***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 
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    ***EXAMPLES*** 
    Input: Summary Bone pain and spinal axial deformity are major concerns in aged patients suffering from osteoporotic vertebral compression fracture ( VCF ) . Pain can be relieved by vertebroplasty or kyphoplasty procedures , in which the compressed vertebral body is filled with substitutes . We r and omly assigned 100 patients with osteoporotic compression fracture at the thoraco-lumbar ( T-L ) junction into two groups : vertebroplasty and kyphoplasty ; we used polymethylmethacrylate ( PMMA ) as the bone filler . Pain before and after treatment was assessed with visual analog scale ( VAS ) scores and vertebral body height and kyphotic wedge angle were measured from reconstructed computed tomography images . More PMMA was used in the kyphoplasty group than in the vertebroplasty group ( 5.56 ± 0.62 vs. 4.91 ± 0.65 mL , p < 0.001 ) . Vertebral body height and kyphotic wedge angle of the T-L spine were also improved ( p < 0.001 ) . VAS pain scores did not differ significantly between the treatment groups . The duration of follow-up was 6 months . Two patients in the kyphoplasty group had an adjacent segment fracture . In terms of clinical outcome there was little difference between the treatment groups . Thus , owing to the higher cost of the kyphotic balloon procedure , we recommend vertebroplasty over kyphoplasty for the treatment of osteoporotic VCFs . Introduction Spinal axial deformities are major concerns in aged patients suffering from osteoporotic vertebral compression fracture . Pain may be relieved by vertebroplasty or kyphoplasty . We investigated the radiological and clinical outcomes of these procedures . Methods One hundred cases of VCF at the thoraco-lumbar junction were r and omly assigned into two groups : vertebroplasty or kyphoplasty ( 50 cases each ) . We used polymethylmethacrylate as the bone filler . Pain before and after treatment was assessed with visual analog scale scores and vertebral body height and kyphotic wedge angle were measured from reconstructed computed tomography images . Results More PMMA was used in the kyphoplasty group than in the vertebroplasty group ( 5.56 ± 0.62 vs. 4.91 ± 0.65 mL , p < 0.001 ) . Vertebral body height and kyphotic wedge angle of the T-L spine were also improved ( p < 0.001 ) . VAS pain scores did not differ significantly between the treatment groups . The duration of follow-up was 6 months . Two patients in the kyphoplasty group had an adjacent segment fracture . Conclusions In terms of clinical outcome there was little difference between the treatment groups . Thus , with the higher cost of the kyphotic balloon procedure , we recommend vertebroplasty over kyphoplasty for the treatment of osteoporotic VCFs Abstract : The purpose of this r and omized , double-masked , placebo-controlled study was to determine the efficacy and safety of risedronate in the prevention of vertebral fractures in postmenopausal women with established osteoporosis . The study was conducted at 80 study centers in Europe and Australia . Postmenopausal women ( n= 1226 ) with two or more prevalent vertebral fractures received risedronate 2.5 or 5 mg/day or placebo ; all subjects also received elemental calcium 1000 mg/day , and up to 500 IU/day vitamin D if baseline levels were low . The study duration was 3 years ; however , the 2.5 mg group was discontinued by protocol amendment after 2 years . Lateral spinal radiographs were taken annually for assessment of vertebral fractures , and bone mineral density was measured by dual-energy X-ray absorptiometry at 6-month intervals . Risedronate 5 mg reduced the risk of new vertebral fractures by 49 % over 3 years compared with control ( p<0.001 ) . A significant reduction of 61 % was seen within the first year ( p= 0.001 ) . The fracture reduction with risedronate 2.5 mg was similar to that in the 5 mg group over 2 years . The risk of nonvertebral fractures was reduced by 33 % compared with control over 3 years ( p= 0.06 ) . Risedronate significantly increased bone mineral density at the spine and hip within 6 months . The adverse-event profile of risedronate , including gastrointestinal adverse events , was similar to that of control . Risedronate 5 mg provides effective and well-tolerated therapy for severe postmenopausal osteoporosis , reducing the incidence of vertebral fractures and improving bone density in women with established disease UNLABELLED Oral daily ( 2.5 mg ) and intermittent ib and ronate ( between-dose interval of > 2 months ) , delivering a similar cumulative exposure , were evaluated in 2946 osteoporotic women with prevalent vertebral fracture . Significant reduction in incident vertebral fracture risk by 62 % and 50 % , respectively , was shown after 3 years . This is the first study to prospect ively show antifracture efficacy for the intermittent administration of a bisphosphonate . INTRODUCTION Bisphosphonates are important therapeutics in postmenopausal osteoporosis . However , they are currently associated with stringent dosing instructions that may impair patient compliance and hence therapeutic efficacy . Less frequent , intermittent administration may help to overcome these deficiencies . This study assessed the efficacy and safety of oral ib and ronate administered either daily or intermittently with a dose-free interval of > 2 months . MATERIAL S AND METHODS This r and omized , double-blind , placebo-controlled , parallel-group study enrolled 2946 postmenopausal women with a BMD T score < or = -2.0 at the lumbar spine in at least one vertebra ( L1-L4 ) and one to four prevalent vertebral fractures ( T4-L4 ) . Patients received placebo or oral ib and ronate administered either daily ( 2.5 mg ) or intermittently ( 20 mg every other day for 12 doses every 3 months ) . RESULTS AND CONCLUSIONS After 3 years , the rate of new vertebral fractures was significantly reduced in patients receiving oral daily ( 4.7 % ) and intermittent ib and ronate ( 4.9 % ) , relative to placebo ( 9.6 % ) . Thus , daily and intermittent oral ib and ronate significantly reduced the risk of new morphometric vertebral fractures by 62 % ( p = 0.0001 ) and 50 % ( p = 0.0006 ) , respectively , versus placebo . Both treatment groups also produced a statistically significant relative risk reduction in clinical vertebral fractures ( 49 % and 48 % for daily and intermittent ib and ronate , respectively ) . Significant and progressive increases in lumbar spine ( 6.5 % , 5.7 % , and 1.3 % for daily ib and ronate , intermittent ib and ronate , and placebo , respectively , at 3 years ) and hip BMD , normalization of bone turnover , and significantly less height loss than in the placebo group were also observed for both ib and ronate regimens . The overall population was at low risk for osteoporotic fractures . Consequently , the incidence of nonvertebral fractures was similar between the ib and ronate and placebo groups after 3 years ( 9.1 % , 8.9 % , and 8.2 % in the daily , intermittent , and placebo groups , respectively ; difference between arms not significant ) . However , findings from a posthoc analysis showed that the daily regimen reduces the risk of nonvertebral fractures ( 69 % ; p = 0.012 ) in a higher-risk subgroup ( femoral neck BMD T score < -3.0 ) . In addition , oral ib and ronate was well tolerated . Oral ib and ronate , whether administered daily or intermittently with an extended between-dose interval of > 2 months , is highly effective in reducing the incidence of osteoporotic fractures in postmenopausal women . This is the first time that significant fracture efficacy has been prospect ively shown with an intermittently administered bisphosphonate in the overall study population of a r and omized , controlled clinical trial . Thus , oral ib and ronate holds promise as an effective and convenient alternative to current bisphosphonate therapies We report a prospect i ve , r and omized , multicenter , open-label 2-year trial of 81 postmenopausal women aged 53 - 79 years with at least one minimal-trauma vertebral fracture ( VF ) and low ( T-score below - 2 ) lumbar bone mineral density ( BMD ) .  Group HRT received piperazine estrone sulfate ( PES ) 0.625 – 1.25 mg/d ± medroxyprogesterone acetate ( MPA ) 2.5 – 5 mg/d ; group HRT/D received HRT plus calcitriol 0.25 µg bd . All with a baseline dietary calcium ( Ca ) of < 1 g/d received Ca carbonate  0.6 g nocte . Final data were on 66 – 70 patients .  On HRT/D , significant ( P < 0.001 ) BMD increases from baseline by DXA were at total body – head , trochanter , Ward ’s , total hip , intertrochanter and femoral shaft ( % group mean Δ 4.2 , 6.1 , 9.3 , 3.7 , 3.3 and 3.3 % , respectively ) . On HRT , at these 6 sites , significant Δs were restricted to the trochanter and Wards . Significant advantages of HRT/D over HRT  were in BMD of total body ( - head ) , total hip and trochanter ( all P= 0.01 ) . The differences in mean Δ at these sites were 1.3 , 2.6 and 3.9 % . At the following , both groups improved significantly -lumbar spine ( AP and lateral ) , forearm shaft and ultradistal tibia/fibula . The weightbearing , site — specific benefits of the combination associated with significant suppression of parathyroid hormone — suggest a beneficial effect on cortical bone . Suppression of bone turnover was significantly greater on HRT/D  ( serum osteocalcin P= 0.024 and urinary hydroxyproline/creatinine ratio P= 0.035 ) . There was no significant difference in the number of patients who developed fresh VFs during the trial ( HRT 8/36 , 22 % ; HRT/D 4/34 , 12 % - intention to treat ) ; likewise in the number who developed incident nonvertebral fractures . This is the first study comparing the 2 treatments in a fracture population . The results indicate a significant benefit of calcitriol combined with HRT on total body BMD and on BMD at the hip , the major site of osteoporotic fracture BACKGROUND Osteoporotic structural damage and bone fragility result from reduced bone formation and increased bone resorption . In a phase 2 clinical trial , strontium ranelate , an orally active drug that dissociates bone remodeling by increasing bone formation and decreasing bone resorption , has been shown to reduce the risk of vertebral fractures and to increase bone mineral density . METHODS To evaluate the efficacy of strontium ranelate in preventing vertebral fractures in a phase 3 trial , we r and omly assigned 1649 postmenopausal women with osteoporosis ( low bone mineral density ) and at least one vertebral fracture to receive 2 g of oral strontium ranelate per day or placebo for three years . We gave calcium and vitamin D supplements to both groups before and during the study . Vertebral radiographs were obtained annually , and measurements of bone mineral density were performed every six months . RESULTS New vertebral fractures occurred in fewer patients in the strontium ranelate group than in the placebo group , with a risk reduction of 49 percent in the first year of treatment and 41 percent during the three-year study period ( relative risk , 0.59 ; 95 percent confidence interval , 0.48 to 0.73 ) . Strontium ranelate increased bone mineral density at month 36 by 14.4 percent at the lumbar spine and 8.3 percent at the femoral neck ( P<0.001 for both comparisons ) . There were no significant differences between the groups in the incidence of serious adverse events . CONCLUSIONS Treatment of postmenopausal osteoporosis with strontium ranelate leads to early and sustained reductions in the risk of vertebral fractures Raloxifene is a selective estrogen receptor modulator that in experimental animals acts as an estrogen receptor antagonist in breast and endometrium but as an estrogen receptor agonist in the skeletal and cardiovascular systems . We conducted a 1-year prospect i ve , r and omized , double-blind trial in 143 postmenopausal osteoporotic women ( mean + /- SD age , 68.4+/-5.0 years ) with at least one prevalent vertebral fractures and low bone mineral density ( BMD ) , comparing groups receiving raloxifene at 60 mg/day ( RLX 
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The weak recommendations address the use of ib and ronate and strontium ranelate to prevent additional symptomatic fractures , the use of  L2 nerve root blocks  to treat the pain associated with L3 or L4 fractures , and the use of  kyphoplasty  to treat  symptomatic fractures  in patients who are neurologically intact