***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 prospect i ve study was to evaluate the bone mineral density ( BMD ) at lumbar spine and femoral neck levels and biochemical parameters of bone turnover in 20 consecutive hyperprolactinemic males before and after an 18-month treatment with different dopamine agonists .  Six patients received bromocriptine at a dose of 2.5 - 10 mg/day ; 7 patients received quinagolide at a dose of 0.075 - 0.3 mg/day ; 7 patients received cabergoline at a dose of 0.5 - 1.5 mg/week . BMD , serum PRL , testosterone , dihydrotestosterone , and osteocalcin ( OC ) , and urinary cross-linked N-telopeptides of type I collagen ( Ntx ) levels were measured before and every 6 months during treatment . At study entry , BMD values were lower in patients than controls at both lumbar spine ( 0.82 + /- 0.03 vs. 1.18 + /- 0.01 g/cm2 ; P < 0.001 ) and femoral neck ( 0.85 + /- 0.02 vs. 0.92 + /- 0.02 g/cm2 ; P < 0.05 ) levels . Osteopenia or osteoporosis was diagnosed in 16 patients at the lumbar spine and in 6 of them at the femoral neck level . A significant inverse correlation was found between lumbar spine and femoral neck BMD values and both PRL levels and disease duration ( P < 0.01 ) . In the 20 patients , serum OC levels were significantly lower ( 2.1 + /- 0.1 vs. 9.3 + /- 2.4 microg/L ; P < 0.01 ) , whereas Ntx levels were significantly higher ( 157.8 + /- 1.1 vs. 96.4 + /- 7.4 nmol bone collagen equivalent/mmol creatinine ; P < 0.001 ) than control values . A significant inverse correlation was found between serum PRL and OC ( P < 0.01 ) , but not Ntx , levels . After 18 months of treatment , serum PRL levels were suppressed , and gonadal function was restored in all 20 patients , as shown by the normalization of serum T ( from 2.2 + /- 0.2 to 5.0 + /- 0.2 microg/L ) and dihydrotestosterone ( 0.3 + /- 0.02 vs. 0.5 + /- 0.01 nmol/L ) levels , without any significant difference among groups . A progressive significant increase in serum OC levels together with a significant decrease in Ntx levels were observed after 6 , 12 , and 18 months of treatment in the 3 groups of patients . A slight , although significant , increase in BMD values was recorded in all patients after 18 months of bromocriptine , quinagolide , and cabergoline treatment , serum OC levels were normalized after treatment , whereas neither urinary Ntx levels nor BMD values were normalized by 18 months of treatment with dopaminergic agents . In conclusion , treatment with bromocriptine , quinagolide , and cabergoline for 18 months , although successfull in suppressing serum PRL levels and restoring gonadal function , was unable to restore lumbar spine and femoral neck BMD and normalize Ntx levels . However , BMD was slightly increased during treatment , suggesting that additional bone loss was prevented after treatment of hyperprolactinemia Background : Fractures have largely been assessed by their impact on quality of life or health care costs . We conducted this study to evaluate the relation between fractures and mortality . Methods : A total of 7753 r and omly selected people ( 2187 men and 5566 women ) aged 50 years and older from across Canada participated in a 5-year observational cohort study  . Incident fractures were identified on the basis of vali date d self-report and were classified by type ( vertebral , pelvic , forearm or wrist , rib , hip and “ other ” ) . We subdivided fracture groups by the year in which the fracture occurred during follow-up ; those occurring in the fourth and fifth years were grouped together . We examined the relation between the time of the incident fracture and death . Results : Compared with participants who had no fracture during follow-up , those who had a vertebral fracture in the second year were at increased risk of death ( adjusted hazard ratio [ HR ] 2.7 , 95 % confidence interval [ CI ] 1.1–6.6 ) ; also at risk were those who had a hip fracture during the first year ( adjusted HR 3.2 , 95 % CI 1.4–7.4 ) . Among women , the risk of death was increased for those with a vertebral fracture during the first year ( adjusted HR 3.7 , 95 % CI 1.1–12.8 ) or the second year of follow-up ( adjusted HR 3.2 , 95 % CI 1.2–8.1 ) . The risk of death was also increased among women with hip fracture during the first year of follow-up ( adjusted HR 3.0 , 95 % CI 1.0–8.7 ) . Interpretation : Vertebral and hip fractures are associated with an increased risk of death . Interventions that reduce the incidence of these fractures need to be implemented to improve survival STUDY OBJECTIVE To determine the effects of alteration of gonadal steroids on bone mass in men with hyperprolactinemic hypogonadism . DESIGN Prospect i ve survey of patients for a median period of 33 months . SETTING Neuroendocrine clinical center of a referral-based university medical center . INTERVENTIONS Reversal of hyperprolactinemia by bromocriptine therapy , transsphenoidal surgery , or radiation therapy , alone or in combination . PATIENTS Consecutive sample of 20 male patients with prolactin-secreting pituitary tumors . MEASUREMENTS AND MAIN RESULTS In patients who had a reversal of hyperprolactinemia and a restoration of gonadal function , a significant increase in bone density of the radial shaft was noted ( mean + /- SE , 0.77 + /- 0.03 to 0.84 + /- 0.03 g/cm2 ; P less than or equal to 0.05 ) . These patients also had a minimal change in the density of vertebral bone ( 109 + /- 9 to 115 + /- 10 mg of potassium phosphate , dibasic/cm3 ) . Patients who remained hypogonadal despite the reversal of hyperprolactinemia had no change in radial ( 0.76 + /- 0.03 to 0.76 + /- 0.04 g/cm2 ) or vertebral bone density ( 105 + /- 10 to 103 + /- 9 mg of potassium phosphate , dibasic/cm3 ) . There was a positive correlation between the change in testosterone level and the change in radial ( r = 0.67 , P less than or equal to 0.003 ) or vertebral bone density ( r = 0.70 , P less than or equal to 0.003 ) . CONCLUSIONS The reversal of hypogonadism , independent of the prolactin concentration , is associated with an improvement in bone mass . Our findings emphasize the importance of gonadal steroids in maintaining skeletal integrity in men Hyperprolactinemia occurs in 25 to 30 percent of young women with amenorrhea , and this condition is known to be associated with osteopenia . To determine whether the osteopenia is affected by treatment of hyperprolactinemia , we studied 32 women with hyperprolactinemic amenorrhea prospect ively for 12 to 72 months to investigate the effects of sustained hyperprolactinemia or return of gonadal function on bone mass . We studied 18 patients using direct photon absorptiometry before and after normalization of serum prolactin levels .  Initial bone densities ranged from 0.55 to 0.77 g per square centimeter ( mean + /- 1 SD , 0.64 + /- 0.05)--densities significantly lower ( P less than 0.001 ) than those of controls ( 0.71 + /- 0.04 g per square centimeter ) . After therapy , bone density increased significantly ( P less than 0.001 ) , to 0.67 + /- 0.05 g per square centimeter , but remained lower ( P less than 0.05 ) than normal . Fourteen patients were followed without therapy . Their initial bone densities ranged from 0.62 to 0.75 g per square centimeter ( mean , 0.67 + /- 0.04)--values significantly lower ( P less than 0.02 ) than those in controls . There was a significant decrease ( P less than 0.002 ) in bone density over time in this group . We conclude that ( 1 ) treatment of hyperprolactinemia increases bone mass in most amenorrheic women with osteopenia , ( 2 ) normalization of serum prolactin levels in such women is associated with prevention of bone loss , and ( 3 ) a subset of untreated women with hyperprolactinemia have progressive osteopenia , which could have adverse long-term health consequences 
    Output:
    
In the limited studies available , fracture prevalence was increased in patients with untreated hyperprolactinemia compared to those on treatment , independent of gonadal function .
Further studies are needed to clarify if post-menopausal women , or high-risk men , with no other indication for treatment , should be on dopamine agonists to decrease fracture risk