***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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    Input: Osteoporosis is a well-recognized adverse effect of corticosteroid therapy . This study aim ed to investigate the effect of etidronate , intermittent cyclical therapy , in the prevention of  corticosteroid-induced bone loss .  Patients with various medical conditions starting high-dose corticosteroid therapy were enrolled in the study . The treatment had to be expected to continue for at least 12 months with the initial 90 days at a mean daily dose of at least 7.5 mg of prednisone , with subsequent treatment of at least 2.5 mg/day . One hundred seventeen patients were r and omly assigned oral etidronate 400 mg/day , or placebo , for 14 days , followed by 76 days of oral calcium carbonate ( 500 mg elemental calcium ) , cycled over 12 months . The primary outcome measure was the difference in percent change from baseline in bone mineral density of the lumbar spine between the groups at the end of year 1 . Secondary measures included changes in femur bone density and in biochemical markers of bone remodeling . The mean ( + /- SEM ) lumbar spine bone density changed 0.30 + /- 0.61 % and -2.79 + /- 0.63 % in the etidronate and placebo groups , respectively . The mean difference between groups after 1 yr was 3.0 + /- 0.84 % ( P = 0.004 ) . The changes in the femoral neck and great trochanter were not different between the groups . There was a decrease in pyridinium crosslinks , significant from baseline at both 6 and 12 months , in the etidronate group . Osteocalcin increased in the placebo group , and difference between groups was -25.07 + /- 14.89 % ( P = 0.032 ) and -34.68 + /- 19.77 % ( P = 0.051 ) , at 6 and 12 months respectively . There was no significant difference between the groups in number of adverse experiences , including gastrointestinal disorders .  Etidronate intermittent cyclical therapy prevents lumbar vertebral bone loss in patients starting high-dose corticosteroid therapy UNLABELLED Oral daily ( 2.5 mg ) and intermittent ib and ronate ( between-dose interval of > 2 months ) , delivering a similar cumulative exposure , were evaluated in 2946 osteoporotic women with prevalent vertebral fracture . Significant reduction in incident vertebral fracture risk by 62 % and 50 % , respectively , was shown after 3 years . This is the first study to prospect ively show antifracture efficacy for the intermittent administration of a bisphosphonate . INTRODUCTION Bisphosphonates are important therapeutics in postmenopausal osteoporosis . However , they are currently associated with stringent dosing instructions that may impair patient compliance and hence therapeutic efficacy . Less frequent , intermittent administration may help to overcome these deficiencies . This study assessed the efficacy and safety of oral ib and ronate administered either daily or intermittently with a dose-free interval of > 2 months . MATERIAL S AND METHODS This r and omized , double-blind , placebo-controlled , parallel-group study enrolled 2946 postmenopausal women with a BMD T score < or = -2.0 at the lumbar spine in at least one vertebra ( L1-L4 ) and one to four prevalent vertebral fractures ( T4-L4 ) . Patients received placebo or oral ib and ronate administered either daily ( 2.5 mg ) or intermittently ( 20 mg every other day for 12 doses every 3 months ) . RESULTS AND CONCLUSIONS After 3 years , the rate of new vertebral fractures was significantly reduced in patients receiving oral daily ( 4.7 % ) and intermittent ib and ronate ( 4.9 % ) , relative to placebo ( 9.6 % ) . Thus , daily and intermittent oral ib and ronate significantly reduced the risk of new morphometric vertebral fractures by 62 % ( p = 0.0001 ) and 50 % ( p = 0.0006 ) , respectively , versus placebo . Both treatment groups also produced a statistically significant relative risk reduction in clinical vertebral fractures ( 49 % and 48 % for daily and intermittent ib and ronate , respectively ) . Significant and progressive increases in lumbar spine ( 6.5 % , 5.7 % , and 1.3 % for daily ib and ronate , intermittent ib and ronate , and placebo , respectively , at 3 years ) and hip BMD , normalization of bone turnover , and significantly less height loss than in the placebo group were also observed for both ib and ronate regimens . The overall population was at low risk for osteoporotic fractures . Consequently , the incidence of nonvertebral fractures was similar between the ib and ronate and placebo groups after 3 years ( 9.1 % , 8.9 % , and 8.2 % in the daily , intermittent , and placebo groups , respectively ; difference between arms not significant ) . However , findings from a posthoc analysis showed that the daily regimen reduces the risk of nonvertebral fractures ( 69 % ; p = 0.012 ) in a higher-risk subgroup ( femoral neck BMD T score < -3.0 ) . In addition , oral ib and ronate was well tolerated . Oral ib and ronate , whether administered daily or intermittently with an extended between-dose interval of > 2 months , is highly effective in reducing the incidence of osteoporotic fractures in postmenopausal women . This is the first time that significant fracture efficacy has been prospect ively shown with an intermittently administered bisphosphonate in the overall study population of a r and omized , controlled clinical trial . Thus , oral ib and ronate holds promise as an effective and convenient alternative to current bisphosphonate therapies Raloxifene is a selective estrogen receptor modulator that in experimental animals acts as an estrogen receptor antagonist in breast and endometrium but as an estrogen receptor agonist in the skeletal and cardiovascular systems . We conducted a 1-year prospect i ve , r and omized , double-blind trial in 143 postmenopausal osteoporotic women ( mean + /- SD age , 68.4+/-5.0 years ) with at least one prevalent vertebral fractures and low bone mineral density ( BMD ) , comparing groups receiving raloxifene at 60 mg/day ( RLX60 ) or 120 mg/day ( RLX120 ) and a control group receiving supplements of 750 mg/day of calcium and 400 IU/day of vitamin D.  There were no differences among groups in the occurrence of uterine bleeding , thrombophlebitis , breast abnormalities , or increased endometrial thickness ( assessed by ultrasonography ) . As compared with controls , the changes in values over 1 year for RLX60 and RLX120 , respectively , were significant for serum bone alkaline phosphatase ( -14.9 % , -8.87 % ) , serum osteocalcin ( -20.7 % , -17.0 % ) , and urinary C-telopeptide fragment of type I collagen/creatinine ( -24.9 % , -30.8 % ) , markers of bone turnover ; for serum total cholesterol ( -7.0 % for RLX60 ) and low density lipoprotein cholesterol ( LDL ) ( -11.4 % for RLX60 ) and for the LDL/HDL cholesterol ratio ( -13.2 % , -8.3 % ) . BMD increased significantly in the total hip ( 1.66 % for RLX60 ) and ultradistal radius ( 2.92 % , 2.50 % ) . There were nonsignificant trends toward increases over controls in BMD for lumbar spine , total body , and total hip ( for RLX120 ) . Using a > 15 % cutoff definition , raloxifene had no effect on incident fractures , but using a > 30 % cutoff , there was a dose-related reduction ( p = 0.047 ) . We conclude that raloxifene therapy is well tolerated , reduces serum lipids , and does not stimulate the uterus or breasts . It has beneficial effects on bone , although , under the conditions of this study , these appear to be of a smaller magnitude than have been reported with estrogen therapy Patients with inflammatory bowel disease ( IBD ) have frequently a bone mineral density ( BMD ) significantly lower than age-matched healthy subjects . The low BMD observed in IBD patients is related also to a higher incidence of bone fractures . In this prospect i ve r and omized study we evaluated the effect of 1-year risedronate administration on bone mass and turnover , and on vertebral fractures in osteoporotic postmenopausal women with IBD in remission . Ninety osteoporotic postmenopausal women were r and omized to receive oral risedronate 35 mg/week ( risedronate group ) or placebo tablets ( placebo group ; one tab/week ) . The duration of treatment was 12 months . At entry and after treatment , lumbar spine and hip BMD , and serum osteocalcin ( OC ) and urinary deoxypyridinoline/creatinine ratio ( DPD-Cr ) levels were evaluated . Vertebral fractures were assessed from thoracic and lumbar lateral and anterior-posterior spinal radiographs taken at baseline , and from lateral spinal radiographs taken at the end of the study . At study entry , no difference between groups was also detected in BMD and in bone turnover markers . At the end of the study , lumbar spine , trochanter and femoral neck BMD was significantly ( p < 0.05 ) higher in comparison with baseline in the risedronate group , whereas a significant ( p < 0.05 ) decrease was observed in the placebo group . For the same visit , a significant ( p < 0.05 ) difference in lumbar spine , trochanter and femoral neck BMD was detected between groups . After 12-month follow-up , serum OC and urinary DPD-Cr levels were significantly ( p < 0.05 ) lower and higher in comparison with basal values in risedronate and placebo group , respectively . At the same time , a significant ( p < 0.05 ) difference in serum OC and urinary DPD-Cr levels was observed between groups . Throughout the study , the incidence of vertebral fractures was significantly ( p < 0.05 ) lower in the risedronate group than in the placebo group ( 12.5 % vs 34.1 % ) . The relative risk ( RR ) to develop a new vertebral fracture after 1 year of risedronate administration was of 0.36 ( 95 % confidence interval , 0.14–0.85 ) . In conclusion , risedronate administration is an effective anti-osteoporotic treatment in osteoporotic postmenopausal women with IBD in remission To demonstrate the clinical benefit of risedronate at 2.5 mg daily in the treatment of involutional osteoporosis , the effect of risedronate on incidence of vertebral fracture was compared with that of etidronate . A total of 547 patients with one to four vertebral fractures were r and omized to receive either treatment with 2.5 mg/day of risedronate or intermittent treatment ( treatment of 2 weeks and off period of 10 weeks ) with 200 mg/day of etidronate for 96 weeks in a double-masked fashion . All patients received 200 mg calcium supplement daily . Lateral and anteroposterior thoracic and lumbar spine radiographs were obtained at baseline and at 24 , 48 , 72 , and 96 weeks . Cumulative incidence rates of patients who had at least one new or worsening vertebral fracture during the 96-week period were 12.3 % for risedronate and 14.2 % for etidronate , and it was verified that the fracture prevention effect of risedronate was not inferior to that of etidronate . The incidence rates of fracture during the initial 24-week period were 8.8 % for risedronate and 6.0 % for etidronate , but the cumulative incidence rate of fracture from 24 to 96 weeks was lower in the risedronate group ( 3.9 % ) as compared to the etidronate group ( 8.7 % ) . Height loss was significantly less in the risedronate group ( −0.28 cm ) than in the etidronate group ( −0.70 cm ) after 96 weeks . Decreases in bone resorption markers including urinary total deoxypyridinoline and NTX were significantly greater in the risedronate group than in the etidronate group throughout the treatment period . An improvement of patient QOL was observed in both groups . No significant difference in the incidence of adverse events was observed between the two treatments . Daily oral risedronate ( 2.5 mg ) was shown to provide an effective therapy for involutional osteoporosis in Japanese patients with good tolerability OBJECTIVES Hip fracture is among the most common causes of acute immobilization in elderly patients leading to increased bone resorption , and elderly patients with hip fracture are at high risk for a subsequent hip fracture . DESIGN In this double-blind , r and omized , prospect i ve study , 80 female patients who were imm 
    Output:
    
Low bone density , as measured by DXA , is an imperfect predictor of fracture risk , identifying fewer than half the people who go on to have an osteoporotic fracture .
Bisphosphonates Good- quality evidence showed that alendronate , etidronate , ib and ronate , and risedronate prevent vertebral fractures .
In addition , evidence from good- quality studies demonstrated that both alendronate and risedronate prevent nonvertebral and hip fractures .
Good- quality evidence indicates that calcitonin does not reduce nonvertebral fractures ( 13 , 16 ) .
Teriparatide Good- quality evidence shows that teriparatide prevents vertebral fractures .