***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 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Study Design . A prospect i ve r and omized clinical trial . Objective . In this study , we determine whether percutaneous vertebroplasty ( PVP ) offers extra benefits to aged patients with acute osteoporotic vertebral compression fractures ( OVCFs ) over conservative therapy ( CV ) . Summary of Background Data . OVCFs are common in the aged population with osteoporosis . While the optimal treatment of aged patients with acute OVCFs remains controversial , PVP , a minimally invasive procedure , is a treatment option to be considered . Methods . Patients aged at 70 years or above with acute OVCF and severe pain from minor or mild trauma were assigned r and omly to PVP and CV groups . The primary outcome was pain relief as measured by VAS score in 1-year follow-up period . The second outcome was quality of life assessed with ODI and Quality of Life Question naire of the European Foundation for Osteoporosis ( QUALEFFO ) . Patient satisfaction surveys were also recorded . Results . A total of 135 patients were enrolled , and 107 ( 56 in PVP group ; 51 in CV group ) completed 1-year follow-up . In PVP group , the vertebroplasty procedure was performed at a mean of 8.4 ± 4.6 days ( range , 2–21 days ) after onset . Vertebroplasty result ed in much greater pain relief than did conservative treatment at postoperative day 1 ( P < 0.0001 ) . At every time point of follow-up , pain relief and quality of life were significantly improved in PVP group than in CV group at 1 week , 1 month , 3 months , 6 months , and 1 year ( all P < 0.0001 ) . The final follow-up surveys indicated that patients in PVP group were significantly more satisfied with given treatment ( P < 0.0001 ) . In addition , lower rate of complications was observed in PVP group ( P < 0.0001 ) . Conclusion . In aged patients with acute OVCF and severe pain , early vertebroplasty yielded faster , better pain relief and improved functional outcomes , which were maintained for 1 year . Furthermore , it showed fewer complications than conservative treatment . Level of Evidence : BACKGROUND CONTEXT Most osteoporotic vertebral compression fractures ( OVCFs ) can be treated conservatively . Recently , kyphoplasty has become a common treatment for painful osteoporotic compression fractures and has shown numerous benefits , such as early pain control and height restoration of the collapsed vertebral body . In spite of being a simple procedure , numerous complications related to kyphoplasty have been reported . Moreover , there is limited evidence to support its superiority . PURPOSE To compare the clinical outcomes of patients with OVCF according to different treatment modalities and identify clinical risk factors related to failure of conservative treatment of OVCF . STUDY DESIGN A prospect i ve study consisting of a review of case report forms . PATIENTS SAMPLE : We prospect ively enrolled 259 patients who had one or two acute painful OVCFs confirmed by magnetic resonance imaging . All patients were treated conservatively in the initial 3 weeks . Kyphoplasty was performed in 91 patients who complained of sustained back pain and disability in spite of conservative treatment for the initial 3 weeks . OUTCOME MEASURES Pain score using visual analog scale ( VAS ) and the Oswestry Disability Index ( ODI ) . METHODS Participants were stratified according to age , sex , level and number of fractures , bone mineral density , body mass index ( BMI ) , collapse rates , and history of spine fractures . Pain scores using VASs were assessed at 1 week and at 1 , 3 , 6 , and 12 months . RESULTS A total of 259 patients were enrolled , and 231 patients ( 82 of 91 patients in the kyphoplasty group [ KP ] and 149 of 168 patients in the conservative treatment group ) completed the 1-year follow-up . About 65 % of patients were treated successfully with conservative treatment . Risk factors for failure of 3 weeks of conservative treatment were older age ( older than 78.5 years ) , severe osteoporosis ( t score less than -2.95 ) , overweight ( BMI more than 25.5 ) , and larger collapse rates ( more than 28.5 % ) . There were significant reductions in VAS and ODI scores in both groups at each follow-up assessment . At the first month , better clinical results were observed in KP . However , there were no significant differences in outcome measures between the two groups at 3 , 6 , or 12 months . Thirteen subsequent compression fractures ( five in KP and eight in the conservative treatment group ) occurred during the 1-year follow-up period . CONCLUSION Both treatments of OVCF showed successful clinical results at the end of the 1-year follow-up period . Kyphoplasty showed better outcomes in the first month only . Given these results , prompt kyphoplasty should not be indicated in the case of a patient with OVCF that has no risk factors for failure with conservative treatment . Rather , a trial of conservative , 3-week treatment would be beneficial Abstract : To examine the risk of mortality following all clinical fractures , we followed 6459 women age 55–81 years participating in the Fracture Intervention Trial for an average of 3.8 years . All fractures and deaths were confirmed by medical record or death certificate . Clinical fractures were fractures that came to medical attention . Fracture status was used as a time-dependent covariate in proportional hazards models . The 907 women who experienced a fracture were older , had lower bone mineral density and were more likely to report a positive fracture history . A total of 122 women died  over the course of the study with 23 of these deaths occurring after a clinical fracture . The age-adjusted relative risk ( 95 % confidence intervals ) of dying following a clinical fracture was 2.15 ( 1.36 , 3.42 ) . This primarily reflected the higher mortality following a hip fracture , 6.68 ( 3.08 , 14.52 ) ; and clinical vertebral fracture , 8.64 ( 4.45 , 16.74 ) . Results were similar after adjusting for treatment assignment , health status and specific common comorbidities . There was no increase in mortality following a forearm or other fracture ( non-hip , non-wrist , non-vertebral fracture ) . In conclusion , clinical vertebral fractures and hip fractures are associated with a substantial increase in mortality among a group of relatively healthy older women Introduction Osteoporotic vertebral fractures ( OVF ) can lead to late collapse which often causes kyphotic spinal deformity , persistent back pain , decreased lung capacity , increased fracture risk and increased mortality . The purpose of our study is to compare the efficacy and safety of vertebroplasty against conservative management of osteoporotic vertebral fractures without neurologic symptoms . Material and methods A total of 66 patients with recent OVF on MRI examination were included in the study . All patients were admitted from September 2009 to September 2012 . The cohort was divided into two groups . The first study group consisted of 33 prospect ively followed consecutive patients who suffered 40 vertebral osteoporotic fractures treated by percutaneous vertebroplasty  ( group 1 ) , and the control group consisted of 33 patients who suffered 41 vertebral osteoporotic fractures treated conservatively because they  refused vertebroplasty  ( group 2 ) . The data collection has been conducted in a prospect i ve registration manner . The inclusion criteria consisted of painful OVF matched with imagistic findings . We assessed the results of pain relief and minimal sagittal area of the vertebral body on the axial CT scan at presentation , after the intervention , at six and 12 months after initial presentation . Results Vertebroplasty with poly(methyl methacrylate ) ( PMMA ) was performed in 30 patients on 39 VBs , including four thoracic vertebras , 27 vertebras of the thoracolumbar jonction and eight lumbar vertebras . Group 2 included 30 patients with 39 OVFs ( four thoracic vertebras , 23 vertebras of the thoracolumbar junction and 11 lumbar vertebras ) . There was no significant difference in VAS scores before treatment ( p = 0.229 ) . The mean VAS was 5.90 in Group 1 and 6.28 in Group 2 before the treatment . Mean VAS after vertebroplasty was 0.85 in Group 1 . The mean VAS at six months was 0.92 in Group 1 and 3.00 in Group 2 ( p < 0.05 ) . The mean VAS at 12 months was 0.92 in Group 1 and 2.36 in Group 2 . The mean improvement rate in VAS scores was 84.40 % and 62.42 % , respectively ( p < 0.05 ) . For Group 1 , mean area of the VBs measured on sagital CT images was 8.288 at the initial presentation , 8.554 postoperatively , 8.541 at five months and 8.508 at 12 months , respectively , and 8.388 at the initial presentation , 7.976 at six months and 7.585 at 12 months for Group 2 ( Fig. 4 ) . Discussion sAlthough conservative treatment is fundamental and achieves good symptom control , in patients who suffer osteoporotic compression fractures ( OCF ) , the incidence of late collapse is high and the prognosis is poor . In order to relieve the pain and avoid VB collapse , vertebroplasty is the recommended treatment in OCFs . Considering the above findings , the dilemma is whether vertebroplasty can change the natural history ( pain and deformity ) of OCFs . Conclusion In our study on OVF , vertebroplasty delivered superior clinical and radiological outcomes over the first year from intervention when compared to conservative treatment of patients with osteoporotic compression fractures without neurological deficit . We believe that the possibility of evolution towards progressive kyphosis is sufficient to justify prophylactic and therapeutic intervention such as vertebroplasty , a minor gesture compared with extensive correction surgery and stabilization OBJECT Osteoporotic vertebral compression fractures ( VCFs ) are a major cause of increased morbidity in older patients . This r and omized controlled trial compared the efficacy of percutaneous vertebroplasty ( PV ) versus optimal medical therapy ( OMT ) in controlling pain and improving the quality of life ( QOL ) in patients with VCFs . Efficacy was measured as the incidence of new vertebral fractures after PV , restoration of vertebral body height ( VBH ) , and correction of deformity . METHODS Of 105 patients with acute osteoporotic VCFs , 82 were eligible for participation : 40 patients underwent PV and 42 received OMT . Primary outcomes were control of pain and improvement in QOL before treatment , and these were measured at 1 week and at 2 , 6 , 12 , 24 , and 36 months after the beginning of the treatment . Radiological evaluation to measure VBH and sagittal index was performed before and after treatment in both groups and after 36 months of follow-up . RESULTS The authors found a statistically significant improvement in pain in the PV group compared with the OMT group at 1 week ( difference -3.1 , 95 % CI -3.72 to -2.28 ; p < 0.001 ) . The QOL improved significantly in the PV group ( difference -14 , 95 % CI -15 to -12.82 ; p < 0.028 ) . One week after PV , the average VBH restoration was 8 mm and the correction of deformity was 8 ° . The incidence of new fractures in the OMT group ( 13.3 % ) was higher than in the PV group ( 2.2 % ; p < 0.01 ) . CONCLUSIONS The PV group had statistically significant improvements in visual analog scale and QOL scores maintained over 24 months , improved VBH maintained over 36 months , and fewer adjacent-level fractures compared with the OMT group BACKGROUND Vertebroplasty has become a common treatment for painful osteoporotic vertebral fractures , but there is limited evidence to support its use . METHODS We performed a multicenter , r and omized , double-blind , placebo-controlled trial in which participants with one or two painful osteoporotic vertebral fractures that were of less than 12 months ' duration and unhealed , as confirmed by magnetic resonance imaging , were r and omly assigned to undergo vertebroplasty or a sham procedure . Participants were stratified according to treatment center , sex , and duration of symptoms ( < 6 weeks or > or = 6 weeks ) . Outcomes were assessed at 1 week and at 1 , 3 , and 6 months . The primary outcome was overall pain ( on a scale of 0 to 10 , with 10 being the maximum imaginable pain ) at 3 months . RESULTS A total of 78 participants were enrolled , and 71 ( 35 of 38 in the vertebroplasty group and 36 of 40 in the placebo group ) completed the 6-month follow-up ( 91 % ) . Vertebroplasty did not result in a significant advantage in any measured outcome at any time point . There were significant reductions in overall pain in both study groups at each follow-up assessment . At 3 months , the mean ( + /-SD ) reductions in the score for pain in the vertebroplasty and control groups were 2.6+/-2.9 and 1.9+/-3.3 , respectively ( adjusted between-group difference , 0.6 ; 95 % confidence interval , -0.7 to 1.8 ) . 
    Output:
    
Pooled results showed significant pain relief in favor of percutaneous cement augmentation compared to CT , direct postoperative and at 6 months follow-up .
At 6 months , a significant difference was observed for functional disability scores in favor of percutaneous cement augmentation .
When comparing percutaneous cement augmentation to placebo , no significant differences were observed .
Despite method ological heterogeneity of the included studies , this review shows overall significant sustained pain relief and superior functional effect in the short- and long term for percutaneous cement augmentation compared to conservative treatment .