***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: CONTEXT Type 1 and type 2 diabetes mellitus are associated with an increased risk of fracture . OBJECTIVE The objective of the study was to compare the bone structure and density between type 1 and type 2 diabetes patients and to investigate fracture associations . DESIGN This was a cross-sectional study . SETTING AND PATIENTS Physician-diagnosed type 1 and type 2 diabetes patients were included from the outpatient clinics at two university hospitals participated in the study . MAIN OUTCOME MEASURES Bone density and structure were assessed by dual-energy x-ray absorptiometry and high-resolution peripheral quantitative computed tomography . Blood sample s were collected for bone turnover markers . Prevalent vertebral fractures were assessed by vertebral fracture assessment and x-ray , and incident fractures were collected from The Danish National Hospital Discharge Register . RESULTS Bone mineral density ( BMD ) was higher in type 2 than type 1 diabetes patients at the hip , femur , and spine ; however , only the hip differed in multivariate-adjusted models . Bone tissue stiffness at the tibia was increased in type 2 diabetes patients also in adjusted models . Sclerostin levels were inversely associated with fracture in type 1 diabetes patients . The patients with the highest tertile of sclerostin had an 81 % decreased risk of a fracture compared with the lowest tertile . CONCLUSIONS Type 1 and type 2 diabetes patients differ in BMD of the hip and tissue stiffness at the tibia . Sclerostin may be a marker independent of BMD to predict fractures in type 1 diabetes patients and thus potentially of clinical importance . Studies with longer follow-up are needed Type 2 diabetes mellitus ( T2DM ) is associated with an increased risk of fractures according to several studies . The underlying mechanisms remain unclear , although small case-control studies indicate poor quality of the cortical bone . We have studied a population -based sample of women aged 75 to 80 years in Gothenburg , r and omly invited from the population register .  Areal bone mineral density ( aBMD ) was measured by dual-energy X-ray absorptiometry ( Hologic Discovery A ) ,  bone microarchitecture by high-resolution peripheral quantitative computed tomography ( HR-pQCT ; ExtremeCT from Scanco Medical AG ) , and reference point indentation was performed with Osteoprobe ( Active Life Scientific ) . Women with T2DM ( n = 99 ) had higher aBMD  compared to controls ( n = 954 ) .  Ultradistal tibial and radial trabecular bone volume fraction ( + 11 % and + 15 % , respectively ) , distal cortical volumetric BMD ( + 1.6 % and + 1.7 % ) , cortical area ( + 11.5 % and + 9.3 % ) , and failure load ( + 7.7 % and + 12.9 % ) were higher in diabetics than in controls . Cortical porosity was lower ( mean ± SD : 1.5 % ± 1.1 % versus 2.0 % ± 1.7 % , p = 0.001 ) in T2DM in the distal radius but not in the ultradistal radius or the tibia . Adjustment for covariates ( age , body mass index , glucocorticoid treatment , smoking , physical activity , calcium intake , bone-active drugs ) eliminated the differences in aBMD but not in HR-pQCT bone variables . However , bone material strength index ( BMSi ) by reference point indentation was lower in T2DM ( 74.6 ± 7.6 versus 78.2 ± 7.5 , p < 0.01 ) , also after adjustment , and women with T2DM performed clearly worse in measures of physical function ( one leg st and ing : -26 % , 30-s chair-st and test : -7 % , timed up and go : + 12 % , walking speed : + 8 % ; p < 0.05 - 0.001 ) compared to controls . In conclusion , we observed a more favorable bone microarchitecture but no difference in adjusted aBMD in elderly women with T2DM in the population compared to nondiabetics . Reduced BMSi and impaired physical function may explain the increased fracture risk in T2DM . © 2016 American Society for Bone and Mineral Research Abstract Many osteoporotics have comorbid diabetes mellitus ( DM ) , hypertension ( HT ) , and dyslipidemia ( DL ) . However , whether such comorbidities alter response to anti-osteoporotic treatment is unknown . We did post hoc analyses of combined data from three  risedronate Japanese phase III trials to determine whether the presence of DM , HT , or DL affects its efficacy and safety . Data from 885 subjects who received 48-week treatment with risedronate were collected and combined from the three phase III trials . They were divided into two groups by the presence or absence of comorbidities : DM ( n = 53 ) versus non-DM ( n = 832 ) ; HT ( n = 278 ) versus non-HT ( n = 607 ) ; and DL ( n = 292 ) versus non-DL ( n = 593 ) . Bone mineral density ( BMD ) , urinary type 1 collagen N-telopeptide ( uNTX ) , and serum bone-specific alkaline phosphatase ( BAP ) were measured at baseline and sequentially until 48 weeks . BMD or bone markers were not different between any of the two groups . Overall , BMD was increased by 5.52 % , and uNTX and BAP were decreased by 35.4 and 33.8 % , respectively . Some bone markers were slightly lower in DM and DL subjects , but the responses to risedronate were not significantly different . Statin users had lower uNTX and BAP , but showed no difference in the treatment response . All the other medications had no apparent effect . Adverse event incidence was marginally higher in DL compared with non-DL ( Relative risk 1.06 ; 95 % confidence interval 1.01–1.11 ) , but was not related to increase in any specific events . Risedronate shows consistent safety and efficacy in suppressing bone turnover and increasing BMD in osteoporosis patients with comorbid DM , HT , and /or DL CONTEXT Type 2 diabetes mellitus ( DM ) is associated with higher bone mineral density ( BMD ) and paradoxically with increased fracture risk . It is not known if low BMD , central to fracture prediction in older adults , identifies fracture risk in patients with DM . OBJECTIVE To determine if femoral neck BMD T score and the World Health Organization Fracture Risk Algorithm ( FRAX ) score are associated with hip and nonspine fracture risk in older adults with type 2 DM . DESIGN , SETTING , AND PARTICIPANTS Data from 3 prospect i ve observational studies with adjudicated fracture outcomes ( Study of Osteoporotic Fractures [ December 1998-July 2008 ] ; Osteoporotic Fractures in Men Study [ March 2000-March 2009 ] ; and Health , Aging , and Body Composition study [ April 1997-June 2007 ] ) were analyzed in older community-dwelling adults ( 9449 women and 7436 men ) in the United States . MAIN OUTCOME MEASURE Self-reported incident fractures , which were verified by radiology reports . RESULTS Of 770 women with DM , 84 experienced a hip fracture and 262 a nonspine fracture during a mean ( SD ) follow-up of 12.6 ( 5.3 ) years . Of 1199 men with DM , 32 experienced a hip fracture and 133 a nonspine fracture during a mean ( SD ) follow-up of 7.5 ( 2.0 ) years . Age-adjusted hazard ratios ( HRs ) for 1-unit decrease in femoral neck BMD T score in women with DM were 1.88 ( 95 % confidence interval [ CI ] , 1.43 - 2.48 ) for hip fracture and 1.52 ( 95 % CI , 1.31 - 1.75 ) for nonspine fracture , and in men with DM were 5.71 ( 95 % CI , 3.42 - 9.53 ) for hip fracture and 2.17 ( 95 % CI , 1.75 - 2.69 ) for nonspine fracture . The FRAX score was also associated with fracture risk in participants with DM ( HRs for 1-unit increase in FRAX hip fracture score , 1.05 ; 95 % CI , 1.03 - 1.07 , for women with DM and 1.16 ; 95 % CI , 1.07 - 1.27 , for men with DM ; HRs for 1-unit increase in FRAX osteoporotic fracture score , 1.04 ; 95 % CI , 1.02 - 1.05 , for women with DM and 1.09 ; 95 % CI , 1.04 - 1.14 , for men with DM ) . However , for a given T score and age or for a given FRAX score , participants with DM had a higher fracture risk than those without DM . For a similar fracture risk , participants with DM had a higher T score than participants without DM . For hip fracture , the estimated mean difference in T score for women was 0.59 ( 95 % CI , 0.31 - 0.87 ) and for men was 0.38 ( 95 % CI , 0.09 - 0.66 ) . CONCLUSIONS Among older adults with type 2 DM , femoral neck BMD T score and FRAX score were associated with hip and nonspine fracture risk ; however , in these patients compared with participants without DM , the fracture risk was higher for a given T score and age or for a given FRAX score [ Purpose ] Diabetes mellitus is a metabolic disorder result ing from a defect in insulin secretion , insulin action , or both . A consequence of this is chronic hyperglycemia with disturbances in carbohydrate , fat and protein metabolism . We investigated whether there is any difference among DM patients and a control group in terms of lumbar and femur BMD ( bone mineral density ) , and st and ard deviation scores ( Z score and T score ) . [ Subjects and Methods ] This r and omized , prospect i ve , controlled , single-blind study was conducted in the Physical Medicine and Rehabilitation Department Faculty of Medicine , Bezm-i Alem Vakıf University . Patients with type 2 diabetes mellitus were included in the patient groups . Healthy individuals were included in the control group . [ Results ] A total of 126 patients completed the study ( 63 in the study group , 63 in the control group ) . There was no significant difference in the results of the laboratory examinations of the cases . The bone mineral densities of the cases were found to be significantly low in terms of the lumbar ( L1–4 ) T scores in the type 2 diabetes group . [ Conclusion ] Although osteoporosis is one of the potential complications of type 1 diabetes , its effect on bone mineral density in type 2 DM is controversial . In different studies , the bone mineral density values have increased , decreased or remained normal . With the exception of the lumbar ( L1–4 ) T score , similar results were obtained in this study UNLABELLED Using data from a r and omized placebo-controlled trial of 10,101 postmenopausal women not selected on the basis of osteoporosis , we examined whether the effect of raloxifene treatment on fractures was consistent across categories of fracture risk . Treatment with raloxifene for 5 yr reduced the risk of clinical vertebral fractures , but not nonvertebral fractures , irrespective of the presence or absence of risk factors for fracture . INTRODUCTION In The Raloxifene Use for The Heart ( RUTH ) trial , women assigned to raloxifene had a lower risk of clinical vertebral fractures but not nonvertebral fractures . However , it is uncertain whether the effect of raloxifene on fractures in this population not selected for low BMD differs according to risk factors for fractures . MATERIAL S AND METHODS We r and omly assigned 10,101 postmenopausal women > or=55 yr of age with documented coronary heart disease or at high risk for coronary events to 60 mg raloxifene daily or placebo and followed them for a median of 5.6 yr . Fractures ( nonvertebral and clinical vertebral ) were prespecified secondary endpoints that were reported at semiannual visits . Fractures were adjudicated and confirmed using X-ray reports or medical records . RESULTS There was no difference between raloxifene and placebo groups in risk of nonvertebral fractures ( 428 versus 438 events ; hazard ratio [ HR ] , 0.96 ; 95 % CI , 0.84 - 1.10 ) , including hip/femur ( 89 versus 103 events ; HR , 0.85 ; 95 % CI , 0.64 - 1.13 ) and wrist ( 107 versus 111 events ; HR , 0.95 ; 95 % CI , 0.73 - 1.24 ) fractures . Women treated with raloxifene had a lower risk of clinical vertebral fractures ( 64 versus 97 events ; HR , 0.65 ; 95 % CI , 0.47 - 0.89 ) 
    Output:
    
Conclusions The presence of diabetes does not alter anti-osteoporotic treatment response , regarding BMD increase and vertebral fracture risk reduction