***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: Purpose : Patients with chronic obstructive pulmonary disease ( COPD ) may be at higher risk for osteoporosis . The primary objective of this case-control study was to determine the prevalence of vertebral fractures among patients with COPD admitted to acute care compared with a gender- and age-matched control group . Subjects and methods : Subjects were identified by chart review s from an acute care hospital in Hamilton , Ontario , in 1999 , including patients who were over 50 years old . In total , 127 patients with ICD-9 codes specifying COPD were r and omly selected and compared with 127 gender- and age-matched controls .  Chest radiographs were interpreted by two radiologists who defined and grade d vertebral fractures using Genant ’s method . Medications taken , or prescribed at discharge , were recorded from charts . Results : The overall prevalence of at least one vertebral fracture was found to be 34/127 ( 26.8 % ) in the COPD patients compared with 30/127 ( 23.6 % ) in the controls ( p=0.556 ) . A significantly greater proportion of COPD patients had at least one severe vertebral fracture ( OR=3.75 , 95 % CI 1.24 to 11.3 ) . Review of hospital chest X-ray reports indicated that only 12 of 64 ( 18.8 % ) patients with vertebral fractures identified by the study radiologists actually had a vertebral fracture noted in the report . The proportion of COPD patients with vertebral fractures who were discharged on  osteoporosis therapy  was 5/27 ( 18.5 % ) . There was a suggestion of lower lung function , as measured by forced vital capacity ( FVC% ) , in patients with severe vertebral fractures ( p=0.067 ) . Conclusions : These data indicate that : ( 1 ) There is an increased proportion of COPD patients with severe vertebral fracture , and ( 2 ) Documentation and treatment of osteoporosis in acute care COPD patients is low . Therefore , there is a need to target this high-risk group for osteoporosis screening and potential clinical management Abstract : The aim of this placebo-controlled , r and omized , single-masked study was to establish the effects of a 10-week ambulatory exercise programme for osteoporotic patients on pain , use of analgesics , functional status , quality of life , balance and muscle strength .  Fifty-three ambulatory postmenopausal women with at least one spinal crush fracture and pains within the last 3 years were r and omized for physiotherapeutic training twice a week for 10 weeks or no training . The training included general training of balance and muscle strength , with stabilization of the lumbar spine . The participants were tested at baseline , week 5 and week 10 with a balance test , muscle strength test and question naires on pain , use of analgesics , functional status and quality of life . Twelve weeks after the supervised training had finished ( week 22 ) they answered the same question naires . The study groups were comparable at baseline . The training group had a significant reduction in use of analgesics ( p= 0.02 ) and pain level ( p= 0.01 ) during the training period . Distribution of functional score improved ; the improvement was reduced at week 22 . Quality of life score improved significantly throughout the study ( p= 0.0008 ) , even after week 22 . Balance improved non-significantly ( p= 0.08 ) . Quadriceps muscle strength improved significantly after 5 weeks ( p= 0.04 ) . Back extensor muscle strength improved almost significantly ( p= 0.09 ) . In conclusion , this training programme for osteoporotic patients  improved balance and level of daily function and decreased experience of pain and use of analgesics . Quality of life was improved even beyond the active training period Objectives : To evaluate and compare nonoperative treatment methods for traumatic thoracic and lumbar compression fractures and burst fractures . Design : Prospect i ve r and omized controlled trial with long-term follow-up . Setting : Two general hospitals in the Netherl and s. Patients / Participants : Patients with a traumatic thoracic or lumbar spine fracture , without neurologic damage , with less than 50 % loss of height of the anterior column and less than 30 % reduction of the spinal canal were included . Intervention : Patients in the compression group were r and omized to physical therapy and postural instructions , a brace for 6 weeks , or a Plaster of Paris cast for 6 or 12 weeks . Patients in the burst group received a brace or a Plaster of Paris cast , both for 12 weeks . Main Outcome Measurements : Follow-up examinations included radiographs , Visual Analogue Scores for toleration of treatment and persistent pain , and an Oswestry Disability Index at long-term follow-up . Results : There were 133 patients : 108 in the compression group and 25 in the burst group . For compression fractures , physical therapy and brace were considered the most tolerable . Brace therapy scored significantly better on the Visual Analogue Scores for residual pain and on the Oswestry Disability Index . None of the treatments had any significant effect on the residual deformity measurements . For burst fractures , no significant differences were found . Conclusions : Brace treatment with supplementary physical therapy is the treatment of choice for patients with compression fractures of the thoracic and lumbar spine . Furthermore , more than 20 % of all patients had moderate or severe back pain at long-term follow-up OBJECTIVES To assess whether group exercise and coping classes reduce physical and psychological impairments and functional disability in older women with prevalent vertebral fractures ( VFs ) . DESIGN R and omized , controlled trial ( modified cross-over ) with site as unit of assignment ; testing at baseline and 3 , 6 , 9 , and 12 months . SETTING Nine North Carolina retirement communities . PARTICIPANTS One hundred eighty-five postmenopausal Caucasian women ( mean age 81 ) , each with at least one VFs . INTERVENTION The intervention group had 6 months of exercise ( 3 meetings weekly , 45 minutes each ) and coping classes ( 2 meetings weekly , 45 minutes each ) in Phase 1 , followed by 6 months of self-maintenance . The control group had 6 months of health education control intervention ( 1 meeting weekly , 45 minutes ) in Phase 1 , followed by the intervention described above . MEASUREMENTS Change in trunk extension strength , change in pain with activities , and change in psychological symptoms . RESULTS Between-group differences in the change in trunk extension strength ( 10.68 foot pounds , P<.001 ) and psychological symptoms ( -0.08 , P=.011 ) were significant for Phase 1 . Changes in pain with activities did not differ between groups ( -0.03 , P=.64 ) ; there was no change in the pain endpoint . In Phase 2 , controls showed significant changes in trunk strength ( 15.02 foot pounds , P<.001 ) and psychological symptoms ( -0.11 , P=.006 ) from baseline . Change in pain with activities was not significant ( -0.03 , P=.70 ) . During self-maintenance , the intervention group did not worsen in psychological symptoms , but improved trunk extension strength was not maintained . CONCLUSION Weak trunk extension strength and psychological symptoms associated with VFs can be improved in older women using group treatment , and psychological improvements are retained for at least 6 months 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 Despite vertebral fracture being a significant risk factor for further fracture , vertebral fractures are often unrecognised . A study was therefore conducted to determine the proportion of patients presenting with a non-vertebral fracture who also have an unrecognised vertebral fracture . Methods Prospect i ve study of patients presenting with a non-vertebral fracture in South Glasgow who underwent DXA evaluation with vertebral morphometry ( MXA ) from DV5/6 to LV4/5 .  Vertebral deformities ( consistent with fracture ) were identified by direct visualisation using the Genant semi-quantitative grading scale . Results Data were available for 337 patients presenting with low trauma non-vertebral fracture ; 261 were female . Of all patients , 10.4 % were aged 50–64 years , 53.2 % were aged 65–74 years and 36.2 % were aged 75 years or over . According to WHO definitions , 35.0 % of patients had normal lumbar spine BMD ( T-score −1 or above ) , 37.4 % were osteopenic ( T-score −1.1 to −2.4 ) and 27.6 % osteoporotic ( T-score −2.5 or lower ) . Humerus ( n=103 , 31 % ) , radius – ulna ( n=90 , 27 % ) and h and /foot ( n=53 , 16 % ) were the most common fractures . For 72 % of patients ( n=241 ) the presenting fracture was the first low trauma fracture to come to clinical attention . The overall prevalence of vertebral deformity established by MXA was 25 % ( n=83 ) ; 45 % ( n=37 ) of patients with vertebral deformity had deformities of more than one vertebra . Of the patients with vertebral deformity and readable scans for grading , 72.5 % ( 58/80 ) had deformities of grade 2 or 3 . Patients presenting with hip fracture , or spine T-score ≤−2.5 , or low BMI , or with more than one prior non-vertebral fracture were all significantly more likely to have evidence of a prevalent vertebral deformity ( p<0.05 ) . However , 19.8 % of patients with an osteopenic T-score had a vertebral deformity ( 48 % of which were multiple ) , and 16.1 % of patients with a normal T-score had a vertebral deformity ( 26.3 % of which were multiple ) . Following non-vertebral fracture , some guidelines suggest that anti-resorptive therapy should be reserved for patients with DXA-proven osteoporosis . However , patients who have one or more prior vertebral fractures ( prevalent at the time of their non-vertebral fracture ) would also become c and i date s for anti-resorptive therapy — which would have not been the case had their vertebral fracture status not been known . Overall in this study , 8.9 % of patients are likely to have had a change in management by virtue of their underlying vertebral deformity status . In other words , 11 patients who present with a non-vertebral fracture would need to undergo vertebral morphometry in order to identify one patient who ought to be managed differently . Conclusions Our results support the recommendation to perform vertebral morphometry in patients who are referred for DXA after experiencing a non-vertebral fracture . Treatment decisions will then better reflect any given patient ’s future absolute fracture risk . The ' Number Needed to Screen ' if vertebral morphometry is used in this way would be seven to identify one patient with vertebral deformity , and 14 to identify one patient with two or more vertebral deformities . Although carrying out MXA will increase radiation exposure for the patient , this increased exposure is significantly less than would be obtained if X-rays of the dorso-lumbar spine were obtained 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 
    Output:
    
Individual trials reported that exercise could improve pain , performance on the Timed Up and Go test , walking speed , back extensor strength , trunk muscle endurance , and quality of life .
However , the findings should be interpreted with caution given that there were also reports of no significant difference between exercise and control groups for pain , Timed Up and Go test performance , trunk extensor muscle strength and quality of life .
No definitive conclusions can be made regarding the benefits of exercise for individuals with vertebral fracture .