***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: The aim of this study was to evaluate the effects of calcitonin ( CT ) treatment on bone pain , osteoporosis , bone fractures and blood chemistry in thalassemic patients . Twenty-four patients with an age range of 10 - 24 years were included , 14 of whom received 100 IU CT  and 250 mg calcium 3 times a week . The others ( n = 10 ) were followed up as a control group with only routine thalassemia therapy . After 1 year of treatment , bone pain disappeared and radiological signs of osteoporosis had improved significantly ( p < 0.01 ) in the treatment group . CT has no important side effects Neridronate is a third generation bisphosphonate with established efficacy in metabolic bone disease . In this r and omized , open‐label study , 118 adults with β‐thalassaemia and bone mineral density ( BMD ) Z scores ≤−2·0 were r and omized 1:1–500 mg calcium with 400 international unis ( iu ) vitamin D daily or 500 mg calcium with 400 iu vitamin D daily plus neridronate 100 mg intravenously every 90 d. Significant increases in BMD at the lumbar spine and total hip were noted in the neridronate group at 6 and 12 months from baseline ( P < 0·001 ) , and values were significantly higher than the control group at both time  intervals . Neridronate also significantly decreased serum bone alkaline phosphatase and C‐telopeptide of collagen type 1 levels from as early as 3 months ( P = 0·04 and P < 0·001 , respectively ) , reaching significantly lower values at 12 months compared with the control group ( P < 0·05 ) . Reductions in back pain and analgesic use were also evident , starting 3 months from commencing treatment . Treatment was well tolerated by all patients . In this largest r and omized trial in thalassaemia‐induced osteoporosis to date , neridronate  was safe and effective in reducing bone resorption and increasing BMD . The associated reduction in back pain and improved quality of life will encourage adherence to therapy . ( Clinical trials.gov identifier NCT01140321 . BACKGROUND Patients with thalassemia major ( Thal ) frequently have low plasma zinc , which has been associated with low bone mass . OBJECTIVE The objective was to determine the effect of zinc supplementation on bone mass in patients with Thal . DESIGN Forty-two subjects ( 21 females aged 10 - 30 y ) with Thal and low bone mass were r and omly assigned to receive 25 mg Zn/d or placebo .  Bone mineral content ( BMC ) and areal bone mineral density ( aBMD ) were assessed by using dual-energy X-ray absorptiometry , and fasting blood was collected for the measurement of plasma zinc at 0 , 12 , and 18 mo . RESULTS Thirty-two subjects , 81 % of whom were transfusion dependent , completed the study ( mean ± SD : 17.1 ± 5.2 y ) . Plasma zinc was ≤70 μg/dL in 11 subjects at baseline and increased significantly with zinc supplementation ( P = 0.014 ) . Use of intention-to-treat analysis and linear models for longitudinal data , adjusted for baseline and pubertal stage , showed that the zinc group had significantly greater increases in whole-body BMC ( adjusted mean ± SE : 63 ± 15 g ; P = 0.02 ) , and aBMD ( 0.023 ± 0.006 g/cm(2 ) ; P = 0.04 ) than did the placebo group after 18 mo . Furthermore , adjusted spine and hip aBMD z scores each decreased by 0.3 SDs ( both P = 0.04 ) in the placebo compared with the zinc group over the 18-mo study . CONCLUSIONS In young patients with Thal , zinc supplementation result ed in greater gains in total-body bone mass than did placebo . Zinc was well tolerated and is worthy of investigation in larger trials in Thal patients across a range of ages and disease severity . This trial was registered at clinical trials.gov as NCT00459732 Osteoporosis is an important cause of morbidity in beta-thalassemia patients .  Bisphosphonates have been recently used for the treatment of osteoporosis in beta-thalassemia . This study is a prospect i ve quasi-experimental study to assess the efficacy and safety of zoledronic acid in thalassemics with osteoporosis . Eighteen thalassemia patients with osteoporosis were given zoledronic acid 4 mg intravenously every 3 months over a period of 12 months . The efficacy of treatment was assessed by measuring ( BMD ) at the lumbar spine , femoral neck , and hip at baseline , 6 , and 12 months . Z-score was used to measure the BMD . Other medical assessment s included markers of bone formation and resorption ( bone alkaline phosphatase ( BAP ) , osteocalcin ( OC ) , and urinary deoxypyridinoline ) , and the assessment of pain score , analgesic score , and performance score .  Ten thalassemic osteoporotic patients were followed up only with serial BMDs as controls . Both groups had no significant difference with respect to age , gender , and baseline BMD . Patients taking zoledronic acid had a significant increase in their lumbar spine , femoral neck , trochanter , and total hip BMD measurements over the 12-month period . Patients in the control group did not have any significant change in BMD measurements . There was a significant change in the levels of OC and BAP over the 12-month follow-up period . There was also a significant decrease in the number of painful sites experienced by the patients . Treatment of thalassemic osteoporotic patients with zoledronic acid is very effective in increasing BMD at the lumbar spine and hip and in reducing pain ; it is also well-tolerated Objective There are some reports in which a condition of zinc deficiency and its associated outcomes with a change in concentration of serum copper among the thalassemic patients has been highlighted . The aim of this prospect i ve study was to determine the serum zinc and copper levels in children with beta-thalassemia major . Methods In this cross sectional study all children under 12 years affected by beta thalassemia major ( 40 patients ) were evaluated for serum zinc and copper levels in Qazvin thalassemia center ( Qazvin , Iran ) in 2007 .  Serum measurements for zinc and copper were performed by atomic absorption spectrophotometer . Findings The mean concentrations of serum zinc and copper levels were 67.35±20.38 and 152.42±24.17 µg/dl respectively . Twenty-six ( 65 % ) of thalassemic patients had zinc concentration under 70 µg/dl ( hypozincemia ) . None of the thalassemic children had copper deficiency . No significant correlation between serum zinc level with age , weight , height , body mass index , duration of blood transfusion , desferrioxamine dose and ferritin level was observed in thalassemic patients ( P=0.3 ) . Conclusion This study revealed that hypozincemia is common in thalassemic patients , but in contrast , there is no copper deficiency . Further evaluation in this regard is recommended OBJECTIVE The osteoporosis seen in thaiassaemia major is of multifactorial origin . The aim of the study was to evaluate the contribution of hypogonadism to the development of this osteoporosis and to assess the efficacy of new sex hormone replacement therapy regimens Abstract : The aim of our r and omized , placebo-controlled study was to investigate the effects of 2 years ’ daily oral administration of alendronate or intramuscular administration of clodronate every 10 days , on bone remodeling parameters and bone mineral density ( BMD ) , safety and tolerability in a group of osteoporotic thalassemic patients . Twenty-five young patients ( mean age 26.6 ± 7.1 years ) with beta-thalassemia major were r and omly divided to receive placebo or 100 mg of clodronate intramuscularly every 10 days or 10 mg of alendronate per os daily . All patients took 500 mg of elemental calcium and 400 IU cholecalciferol in the evening at meal time . After 2 years , pyridinium crosslinks , which are bone resorption markers , did not differ significantly from baseline values in the placebo group , whereas they had decreased significantly in the clodronate and alendronate groups . Osteocalcin , a bone formation marker , did not change significantly in the placebo group , whereas it decreased slightly , but not significantly , in the clodronate and alendronate groups after 12 and 24 months . At the end of the study , the lumbar spine BMD had decreased significantly in the placebo group ; it did not change significantly in the clodronate group ; in the alendronate group it had increased but not significantly , whereas the increase was significant with respect to the placebo  group . Femoral neck BMD decreased significantly in the placebo group ; it did not change significantly in the clodronate group , but increased significantly in the alendronate group . No relevant side effects were recorded during our study . In conclusion , in patients with thalassemia-induced osteoporosis , the daily administration of alendronate  significantly increases BMD , the most important predictor of the risk of fracture at several sites . Clodronate treatment at our dosage is ineffective in this pathology in spite of the good compliance of patients Osteoporosis in Β-thalassemia major has emerged as a topic of interest since optimized transfusion regimens have increased life expectancy and quality in these patients . Although the pathogenesis of thalassemic osteopathy is multifactorial , the evidence of an increased resorption phase suggests that the use of antiresorptive drugs such as bisphosphonates can be considered a valuable therapeutic strategy to reduce bone turnover and the risk of fragility fractures . We compared the effects of long-term cyclical clodronate therapy ( 300 mg intravenous infusion every 3 weeks for 2 years ) and of an active placebo ( calcium 1 vitamin D ) on bone mass and bone turnover in 30 male patients with Β-thalassemia major . We also tested the possibility of using quantitative ultrasound ( QUS ) for assessing bone involvement in thalassemic osteopenia and in monitoring the response to antiresorptive therapy . Broadb and ultrasound attenuation ( BUA ) was significantly reduced in patients with Β-thalassemia major as compared to healthy controls . In calcium and vitamin D-treated patients , a significant decline in spine , femoral , and total body areal bone density was observed . In the patients given intravenous clodronate we measured a substantial stability of bone mass , which was not significantly changed at the end of the study . The urinary excretion of deoxypyridinoline ( a marker of bone resorption ) showed a progressive significant decline throughout the study period in clodronate-treated patients . No significant change was observed in BUA values in both groups of patients . These results indicate that intermittent intravenous clodronate administration was not able to increase areal bone density in our thalassemic patients . Moreover , this is the first study to have assessed the usefulness of broadb and ultrasound measurements in Β-thalassemia major BACKGROUND AND OBJECTIVES The aim of this study was to evaluate the effect of zoledronic acid ( ZA ) on thalassemia-induced osteoporosis . DESIGN AND METHODS We studied 66 thalassemia patients with osteoporosis , who were r and omized to receive 4 mg ZA iv , every 6 months ( 23 patients ; group A ) or every 3 months ( 21 patients ; group B ) , or to receive  placebo  every 3 months ( 22 patients ; group C ) , for a period of 1 year . Bone mineral density ( BMD ) of the lumbar spine , femoral neck and wrist was determined before and 12 months after treatment . Pain scores and markers of bone resorption [ C-telopeptide of collagen type-I ( CTX ) , 5b-isoform of TRAP ] , bone formation [ bone-alkaline phosphatase ( bALP ) , osteocalcin ( OC ) , C-telopeptide of procollagen type-I ( CICP ) ] , and osteoclast stimulators [ sRANKL , osteoprotegerin ( OPG ) , osteopontin ] were also measured at baseline and before each treatment administration . RESULTS The values of CTX , bALP , CICP , sRANKL , and OPG were higher in the all patients than in the controls . Patients in group A showed no differences in BMD of all sites at 12 months , while they had reductions in bone pain , bALP , OC and OPG . Conversely patients in group B had a significant increase in their lumbar spine BMD , which was accompanied by dramatic reductions in bone pain , CTX , bALP , CICP , and OC . Patients in group C showed no alteration in BMD of any studied site or in bone pain , while they had an aggravation in bone resorption . INTERPRETATION AND CONCLUSIONS ZA , at a dose of 4 mg , iv , every 3 months is an effective treatment for increasing BMD and reducing bone resorption in thalassemia-induced osteoporosis Beta-thalassaemia major is associated with low bone mass and fractures . We conducted a 2 year r and 
    Output:
    
There were no major adverse effects reported in two of the bisphosphonate trials ; in the neridronate trial there was a reduction noted in the use of analgesic drugs and in the reported back pain score in favour of bisphosphonate treatment .
There is evidence to indicate an increase in bone mineral density at the femoral neck , lumbar spine and forearm after administration of bisphosphonates and at the lumbar spine and hip after zinc sulphate supplementation .