puberty favors bone expansion about three times more than mineralization. The bone gains are higher for boys than girls, and for peripubertal than older players. The bone growth implications are discussed considering limitations and future research.