These findings do not support a role for GRF, bone density, or tibial bone geometry in the development of tibial stress fractures, suggesting that other risk factors were more important in this cohort of female runners.

Introduction:Overactive bladder (OAB) is a prevalent condition that has a significant impact on quality of life. The usual treatment approach is both behavioral and pharmacological. The first-line pharmacological treatment commonly utilizes anticholinergic agents, which may be limited by their tolerability, efficacy, and long-term compliance. Developments in elucidating the pathophysiology of OAB and alternative targets for pharmacological therapy have led to newer agents being developed to manage this condition. These agents include mirabegron and botulinum toxin, which have alternate mechanism of action and avoid the anticholinergic side effects. Objectives: To provide an update for clinicians managing OAB with an overview of the existing and newer medical options for OAB, including pharmacology, efficacy, side-effect profile, tolerability, and impact on patient quality of life. Methods: PubMed and Medline were searched for randomized controlled drug trials in adults with OAB, meta-analyses of medical therapy for OAB, and individual drug names, including the keywords efficacy, tolerability, quality of life, and compliance. Nonhuman studies, pediatric trials, and those involving patients with neurogenic bladder dysfunction (with the exception of studies involving botulinum toxin A) were excluded. Results: There is level 1, Grade A evidence to support the efficacy of anticholinergic drugs, botulinum toxin, and mirabegron for OAB. Long-term compliance with anticholinergic medications is limited. The mechanism of action, effectiveness, and side effects of these drugs are discussed, and where the data are available compared with other OAB medications. Conclusion: Most of the anticholinergic agents have comparative efficacies and core side-effect profiles, with individual variations relating to their muscarinic receptor selectivity, pharmacokinetics, and metabolism. Newer agents, with alternative sites of action, such as mirabegron and botulinum toxin, provide additional treatment options for patients intolerant to or inadequately treated with anticholinergics. Keywords: antimuscarinics, mirabegron, botulinum toxin, incontinence IntroductionOveractive bladder (OAB) is a collection of symptoms consisting of urinary urgency (the sudden compelling desire to void that is difficult to defer), frequency and nocturia (usually), and incontinence (sometimes). Urinary frequency is the patient's subjective complaint that he or she voids too often during the day. Nocturia is the need to wake at night once or more to void. Urge urinary incontinence (UI) is involuntary leakage of urine accompanied or immediately preceded by urgency. 1 OAB is often but not always associated with detrusor overactivity (DO) on urodynamic evaluation. OAB is a symptom and DO is an urodynamic finding. OAB may be 2Jayarajan and Radomski idiopathic (non-neurological) or secondary to a neurological cause (eg, multiple sclerosis, spinal cord injury). Idiopathic OAB may be due to bladder outlet obstruction, or have no discernible cause. OAB is further subc...

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