***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: BACKGROUND Sclerostin is an osteocyte-derived inhibitor of osteoblast activity . The monoclonal antibody romosozumab binds to sclerostin and increases bone formation . METHODS In a phase 2 , multicenter , international , r and omized , placebo-controlled , parallel-group , eight-group study , we evaluated the efficacy and safety of romosozumab over a 12-month period in 419 postmenopausal women , 55 to 85 years of age , who had low bone mineral density ( a T score of -2.0 or less at the lumbar spine , total hip , or femoral neck and -3.5 or more at each of the three sites ) . Participants were r and omly assigned to receive subcutaneous romosozumab monthly ( at a dose of 70 mg , 140 mg , or 210 mg ) or every 3 months ( 140 mg or 210 mg ) , subcutaneous placebo , or an open-label active comparator -- oral alendronate ( 70 mg weekly ) or subcutaneous teriparatide ( 20 μg daily ) . The primary end point was the percentage change from baseline in bone mineral density at the lumbar spine at 12 months . Secondary end points included percentage changes in bone mineral density at other sites and in markers of bone turnover . RESULTS All dose levels of romosozumab were associated with significant increases in bone mineral density at the lumbar spine , including an increase of 11.3 % with the 210-mg monthly dose , as compared with a decrease of 0.1 % with placebo and increases of 4.1 % with alendronate and 7.1 % with teriparatide . Romosozumab was also associated with large increases in bone mineral density at the total hip and femoral neck , as well as transitory increases in bone-formation markers and sustained decreases in a bone-resorption marker . Except for mild , generally nonrecurring injection-site reactions  with romosozumab  , adverse events were similar among groups . CONCLUSIONS In postmenopausal women with low bone mass  , romosozumab was associated with increased bone mineral density and bone formation and with decreased bone resorption . ( Funded by Amgen and UCB Pharma ; Clinical Trials.gov number , NCT00896532 . ) A total of 45 tibial shaft fractures , all conservatively treated and with union delayed for more than 16 but less than 32 weeks were entered in a double-blind multi-centre trial . The fractures were selected for their liability to delayed union by the presence of moderate or severe displacement , angulation or comminution or a compound lesion with moderate or severe injury to skin and soft tissues . Treatment was by plaster immobilisation in all , with active electromagnetic stimulation units in 20 patients and dummy control units in 25 patients for 12 weeks . Radiographs were assessed blindly and independently by a radiologist and an orthopaedic surgeon . Statistical analysis showed the treatment groups to be comparable except in their age distribution , but age was not found to affect the outcome and the effect of treatment was consistent for each age group . The radiologist 's assessment of the active group showed radiological union in five fractures , progress to union in five but no progress to union in 10 . In the control group there was union in one fracture and progress towards union in one but no progress in 23 . Using Fisher 's exact test , the results were very significantly in favour of the active group ( p = 0.002 ) . The orthopaedic surgeon 's assessment showed union in nine fractures and absence of union in 11 fractures in the active group . There was union in three fractures and absence of union in 22 fractures in the control group . These results were also significantly in favour of the active group ( p = 0.02 ) . It was concluded that pulsed electromagnetic fields significantly influence healing in tibial fractures with delayed union This prospect i ve longitudinal cohort study was to assess the 10-yr hip fracture incidence and mortality trend of person ≥50 yr of age between 2002 and 2011 of eight hospitals in Jeju Isl and . Sex-specific incidence rate ( per 100,000 person-years ) were calculated based on that estimated for the population in the United States in 2008 . Poisson and logistic regressions were used to examine trends in incidence and mortality . There was a 101 % increase in the number of hip fractures from 151 in 2002 to 304 in 2011 . The crude incidence of hip fractures in the Jeju population ≥50 yr of age increased from 126.6/100,000 to 183.7/100,000 . The fracture incidence in the population st and ardized to the 2008 population in the United States increased from 100.6/100,000 for men and 194.4/100,000 for women in 2002 to 114.2/100,000 for men and 278.4/100,000 for women in 2011 . The annual increasing incidence rate of hip fracture was 4.3 % ( 5.3 % in women and 2.2 % in men ) . Poisson regression did not show significant trends in the mortality rates for all age groups or for both genders . The total number of hip fractures increased two-fold and the incidence rate of hip fractures increased markedly during the 10-yr study period . Graphical Summary The effect of teriparatide and risedronate on back pain was tested , and there was no difference in the proportion of patients experiencing a reduction in back pain between groups after 6 or 18 months . Patients receiving teriparatide had greater increases in bone mineral density and had fewer vertebral fractures . Introduction This study aim ed to underst and the effect of teriparatide in reducing back pain in patients with prevalent back pain and vertebral fracture compared to risedronate .  Methods In an 18-month r and omized , double-blind , double-dummy trial , we investigated the effects of teriparatide ( 20 μg/day ) vs. risedronate ( 35 mg/week ) in postmenopausal women with back pain likely due to vertebral fracture . The primary objective was to compare the proportion of subjects reporting ≥30 % reduction in worst back pain severity from baseline to 6 months as assessed by a numeric rating scale in each treatment group . Pre-specified secondary and exploratory outcomes included assessment s of average and worst back pain at additional time points , disability and quality of life , bone mineral density , incidence of fractures , and safety . Results At 6 months , 59 % of teriparatide and 57 % of risedronate patients reported ≥30 % reduction in worst back pain and there were no differences between groups in the proportion of patients experiencing reduction in worst or average back pain at any time point , disability , or quality of life . There was a greater increase from baseline in bone mineral density at the lumbar spine ( p = 0.001 ) and femoral neck ( p = 0.02 ) with teriparatide compared to risedronate and a lower incidence of vertebral fractures at 18 months ( 4 % teriparatide and 9 % risedronate ; p = 0.01 ) . Vertebral fractures were less severe ( p = 0.04 ) in the teriparatide group . There was no difference in the overall incidence of adverse events . Conclusions Although there were no differences in back pain-related endpoints , patients receiving teriparatide had greater skeletal benefit than those receiving risedronate BACKGROUND This report describes changes in eight areas of functioning after a hip fracture , identifies the point at which maximal levels of recovery are reached in each area , and evaluates the sequence of recuperation across multiple functional domains . METHODS . Community-residing hip fracture patients ( n = 674 ) admitted to eight hospitals in Baltimore , Maryl and , 1990 - 1991 were followed prospect ively for 2 years from the time of hospitalization . Eight areas of function ( i.e. , upper and lower extremity physical and instrumental activities of daily living ; gait and balance ; social , cognitive , and affective function ) were measured by personal interview and direct observation during hospitalization at 2 , 6 , 12 , 18 , and 24 months . Levels of recovery are described in each area , and time to reach maximal recovery was estimated using Generalized Estimating Equations and longitudinal data . RESULTS Most areas of functioning showed progressive lessening of dependence over the first postfracture year , with different levels of recovery and time to maximum levels observed for each area . New dependency in physical and instrumental tasks for those not requiring equipment or human assistance prefracture ranged from as low as 20.3 % for putting on pants to as high as 89.9 % for climbing five stairs . Recuperation times were specific to area of function , ranging from approximately 4 months for depressive symptoms ( 3.9 months ) , upper extremity function ( 4.3 months ) , and cognition ( 4.4 months ) to almost a year for lower extremity function ( 11.2 months ) . CONCLUSIONS Functional disability following hip fracture is significant , patterns of recovery differ by area of function , and there appears to be an orderly sequence by which areas of function reach their maximal levels CONTEXT Hip fractures are common in the elderly , and despite st and ard rehabilitation , many patients fail to regain their prefracture ambulatory or functional status . OBJECTIVE To determine whether extended outpatient rehabilitation that includes progressive resistance training improves physical function and reduces disability compared with low-intensity home exercise among physically frail elderly patients with hip fracture . DESIGN , SETTING , AND PATIENTS R and omized controlled trial conducted between August 1998 and May 2003 among 90 community-dwelling women and men aged 65 years or older who had had surgical repair of a proximal femur fracture no more than 16 weeks prior and had completed st and ard physical therapy .  INTERVENTION Participants were r and omly assigned to 6 months of either supervised physical therapy and exercise training ( n = 46 ) or home exercise ( control condition ; n = 44 ) . MAIN OUTCOME MEASURES Primary outcome measures were total scores on a modified Physical Performance Test ( PPT ) , the Functional Status Question naire physical function subscale ( FSQ ) , and activities of daily living scales . Secondary outcome measures were st and ardized measures of skeletal muscle strength , gait , balance , quality of life , and body composition . Participants were evaluated at baseline , 3 months , and 6 months . RESULTS Changes over time in the PPT and FSQ scores favored the physical therapy group ( P = .003 and P = .01 , respectively ) . Mean change ( SD ) in PPT score for physical therapy was + 6.5 ( 5.5 ) points ( 95 % confidence interval [ CI ] , 4.6 - 8.3 ) , and for the control condition was + 2.5 ( 3.7 ) points ( 95 % CI , 1.4 - 3.6 points ) . Mean change ( SD ) in FSQ score for physical therapy was + 5.2 ( 5.4 ) points ( 95 % CI , 3.5 - 6.9 ) and for the control condition was + 2.9 ( 3.8 ) points ( 95 % CI , 1.7 - 4.0 ) . Physical therapy also had significantly greater improvements than the control condition in measures of muscle strength , walking speed , balance , and perceived health but not bone mineral density or fat-free mass . CONCLUSION In community-dwelling frail elderly patients with hip fracture , 6 months of extended outpatient rehabilitation that includes progressive resistance training can improve physical function and quality of life and reduce disability compared with low-intensity home exercise Background Teriparatide ( parathyreoid hormone ; PTH 1 - 34 ) increases skeletal mass in humans and improves fracture healing in animals . A recent r and omized multicenter trial of nonoperated distal radial fractures showed a moderate shortening of the time to restoration of cortical continuity by treatment with 20 μg ( low-dose ) teriparatide per day , but not with 40 μg ( high-dose ) . As radiographic cortical continuity appears late in the healing process , perhaps too late for clinical relevance , we studied the qualitative appearance of the callus 5 weeks after fracture . Methods One third of the patients of the international trial were treated at Linköping University Hospital . The multicenter trial did not evaluate early callus formation . We therefore made a blinded qualitative scoring of the callus at 5 weeks in our 27 patients . Callus formation was arbitrarily classified as rich , intermediate , or poor . Results 9 patients were classified as rich ( none had received placebo , 3 low-dose teriparatide , and 6 high-dose teriparatide ) . 9 patients were classified as intermediate ( 1 had received placebo , 5 low-dose , and 3 high-dose ) . 9 patients were classified as poor ( 7 had received placebo , 1 low-dose , and 1 high-dose ) ( p < 0.001 ) . Interpretation This is a post hoc subgroup analysis of an outcome variable , which was not in the official protocol . The results must therefore be interpreted with caution . However , in combination with the results of the larger trial , the data suggest that radiographic quality at an early time point might be a sensitive variable , perhaps better than time to cortical continuity . Moreover , teriparatide appeared to improve early callus formation in distal radial fractures OBJECTIVE To investigate the effect of terip 
    Output:
    
Our findings suggest that teriparatide provide selective advantages to fracture healing or functional recovery in the management of osteoporotic fractures .