***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: We interviewed 327 women who had been 50 to 74 years of age when treated for fracture of the hip of lower forearm , to determine their use ( or lack of use ) of estrogen preparations .  Their responses were compared with those in a r and om sample of 567 women who were of similar age and from the same region . The risk of fracture was 50 to 60 per cent lower in women who had used these drugs for six years or longer than in women who hadnot used them ( 95 per cent confidence interval of relative risk , 0.3 to 0.6 ) ; those using them for shorter periods received less benefit , if any . A decreased risk of fracture was clearly evident only in women still taking estrogens and evident at either common daily dose ( 0.625 and 1.25 mg ) . In conjunction with the finding that estrogens can retard the development of osteoporosis in postmenopausal women , our data argue that lowering of the risk of hip and forearm fractures must be weighed as a benefit of long-term estrogen use Summary To develop an improved treatment schedule for osteoporosis , a study was undertaken in 100 postmenopausal women using a modified ADFR 90-day cyclical regimen with etidronate .  After one year of treatment , the etidronate-treated group showed a significant increase in bone density of the spine , which continued over the following 2 years of treatment and remained stable during the fourth year . In contrast , in the non-etidronate group , bone density decreased significantly after four years . In addition , the fracture rate was significantly lower in the etidronate group than in the non-etidronate group . Side effects were minimal in both groups and no serious adverse reactions were reported . In conclusion , it appears that a cyclical regimen using 1,25-dihydroxyvitamin D3 , etidronate and calcium increases bone mass and reduces fractures with no significant side effects , thus making a useful contribution in the treatment of postmenopausal osteoporosis OBJECTIVE : To define the effects of therapeutic exercise on bone density and back complaints . METHODS : A r and omised controlled trial with parallel groups was conducted in an outpatient clinic , Medical School , University of Vienna . Ninety two sedentary post-menopausal women with back problems were r and omly allocated to either exercise ( groups 1 and 2 ) or control ( group 3 , no exercise , n = 31 ) ; the exercise group was retrospectively subdivided into compliant ( group 1 , n = 27 ) and not fully compliant patients ( group 2 , n = 34 ) . Regular , initially supervised therapeutic exercise aim ed at restoring biomechanical function was performed for four years . Bone density in the forearm was measured by single photon absorptiometry at entry and after four years ; subjective back complaints were documented . RESULTS : A significant decrease in bone density was observed in groups 2 and 3 ; no change was noted in group 1 ; back complaints decreased in group 1 only . CONCLUSIONS : Sedentary postmenopausal women may benefit from regular long term therapeutic exercise in terms of subjective back complaints and slowed loss of bone mass A population -based case-control study was conducted to examine the effects of past and recent physical activity on the  risk of hip fracture in women . Cases included females aged 55 - 84 years with a first diagnosis of hip fracture in 1989 in metropolitan Toronto , Canada . Controls were a population -based r and om sample frequency matched by 5-year age groups . Data were collected on 381 cases and 1,138 controls by self-administered mailed question naires  or  telephone interviews  . Past activity  was calculated as a compilation of activity scores at ages 16 , 30 , and 50 years . Recent activity  was defined as activity in the past year for controls and activity in the year before fracture for cases . Multiple logistic regression was used to control for age , previous fracture , obesity , smoking , osteoporosis , epilepsy , stroke or Parkinson 's disease , daily intake of dietary calcium , and duration of use of supplemental calcium , fluoride , and estrogen . After recent activity was adjusted for , statistically significant effects were found for women who in the past had been active ( odds ratio estimate ( OR ) = 0.66 , 95 % confidence interval ( CI ) 0.45 - 0.96 ) or very active ( OR = 0.54 , 95 % CI 0.33 - 0.88 ) . After past activity was adjusted for , a similar protective effect was found for women who were moderately active recently ( OR = 0.61 , 95 % CI 0.41 - 0.90 ) , but women who were very active recently were not protected from hip fracture ( OR = 1.15 , 95 % CI 0.72 - 1.83 ) . This study showed evidence of independent protective effects of  past physical activity  and of moderate levels of recent physical activity  on the risk of hip fracture in postmenopausal women Because of uncertainty about the place of hormones in the treatment of  postmenopausal bone loss  vertebral and forearm bone loss was measured by absorptiometry in early post-menopausal women before and after continuous or sequential treatment with combined oestrogen and progestogen  in a double blind placebo controlled trial . Treatment with hormones significantly reversed the vertebral bone loss . The net gain in vertebral bone density amounted to 6·4 % a year with continuous supplementation and 5·4 % a year with sequential supplementation ; the net gain in forearm bone density was lower ( 3·6 % with continuous and 3·7 % with sequential supplementation ) . Before a policy of supplementation with hormones can be recommended to all postmenopausal women with the aim of reducing the incidence of vertebral crush fractures further studies with different doses and combinations of hormones , administered over several years , are needed The aims of this study were to ascertain vertebral deformity prevalence in elderly men and women and to describe the association between bone mineral density ( BMD ) at the lumbar spine and femoral neck , severity of spinal degenerative disease and vertebral deformity prevalence . We performed st and ardized spinal radiographs in a r and om sample of 300 elderly men and women participating in the Dubbo Osteoporosis Epidemiology Study , a population -based study of fracture risk factors .  Radiographs were read independently by masked observers for the prevalence of vertebral deformity and severity of osteophytosis .  BMD was measured by dual-energy X-ray absorptiometry . The prevalence of vertebral deformities was critically dependent on the criterion used . The less strict criteria seemed to overestimate deformities at either end of the spine region analysed . However , irrespective of the criterion used , prevalence of deformity was higher in men than in women ( 25 % vs 20 % for the 3 SD criterion , 17 % vs 12 % for the 4 SD criterion and 27 % vs 25 % for the 25 % criterion ) . Femoral neck BMD was more strongly associated with vertebral deformities than spinal BMD for the 25 % criterion ( OR/SD change in BMD 1.39 ( p=0.02 ) vs 1.20 ( p=0.19 ) ) , 3 SD criterion ( OR/SD change in BMD 1.45 ( p=0.01 ) vs 1.10 ( p=0.34 ) ) and 4 SD criterion ( OR/SD change in BMD 1.98 ( p=0.0002 ) vs 1.68 ( p=0.008 ) ) . BMD was also more strongly associated with biconcave deformities than either wedge or crush deformities and more so in men than in women . Severity of spinal osteophytosis was not associated with vertebral deformity . In conclusion , femoral neck BMD is at least equivalent to the lumbar spine BMD in strength of association with prevalent vertebral fractures . Spinal osteophytosis falsely elevates BMD without a concomitant decrease in fracture risk , indicating that any interpretation of spinal BMD needs to be adjusted for osteophytosis . These findings support the use of  femoral neck bone densitometry  in older men and women . Moreover , these data indicate that current criteria for radiological assessment of vertebral deformity are sufficiently loose to include a substantial proportion of non-fractures in the elderly , with important implication s for the design of clinical trials . However , irrespective of the criterion used , vertebral deformities in men are at least as common , if not more so , than in women , suggesting that vertebral osteoporotic  fractures  are overlooked in men OBJECTIVE Oral alendronate sodium is a potent , specific inhibitor of osteoclast-mediated bone resorption . To assess its efficacy and safety , a 3-year , r and omized , double-blind , multicenter study of 478 postmenopausal women with osteoporosis was conducted . PATIENTS AND METHODS Subjects received either placebo , alendronate 5 or 10 mg/day for 3 years , or 20 mg/day for 2 years followed by 5 mg/day for 1 year ( 20/5 mg ) . All subjects received 500 mg/day of supplemental calcium . Bone mineral density ( BMD ) was measured by dual energy x-ray absorptiometry ( DXA ) . RESULTS After 3 years , alendronate 10 mg induced marked increases in BMD of the lumbar spine ( 9.6 + /- 0.4 % ) , femoral neck ( 4.7 + /- 0.7 % ) and trochanter ( 7.4 + /- 0.6 % ) ( mean + /- SE ; each P < or = 0.001 ) versus decreases of 0.8 to 1.6 % with placebo . Progressive increases at these sites in the alendoronate 10 mg group were significant during both the second and third years . Alendronate 10 mg increased total body BMD ( 1.6 + /- 0.3 % , P < or = 0.001 ) , and prevented loss but did not increase BMD at the 1/3 forearm site . Alendronate 20/5 mg was no more effective , whereas alendronate 5 mg was significantly less effective than 10 mg at all sites . Bone turnover decreased to a stable nadir over 3 months for resorption markers ( urine deoxypyridinoline ) and over 6 months for formation markers ( alkaline phosphatase and osteocalcin ) . Mean loss of stature was reduced by 41 % in alendronate treated subjects ( P = 0.01 ) . CONCLUSION The safety profile of alendronate was similar to that of placebo . At 10 mg , there were no trends toward increased frequency of any adverse experience except for abdominal pain , which was usually mild , transient , and resolved with continued treatment . Thus , alendronate appears to be an important advance in the treatment of osteoporosis in postmenopausal women Objective To investigate the magnitude and pattern of the changes in bone mass during five years of continuous and cyclic sequential oestrogen/progestin treatment 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 fract 
    Output:
    
The literature review did not identify any clinical trials of preventive counseling for osteoporosis .
Current smoking has been associated with lower bone mineral density ( BMD ) and increased risk for fracture after minimal trauma in most studies ( 2 ) .
In a follow-up multivariate analysis of the Study of Osteoporotic Fractures , axial BMD was positively associated with physical activity ( 53 ) .