***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 The aim of this study was to assess the efficacy , tolerability and safety of risedronate in adults with CF . METHODS Patients with a lumbar spine ( LS ) , total hip ( TH ) or femoral neck ( FN ) bone mineral density ( BMD ) Z-score of -1 or less were r and omised to receive risedronate 35 mg weekly or placebo , and calcium (1g)+vitamin D(3 ) ( 800IU ) . RESULTS At baseline , BMD Z-scores in the risedronate ( n=17 ) and placebo ( n=19 ) groups were similar . By 24 months , 7/17 risedronate patients vs 0/19 placebo patients stopped the study medication due to bone pain . After 24 months treatment , the mean difference ( 95 % CI ) in change in LS , TH and FN BMD between the risedronate vs placebo groups was 4.3 % ( 0.4 , 8.2 ) p=0.03 ; 4.0 % ( -0.5 , 8.6 ) p=0.08 ; and 2.4 % ( -3.5 , 8.2 ) p=0.41 . CONCLUSIONS After two years treatment there was a significant increase in LS BMD with weekly risedronate compared to placebo BACKGROUND Low bone mineral density ( BMD ) is prevalent in adults with cystic fibrosis . The aim of this study was to assess the effect of intravenous pamidronate on BMD in these subjects . METHODS Patients were invited to participate if they had a BMD Z score of –2 or less in the lumbar spine , proximal femur , or distal forearm . Patients were r and omised to receive either 30 mg intravenous pamidronate every 3 months + 1 g calcium daily ( pamidronate group ) or 1 g calcium daily ( control group ) . All pancreatic insufficient patients were prescribed oral vitamin D supplements . RESULTS After 6 months of treatment the pamidronate group ( n=13 ) showed a significant increase in absolute BMD compared with the control group ( n=15 ) in the lumbar spine ( mean difference 5.8 % ( CI 2.7 % to 8.9 % ) ) and total hip ( mean difference 3.0 % ( CI 0.3 % to 5.6 % ) ) . However , the pamidronate group showed a reduction in BMD compared with the control group in the distal forearm ( mean difference –1.7 % ( CI –3.7 % to 0.3 % ) ) . The use of pamidronate was associated with a high incidence of bone pain in non-corticosteroid treated individuals . CONCLUSION Intravenous pamidronate increases axial BMD in adults with cystic fibrosis , but the high incidence of bone pain associated with this treatment might limit its use Background : Approximately two thirds of adult patients with cystic fibrosis have reduced bone mineral density and up to one quarter have osteoporosis at one or more sites . Any bone mineral deficits are likely to be exacerbated in patients following lung transplantation by their immunosuppressive regimen . Vertebral collapse and rib fractures will impair the ability to cough and the efficacy of physiotherapy treatments . Methods : Patients attending the Leeds Regional Adult Cystic Fibrosis Unit with either osteopenia or osteoporosis on dual energy x ray absorptiometry ( DXA ) scanning were offered treatment with oral bisphosphonates after exclusion of abnormal vitamin D , calcium , or phosphate levels , abnormal thyroid function , or hypogonadism . Those declining treatment or patients with a normal initial DXA scan formed the control group . A second DXA scan was performed after a mean of 2.4 years in the treatment group and 2.9 years in the non-treatment group . Patients in the active group were asked to complete a short question naire detailing their adherence to treatment . Results : The medians of the differences in annual changes in bone parameters between treatment and control groups showed significant differences in bone mineralisation in favour of the treatment group at the lumbar spine ( L2–L4 ) , the femoral neck , and for total body measurements . There were no significant differences in weight , height , or body composition in either patient group . Most treated patients stated that they adhered to treatment most of the time . Conclusion : Treatment with oral bisphosphonates may improve bone mineralisation in adult patients with cystic fibrosis . The results of this pilot study need to be further explored in a r and omised controlled trial 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 Severe osteogenesis imperfecta is a disorder characterized by osteopenia , frequent fractures , progressive deformity , loss of mobility , and chronic bone pain . There is no effective therapy for the disorder . We assessed the effects of treatment with a bisphosphonate on bone resorption . METHODS In an uncontrolled observational study involving 30 children who were 3 to 16 years old and had severe osteogenesis imperfecta , we administered pamidronate intravenously ( mean [ + /-SD ] dose , 6.8+/-1.1 mg per kilogram of body weight per year ) at 4-to-6-month intervals for 1.3 to 5.0 years . Clinical status , biochemical characteristics reflecting bone turnover , the bone mineral density of the lumbar spine , and radiologic changes were assessed regularly during treatment . RESULTS Administration of pamidronate result ed in sustained reductions in serum alkaline phosphatase concentrations and in the urinary excretion of calcium and type I collagen N-telopeptide . There was a mean annualized increase of 41.9+/-29.0 percent in bone mineral density , and the deviation of bone mineral density from normal , as indicated by the z score , improved from -5.3+/-1.2 to -3.4+/-1.5 . The cortical width of the metacarpals increased by 27+/-20.2 percent per year . The increases in the size of the vertebral bodies suggested that new bone had formed . The mean incidence of radiologically confirmed fractures decreased by 1.7 per year ( P<0.001 ) . Treatment with pamidronate did not alter the rate of fracture healing , the growth rate , or the appearance of the growth plates . Mobility and ambulation improved in 16 children and remained unchanged in the other 14 . All the children reported substantial relief of chronic pain and fatigue . CONCLUSIONS In children with severe osteogenesis imperfecta , cyclic administration of intravenous pamidronate improved clinical outcomes , reduced bone resorption , and increased bone density BACKGROUND Many risk factors for hip fractures have been suggested but have not been evaluated in a comprehensive prospect i ve study . METHODS We assessed potential risk factors , including bone mass , in 9516 white women 65 years of age or older who had had no previous hip fracture . We then followed these women at 4-month intervals for an average of 4.1 years to determine the frequency of hip fracture . All reports of hip fractures were vali date d by review of x-ray films . RESULTS During the follow-up period , 192 women had first hip fractures not due to motor vehicle accidents . In multivariable age-adjusted analyses , a maternal history of hip fracture doubled the risk of hip fracture ( relative risk , 2.0 ; 95 percent confidence interval , 1.4 to 2.9 ) , and the increase in risk remained significant after adjustment for bone density . Women who had gained weight since the age of 25 had a lower risk . The risk was higher among women who had previous fractures of any type after the age of 50 , were tall at the age of 25 , rated their own health as fair or poor , had previous hyperthyroidism , had been treated with long-acting benzodiazepines or anticonvulsant drugs , ingested greater amounts of caffeine , or spent four hours a day or less on their feet . Examination findings associated with an increased risk included the inability to rise from a chair without using one 's arms , poor depth perception , poor contrast sensitivity , and tachycardia at rest . Low calcaneal bone density was also an independent risk factor . The incidence of hip fracture ranged from 1.1 ( 95 percent confidence interval , 0.5 to 1.6 ) per 1,000 woman-years among women with no more than two risk factors and normal calcaneal bone density for their age to 27 ( 95 percent confidence interval , 20 to 34 ) per 1,000 woman-years among those with five or more risk factors and bone density in the lowest third for their age . CONCLUSIONS Women with multiple risk factors and low bone density have an especially high risk of hip fracture . Maintaining body weight , walking for exercise , avoiding long-acting benzodiazepines , minimizing caffeine intake , and treating impaired visual function are among the steps that may decrease the risk BACKGROUND Osteoporosis is a common complication of cystic fibrosis . OBJECTIVE To determine the prevalence of osteopenia and osteoporosis in adults with cystic fibrosis and to look for factors associated with low bone mineral density ( BMD ) values . METHODS During this prospect i ve 2-year study , we collected clinical data ( history , body mass index , and treatments ) and laboratory data ( nutritional and hormonal status , markers for inflammation and bone turnover , and calcium and phosphate levels ) . Lung function tests and a 6-meter walking test were performed .  BMD was measured at the spine , total hip , and femoral neck . RESULTS We included 55 patients ( 31 women ) with a mean age of 31.9 years ; 14 were homozygous and 25 heterozygous for the deltaF508 mutation and 20 ( 36 % ) had a history of fractures .  BMD values indicated osteopenia in 32 ( 58.2 % ) patients and osteoporosis in 11 ( 20 % ) patients at one or more measurement sites . At all three sites , BMD values correlated with the body mass index , forced vital capacity as % predicted , and forced expiratory volume in 1 s as % predicted ; at the femoral neck and total hip , BMD values correlated with the 6-meter walking test result and grip strength . CONCLUSION BMD was low in 78.2 % of adults with cystic fibrosis . Three factors reflecting lung disease severity were associated with low BMD values , namely , respiratory function , physical function ( walking test and grip strength ) , and nutritional status Bisphosphonates are potent inhibitors of bone resorption and are widely used in the treatment of bone diseases . One of the side effects of administered aminobisphosphon 
    Output:
    
Bone pain was the most common adverse event with intravenous agents .
Flu-like symptoms were also increased in those taking bisphosphonates .
Oral and intravenous bisphosphonates increase bone mineral density in people with cystic fibrosis .
Severe bone pain and flu-like symptoms may occur with intravenous agents .