Advantages and limitations
There exist several advantages to the present study: (i) Subjects in this study underwent OMOST and tested positive, thereby mitigating the error in baseline characteristics and selection bias, resulting in increased credibility of the RCT outcomes. (ii) In the statistical analysis of this study's RCT data, the exclusion of baseline characteristics and measured indexes in the attrition population led to a reduction in result dispersion and an increase in result credibility. (iii) By rigorously establishing inclusion and exclusion criteria for subjects, bias in subject selection was reduced and the credibility of study results was enhanced; the implementation of such criteria contributed to reducing bias further and increasing the reliability of the RCT outcomes.There exist certain limitations to the present study: (i) Sample size and attrition: The sample size in this study was limited, and attrition led to a reduction in the number of participants. Future studies should aim for larger sample sizes to increase statistical power and minimize the impact of attrition on the results. (ii) Baseline characteristics: Although efforts were made to ensure comparable baseline characteristics, there may still be variations among individuals. Future studies could consider stratifying participants based on baseline characteristics to reduce confounding factors and enhance result validity. (iii) Adherence to TC exercise: It is possible that the adherence to TC exercise interventions varied among participants, potentially affecting the outcomes. Future studies should consider monitoring adherence rates and potential influencing factors to better understand the impact of adherence on the results. (iv) Generalizability: The participants in this study were self-selected, which may limit the generalizability of the findings. Future studies could consider recruiting participants from a wider range of populations to improve the external validity of the results. (v) Outcome measurements: Although DXA was used to measure BMD in this study, there is a margin of error associated with this method. Future studies could consider using additional measurement techniques or incorporating multiple outcome measures to provide a more comprehensive evaluation of BMD.