***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: Falls and their consequences are serious health problems among older population s. To study predisposing and precipitating factors for falls among older people in residential care we used a cross-sectional study design with a prospect i ve follow up for falls . Fifty-eight women and 25 men , with a mean age of 79.6 y , were included and prospect ively followed up regarding falls for a period of 1 y after baseline assessment s. All those who fell were assessed regarding factors that might have precipitated the fall . The incidence rate was 2.29 falls/person years . Antidepressants ( selective serotonin reuptake inhibitors , SSRIs ) , impaired vision and being unable to use stairs without assistance were independently associated with being a ' faller ' . Twenty-eight ( 53.8 % ) of the fallers suffered injuries as a result of their falls , including 21 fractures . Twenty-seven percent of the falls were judged to be precipitated by an acute illness or disease and 8.6 % by a side effect of a drug . Acute symptoms of diseases or drug side effects were associated with 58 % of the falls which result ed in fractures . We conclude that SSRIs seem to constitute one important factor that predisposes older people to fall , once or repeatedly . Since acute illnesses and drug side-effects were important precipitating factors , falls should be regarded as a possible symptom of disease or a side-effect of a drug until it is proven otherwise BACKGROUND Physical activity has been related to enhanced bone mass and improved physical functioning and thus may reduce the risk for osteoporotic fracture .  OBJECTIVE To determine whether higher levels of physical activity are related to lower incidence of  hip , wrist , and vertebral fractures . DESIGN Prospect i ve cohort study . SETTING Four clinical centers in Baltimore , Maryl and ; Portl and , Oregon ; Minneapolis , Minnesota ; and the Monongahela Valley , Pennsylvania . PARTICIPANTS 9704 nonblack women 65 years of age or older . MEASUREMENTS  Physical activity  was assessed by question naire at baseline . Hip and wrist fractures were followed for an average of 7.6 years . The incidence of vertebral fracture was determined morphometrically by using radiography at baseline and an average of 3.7 years later . RESULTS Higher levels of leisure time , sport activity , and household chores and fewer hours of sitting daily were associated with a significantly reduced relative risk for hip fracture after adjustment for age , dietary factors , falls at baseline , and functional and health status . Very active women ( fourth and fifth quintiles ) had a statistically significant 36 % reduction in hip fractures ( relative risk , 0.64 [ 95 % CI , 0.45 to 0.891 ) compared with the least active women ( lowest quintile ) . The intensity of physical activity  was also related to fracture risk : Moderately to vigorously active women had statistically significant reductions of 42 % and 33 % in risk for hip and vertebral fractures , respectively , compared with inactive women . Total physical activity , hours of household chores per day , and hours of sitting per day were not significantly associated with wrist or vertebral fractures . CONCLUSIONS Among older community-dwelling women , physical activity is associated with a reduced risk for hip fracture but not wrist or vertebral fracture OBJECTIVE To evaluate the effects of two exercise approaches , Tai Chi ( TC ) and computerized balance training ( BT ) , on specified primary outcomes ( biomedical , functional , and psychosocial indicators of frailty ) and secondary outcomes ( occurrence of falls ) . DESIGN The Atlanta FICSIT ( Frailty and Injuries : Cooperative Studies of Intervention Techniques ) , a prospect i ve , r and omized , controlled clinical trial with three arms ( TC , BT , and education [ ED ] . Intervention length was 15 weeks , with primary outcomes measured before and after intervention and at 4-month follow-up . Falls were monitored continuously throughout the study . SETTING Persons aged 70 and older living in the community . PARTICIPANTS A total of 200 participants , 162 women and 38 men ; mean age was 76.2 . MEASUREMENTS Biomedical ( strength , flexibility , cardiovascular endurance , body composition ) , functional ( IADL ) , and psychosocial well-being ( CES-D scale , fear of falling question naire , self-perception of present and future health , mastery index , perceived quality of sleep , and intrusiveness ) variables . RESULTS Grip strength declined in all groups , and lower extremity range of motion showed limited but statistically significant changes . Lowered blood pressure before and after a 12-minute walk was seen following TC participation . Fear of falling responses and intrusiveness responses were reduced after the TC intervention compared with the ED group ( P = .046 and P = .058 , respectively ) . After adjusting for fall risk factors , TC was found to reduce the risk of multiple falls by 47.5 % . CONCLUSIONS A moderate TC intervention can impact favorably on defined biomedical and psychosocial indices of frailty . This intervention can also have favorable effects upon the occurrence of falls .  Tai Chi warrants further study as an exercise treatment to improve the health of older people The aim of this population -based matched case-control study was to evaluate the effect of risk factors for hip fracture in Oslo , Norway , which has some of the highest incidence rates ever reported . The study population comprised all non-institutionalized persons 50 years or older living in the catchment area of two Oslo hospitals , and cases were 246 patients admitted for hip fracture during a 1-year period . The controls were r and omly selected from the study population , matched 1:1 for age and sex . Hip fracture was associated with lean body stature , smoking , low grip strength and decreased levels of physical activity , and inversely with length of education . In addition , hip fracture was inversely related to indicators of total food intake ( number of meals per day , frequency of dinners , and slices of bread per day ) . A relation between hip fracture and low vitamin D intake was also suggested , whereas no association with dietary calcium intake was found . Finally , increased risk of fracture was seen in persons reporting two or more hospital admissions in the previous 2 years , and in those reporting weight reduction due to poor appetite during the previous year . In conclusion , the risk factor pattern for hip fracture was much the same in the elderly population of Oslo as previously described in other population s with a lower incidence of fracture . This study also indicates a relation between hip fracture and low food intake BACKGROUND Physical activity has been related to reduced risk of osteoporotic hip fractures , but the evidence among men is weak . OBJECTIVE To determine the association between baseline leisure physical activity and future risk of osteoporotic hip fracture in men . METHODS At baseline in 1975 our prospect i ve study cohort included 3,262 men who were 44 years or older and did not have chronic disease restricting their ability to exercise .  At baseline , physical activity was assessed by a question naire . Hip fractures were followed for 21 years , or from the age of 50 years for subjects who were initially younger than 50 years . RESULTS The hazard ratio of osteoporotic hip fracture , adjusted for other possible predictors ( height , body mass index , baseline diseases , smoking , use of alcohol , work-related physical activity , and occupational group ) , in men participating in vigorous physical activity compared with men not participating was 0.38 ( 95 % confidence interval , 0.16 - 0.91 ) ( P = .03 ) . CONCLUSION These results provide further evidence that there is an inverse association between baseline physical activity  and future hip fracture risk among men BACKGROUND Despite its association with disability , death , and increased medical costs , osteoporosis in men has been relatively neglected as a subject of study . There have been no large , controlled trials of treatment in men . METHODS In a two-year double-blind trial , we studied the effect of 10 mg of alendronate or placebo , given daily , on bone mineral density in 241 men ( age , 31 to 87 years ; mean , 63 ) with osteoporosis . Approximately one third had low serum free testosterone concentrations at base line ; the rest had normal concentrations . Men with other secondary causes of osteoporosis were excluded . All the men received calcium and vitamin D supplements . The main outcome measures were the percent changes in lumbar-spine , hip , and total-body bone mineral density . RESULTS The men who received alendronate had a mean ( + /-SE ) increase in bone mineral density of 7.1+/-0.3 percent at the lumbar spine , 2.5+/-0.4 percent at the femoral neck , and 2.0+/-0.2 percent for the total body ( P<0.001 for all comparisons with base line ) . In contrast , men who received placebo had an increase in lumbar-spine bone mineral density of 1.8+/-0.5 percent ( P<0.001 for the comparison with base line ) and no significant changes in femoral-neck or total-body bone mineral density . The increase in bone mineral density in the alendronate group was greater than that in the placebo group at all measurement sites ( P<0.001 ) . The incidence of vertebral fractures was lower in the alendronate group than in the placebo group ( 0.8 percent vs. 7.1 percent , P=0.02 ) . Men in the placebo group had a 2.4-mm decrease in height , as compared with a decrease of 0.6 mm in the alendronate group ( P=0.02 ) . Alendronate was generally well tolerated . CONCLUSIONS In men with osteoporosis , alendronate significantly increases spine , hip , and total-body bone mineral density and helps prevent vertebral fractures and decreases in height 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 daily ) at 24 months , with maintenance of the double blind . Lateral spine radiography was done at baseline and at 24 and 36 months . New vertebral fractures , the primary endpoint , were defined by morphometry as a decrease of 20 % ( and at least 4 mm ) in at least one vertebral height between the baseline and latest follow-up radiograph . Non-spine clinical fractures were confirmed by radiographic reports . New symptomatic vertebral fractures were based on self-report and confirmed by radiography . FINDINGS Follow-up radiographs were obtained for 1946 women ( 98 % of surviving participants ) . 78 ( 8.0 % ) of women in the alendronate group had one or more new morphometric vertebral fractures compared with 145 ( 15.0 % ) in the placebo group ( relative risk 0.53 [ 95 % Cl 0.41 - 0.68 ] ) . For clinical ly apparent vertebral fractures , the corresponding numbers were 23 ( 2.3 % ) alendronate and 50 ( 5.0 % ) placebo ( relative hazard 0.45 [ 0.27 - 0.72 ] ) . The risk of any clinical fracture , the main secondary endpoint , was lower in the alendronate than in the placebo group ( 139 [ 13.6 % ] vs 183 [ 18.2 % ] ; relative hazard 0.72 [ 0.58 - 0.90 ] ) . The relative hazards for hip fracture and wrist fracture for alendronate versus placebo were 0.49 ( 0.23 - 0.99 ) and 0.52 ( 0.31 - 0.87 ) . There was no significant difference between the groups in numbers of adverse experiences , including upper-gastrointestinal disorders . INTERPRETATION We conclude that among women with low bone mass and existing vertebral  fractures , alendronate is well tolerated and substantially reduces the frequency of morphometric and clinical vertebral fractures , as well as other clinical fractures BACKGROUND Past studies suggest multidisciplinary interventions that include physical therapy ( PT ) can improve function of nursing home residents . This trial specifically evaluates effects of PT for frail long-stay nursing home residents . DESIGN R and omized , controlled trial . SETTING One academic nursing home and eight community nursing homes . PATIENTS A total of 194 elderly nursing home residents dependent in at least two activities of daily living residing in the nursing home for at least 3 months . INTERVENTIONS Patients were r and omized to individually tailored one-on-one PT sessions or friendly visits ( FVs ) three times a week for 4 months . Physical therapy included range-of-motion , strength , balance , transfer , and mobility exercises . MAIN OUTCOME MEASURES Performance-based physical function assessed by the Physical Disability Index ; self-perceived health status assessed with the Sickness Impact Profile ; observer-reported activities of daily living ; and falls . RESULTS 
    Output:
    
RESULTS The evidence that physical activity modifies the risk factors for fall is compelling , although RCT with fractures as end point are lacking .
Physical activity is associated with improved muscle strength , co-ordination and balance .
Physical training increases muscle strength also in octogenarians by up to 200 % , i.e. a much more pronounced effect than the corresponding increase in muscle volume or bone mass .
There is also evidence that physical activity decreases the actual number of falls .
Observational cohort and case-control studies imply that physical activity is associated with reduced hip fracture risk .