***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    ***EXAMPLES*** 
    Input: Study Design . An Institutional Review Board-approved Phase I efficacy study of inflatable bone tamp usage in the treatment of symptomatic osteoporotic compression fractures . Objectives . To evaluate the safety and efficacy of inflatable bone tamp reduction and cement augmentation , “ kyphoplasty , ” in the treatment of painful osteoporotic vertebral compression fractures . Summary of Background Data . Osteoporotic compression fractures can result in progressive kyphosis and chronic pain . Traditional treatment for these patients includes bed rest , analgesics , and bracing . Augmentation of vertebral compression fractures with polymethylmethacrylate , “ vertebroplasty , ” has been used to treat pain . This technique , however , makes no attempt to restore the height of the collapsed vertebral body . Kyphoplasty is a new technique that involves the introduction of inflatable bone tamps into the vertebral body . Once inflated , the bone tamps restore the vertebral body back toward its original height while creating a cavity that can be filled with bone cement . Patients and Methods . Seventy consecutive kyphoplasty procedures were performed in 30 patients . The indications included painful primary or secondary osteoporotic vertebral compression fractures . Mean duration of symptoms was 5.9 months . Symptomatic levels were identified by correlating the clinical data with MRI findings . Perioperative variables and bone tamp complications or issues were recorded and analyzed . Preoperative and postoperative radiographs were compared to calculate the percentage height restored . Outcome data were obtained by comparing preoperative and latest postoperative SF-36 data . Results . At the completion of the Phase I study there were no major complications related directly to use of this technique or use of the inflatable bone tamp . In 70 % of the vertebral bodies  kyphoplasty  restored 47 % of the lost height . Cement leakage occurred at six levels ( 8.6 % ) . SF-36 scores for Bodily Pain 11.6–58.7 , ( P = 0.0001 ) and Physical Function 11.7–47.4 , ( P = 0.002 ) were among those that showed significant improvement . Conclusions . The inflatable bone tamp was efficacious in the treatment of osteoporotic vertebral compression fractures .  Kyphoplasty is associated with early clinical improvement of pain and function as well as restoration of vertebral body height in the treatment of painful osteoporotic compression fractures BACKGROUND Previous studies have shown that alendronate can increase bone mineral density ( BMD ) and prevent radiographically defined ( morphometric ) vertebral fractures . The Fracture Intervention Trial aim ed to investigate the effect of alendronate on the risk of morphometric as well as clinical ly evident fractures in postmenopausal women with low bone mass . METHODS Women aged 55 - 81 with low femoral-neck BMD were enrolled in two study groups based on presence or absence of an existing vertebral fracture . Results for women with at least one vertebral fracture at baseline are reported here . 2027 women were r and omly assigned placebo ( 1005 ) or alendronate ( 1022 ) and followed up for 36 months . The dose of alendronate ( initially 5 mg daily ) was increased ( to 10 mg daily ) at 24 months , with maintenance of the double blind . Lateral spine radiography was done at baseline and at 24 and 36 months . New vertebral fractures , the primary endpoint , were defined by morphometry as a decrease of 20 % ( and at least 4 mm ) in at least one vertebral height between the baseline and latest follow-up radiograph . Non-spine clinical fractures were confirmed by radiographic reports . New symptomatic vertebral fractures were based on self-report and confirmed by radiography . FINDINGS Follow-up radiographs were obtained for 1946 women ( 98 % of surviving participants ) . 78 ( 8.0 % ) of women in the alendronate group had one or more new morphometric vertebral fractures compared with 145 ( 15.0 % ) in the placebo group ( relative risk 0.53 [ 95 % Cl 0.41 - 0.68 ] ) . For clinical ly apparent vertebral fractures , the corresponding numbers were 23 ( 2.3 % ) alendronate and 50 ( 5.0 % ) placebo ( relative hazard 0.45 [ 0.27 - 0.72 ] ) . The risk of any clinical fracture , the main secondary endpoint , was lower in the alendronate than in the placebo group ( 139 [ 13.6 % ] vs 183 [ 18.2 % ] ; relative hazard 0.72 [ 0.58 - 0.90 ] ) . The relative hazards for hip fracture and wrist fracture for alendronate versus placebo were 0.49 ( 0.23 - 0.99 ) and 0.52 ( 0.31 - 0.87 ) . There was no significant difference between the groups in numbers of adverse experiences , including upper-gastrointestinal disorders . INTERPRETATION We conclude that among women with low bone mass and existing vertebral  fractures , alendronate is well tolerated and substantially reduces the frequency of morphometric and clinical vertebral fractures , as well as other clinical fractures CONTEXT Alendronate sodium reduces fracture risk in postmenopausal women who have vertebral fractures , but its effects on fracture risk have not been studied for women without vertebral fractures . OBJECTIVE To test the hypothesis that 4 years of alendronate would decrease the risk of clinical and vertebral fractures in women who have low bone mineral density ( BMD ) but no vertebral fractures . DESIGN R and omized , blinded , placebo-controlled trial . SETTING Eleven community-based clinical research centers . SUBJECTS Women aged 54 to 81 years with a femoral neck BMD of 0.68 g/cm2 or less ( Hologic Inc , Waltham , Mass ) but no vertebral fracture ; 4432 were r and omized to alendronate or placebo and 4272 ( 96 % ) completed outcome measurements at the final visit ( an average of 4.2 years later ) . INTERVENTION All participants reporting calcium intakes of 1000 mg/d or less received a supplement containing 500 mg of calcium and 250 IU of cholecalciferol . Subjects were r and omly assigned to either placebo or 5 mg/d of alendronate sodium for 2 years followed by 10 mg/d for the remainder of the trial . MAIN OUTCOME MEASURES Clinical fractures confirmed by x-ray reports , new vertebral deformities detected by morphometric measurements on radiographs , and BMD measured by dual x-ray absorptiometry . RESULTS Alendronate increased BMD at all sites studied ( P<.001 ) and reduced clinical fractures from 312 in the placebo group to 272 in the intervention group , but not significantly so ( 14 % reduction ; relative hazard [ RH ] , 0.86 ; 95 % confidence interval [ CI ] , 0.73 - 1.01 ) . Alendronate reduced clinical fractures by 36 % in women with baseline osteoporosis at the femoral neck ( > 2.5 SDs below the normal young adult mean ; RH , 0.64 ; 95 % CI , 0.50 - 0.82 ; treatment-control difference , 6.5 % ; number needed to treat [ NNT ] , 15 ) , but there was no significant reduction among those with higher BMD ( RH , 1.08 ; 95 % CI , 0.87 - 1.35 ) . Alendronate decreased the risk of radiographic vertebral fractures by 44 % overall ( relative risk , 0.56 ; 95 % CI , 0.39 - 0.80 ; treatment-control difference , 1.7 % ; NNT , 60 ) . Alendronate did not increase the risk of gastrointestinal or other adverse effects . CONCLUSIONS In women with low BMD but without vertebral fractures , 4 years of alendronate safely increased BMD and decreased the risk of first vertebral deformity .  Alendronate significantly reduced the risk of clinical fractures among women with osteoporosis but not among women with higher BMD The purpose of this study was to estimate the  hospital cost of vertebral fractures in the EU using national data sets to explore some of the method ologic limitations associated with such an approach . Hospital costs for vertebral fractures across the EU were compared with the hospital costs associated with hip fractures . Additionally , these costs were placed into the health care context by making comparisons with national health care expenditure . All EU Ministries of Health were contacted to identify national data sets to estimate the average length of stay , cost per diem and the number of patients discharged with vertebral fractures .  Where national information was not available expert opinion and data from the relevant literature were used instead . Countries show a marked difference in the length of stay between men and women , with differences ranging from 0.32 days in Austria to 20.2 days in Spain . The average hospitalization rate was found to be 8 % across the EU , with higher rates found for men than for women . Interestingly a positive correlation between health expenditure per capita and hospitalization rates was found . The total cost of vertebral fractures in the EU was estimated at € 377 million per year . Across the EU the hospital cost of a vertebral fracture was on average 63 % that of a hip fracture . National data sets allow us to estimate the cost of vertebral fractures in the EU but show limitations . In the absence of largescale prospect i ve studies , national data sets need to be further refined to ensure more accurate estimations of the cost of vertebral fractures in the EU CONTEXT Raloxifene hydrochloride , a selective estrogen receptor modulator , prevents bone loss in postmenopausal women , but whether it reduces fracture risk in these women is not known . OBJECTIVE To determine the effect of raloxifene therapy on risk of vertebral and nonvertebral fractures . DESIGN The Multiple Outcomes of Raloxifene Evaluation ( MORE ) study , a multicenter , r and omized , blinded , placebo-controlled trial . SETTING AND PARTICIPANTS A total of 7705 women aged 31 to 80 years in 25 countries who had been postmenopausal for at least 2 years and who met World Health Organization criteria for having osteoporosis . The study began in 1994 and had up to 36 months of follow-up for primary efficacy measurements and nonserious adverse events and up to 40 months of follow-up for serious adverse events . INTERVENTIONS Participants were r and omized to 60 mg/d or 120 mg/d of raloxifene or to identically appearing placebo pills ; in addition , all women received supplemental calcium and cholecalciferol . MAIN OUTCOME MEASURES Incident vertebral fracture was determined radiographically at baseline and at scheduled 24- and 36-month visits . Nonvertebral fracture was ascertained by interview at 6-month-interim visits . Bone mineral density was determined annually by dual-energy x-ray absorptiometry . RESULTS At 36 months of the evaluable radiographs in 6828 women , 503 ( 7.4 % ) had at least 1 new vertebral fracture , including 10.1 % of women receiving placebo , 6.6 % of those receiving 60 mg/d of raloxifene , and 5.4 % of those receiving 120 mg/d of raloxifene .  Risk of vertebral fracture was reduced in both study groups receiving raloxifene ( for 60-mg/d group : relative risk [ RR ] , 0.7 ; 95 % confidence interval [ CI ] , 0.5 - 0.8 ; for 120-mg/d group : RR , 0.5 ; 95 % CI , 0.4 - 0.7 ) . Frequency of vertebral fracture was reduced both in women who did and did not have prevalent fracture . Risk of nonvertebral fracture for raloxifene vs placebo did not differ significantly ( RR , 0.9 ; 95 % CI , 0.8 - 1.1 for both raloxifene groups combined ) . Compared with placebo , raloxifene increased bone mineral density in the femoral neck by 2.1 % ( 60 mg ) and 2.4 % ( 120 mg ) and in the spine by 2.6 % ( 60 mg ) and 2.7 % ( 120 mg ) P<0.001 for all comparisons ) . Women receiving raloxifene had increased risk of venous thromboembolus vs placebo ( RR , 3.1 ; 95 % CI , 1.5 - 6.2 ) . Raloxifene did not cause vaginal bleeding or breast pain and was associated with a lower incidence of breast cancer . CONCLUSIONS In postmenopausal women with osteoporosis , raloxifene increases bone mineral density in the spine and femoral neck and reduces risk of vertebral fracture Radiographically detected vertebral fractures ( hereafter referred to as vertebral fractures ) are a hallmark of postmenopausal osteoporosis and an important end point in clinical trials of osteoporosis treatment . Women with vertebral fractures have low bone mass compared with women without these fract 
    Output:
    
The rates of back pain , moderate or severe back pain , and severe back pain per 100 patient-years were numerically lower in the teriparatide versus comparator groups in each study .
In conclusion , patients r and omized to teriparatide had a reduced risk of new or worsening back pain compared to patients r and omized to placebo , hormone replacement therapy or alendronate