human
***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: CONTEXT There are few data on long-term mortality following  osteoporotic fracture and fewer following subsequent fracture . OBJECTIVES To examine long-term mortality risk in women and men following all osteoporotic fractures  and to assess the association of subsequent fracture with that risk . DESIGN , SETTING , AND PARTICIPANTS Prospect i ve cohort from the Dubbo Osteoporosis Epidemiology Study of community-dwelling women and men aged 60 years and older from Dubbo , Australia , who sustained a fracture between April 1989 and May 2007 . MAIN OUTCOME MEASURES Age- and sex-specific st and ardized mortality ratios ( SMRs ) compared with the overall Dubbo population for hip , vertebral , major , and minor fractures . RESULTS In women , there were 952 low-trauma fractures followed by 461 deaths , and in men , 343 fractures were followed by 197 deaths .  Age-adjusted SMRs were increased following hip fractures ( SMRs , 2.43 [ 95 % confidence interval [ CI ] , 2.02 - 2.93 ] and 3.51 [ 95 % CI , 2.65 - 4.66 ] ) , vertebral fractures ( SMRs , 1.82 [ 95 % CI , 1.52 - 2.17 ] and 2.12 [ 95 % CI , 1.66 - 2.72 ] ) , major fractures ( SMRs , 1.65 [ 95 % CI , 1.31 - 2.08 ] and 1.70 [ 95 % CI , 1.23 - 2.36 ] ) , and minor fractures ( SMRs , 1.42 [ 95 % CI , 1.19 - 1.70 ] and 1.33 [ 95 % CI , 0.99 - 1.80 ] ) for both women and men , respectively . Mortality was increased for all ages for all fractures except minor fractures for which increased mortality was only apparent for those older than 75 years . Increased mortality risk persisted for 5 years for all fractures and up to 10 years for hip fractures . Increases in absolute mortality that were above expected , for 5 years after fracture , ranged from 1.3 to 13.2 per 100 person-years in women and from 2.7 to 22.3 per 100 person-years in men , depending on fracture type . Subsequent fracture was associated with an increased mortality hazard ratio of 1.91 ( 95 % CI , 1.54 - 2.37 ) in women and 2.99 ( 95 % CI , 2.11 - 4.24 ) in men . Mortality risk following a subsequent fracture then declined but beyond 5 years still remained higher than in the general population ( SMR , 1.41 [ 95 % CI , 1.01 - 1.97 ] and SMR , 1.78 [ 95 % CI , 0.96 - 3.31 ] for women and men , respectively ) . Predictors of mortality after any fragility fracture for both men and women included age , quadriceps weakness , and subsequent fracture but not comorbidities . Low bone mineral density , having smoked , and sway were also predictors for women and less physical activity for men . CONCLUSIONS In a sample of older women and men , all low-trauma fractures were associated with increased mortality risk for 5 to 10 years . Subsequent fracture was associated with increased mortality risk for an additional 5 years OBJECTIVE --To study the mortality and morbidity associated with proximal femoral fractures with reference to fracture type ( intracapsular and extracapsular )  . DESIGN --Consecutive prospect i ve study with 12 month follow ups . SETTING --Two British trauma receiving centres . PATIENTS --1000 consecutive acute proximal femoral fractures ( fractured necks of femur ) in 972 patients . RESULTS --Significantly higher mortality at one year was seen in patients with extracapsular fractures ( 188/490 ; 38 % ) than in those with intracapsular fractures ( 147/510 ; 29 % ; p < 0.01 ) . Greater morbidity was experienced during the study period by patients with extracapsular fractures , who were less mobile and less independent at the time of their injury . CONCLUSIONS --The rise in average age of presentation with proximal femoral fracture is associated with a persistently high mortality ( 33 % ) and morbidity , greater in patients with an extracapsular fracture . Comparison with other studies , principally from outside Britain , is difficult , but despite advancing st and ards of care the mortality and morbidity of femoral neck fractures remains high , placing an ever increasing burden on the health service 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 OBJECTIVES To evaluate the incremental cost in the year after hip fracture . DESIGN Prospect i ve cohort study . SETTING Baltimore , Maryl and . PARTICIPANTS 759 community dwelling older patients who sustained a hip fracture and participated in the Baltimore Hip Fracture Study . MEASUREMENTS Re source use for direct medical care , formal nonmedical care , and informal care in the 6 months before and the year after fracture was estimated from interviews with patients or proxy respondents .  Costs in 1993 dollars were estimated by multiplying re sources times national unit cost estimates . RESULTS The annualized costs in the year before the fracture ranged between $ 18,523 and $ 20,928 . The costs in the year after the fracture equaled $ 37,250 . The incremental costs in the year after the fracture , compared with the costs in the year before the fracture , ranged between $ 16,322 and $ 18,727 . The largest cost differences were attributable to hospitalizations , nursing home stays , and rehabilitation services . CONCLUSIONS Because we compared the costs after a fracture with costs before , our estimates of the incremental cost of a hip fracture are lower than others in the literature . These results , obtained from interviews with patients enrolled in a cohort study , or their proxies , provide the best data available to date on the economic cost of hip fractures among community-dwelling older persons BACKGROUND underst and ing the determinants of health burden after a fracture in ageing population s is important . OBJECTIVE assess the effect of clinical vertebral and other osteoporotic fractures on function and the subsequent risk of hospitalisation . DESIGN individuals from the prospect i ve population -based cohort study Age , Gene/Environment Susceptibility (AGES)-Reykjavik study were examined between 2002 and 2006 and followed up for 5.4 years . SUBJECTS a total of 5,764 individuals , 57.7 % women , born 1907 - 35 , mean age 77 . METHOD four groups with a verified fracture status were used ; vertebral fractures , other osteoporotic fractures excluding vertebral , non-osteoporotic fractures and not-fractured were compared and analysed for the effect on mobility , strength , QoL , ADL , co-morbidity and hospitalisation . RESULTS worst performance on functional tests was in the vertebral fracture group for women ( P < 0.0001 ) and the other osteoporotic fractures group for men ( P < 0.05 ) . Both vertebral and other osteoporotic fractures , showed an increased risk of hospitalisation , HR = 1.4 ( 95 % CI : 1.3 - 1.7 ) and 1.2 ( 95 % CI : 1.1 - 1.2 ) respectively ( P < 0.0001 ) . Individuals with vertebral fractures had 50 % ( P < 0.0001 ) longer hospitalisation than not-fractured and 33 % ( P < 0.002 ) longer than the other osteoporotic fractures group . CONCLUSION individuals with a history of clinical vertebral fracture seem to carry the greatest health burden compared with other fracture groups , emphasising the attention which should be given to those individuals CONTEXT There are few published long-term data on absolute risk of subsequent fracture ( refracture ) following initial low-trauma fracture in women and fewer in men . OBJECTIVE To examine long-term risk of subsequent fracture  following initial osteoporotic fracture in men and women . DESIGN , SETTING , AND PARTICIPANTS Prospect i ve cohort study ( Dubbo Osteoporosis Epidemiology Study ) in Australia of 2245 community-dwelling women and 1760 men aged 60 years or older followed up for 16 years from July 1989 through April 2005 . MAIN OUTCOME MEASURE Incidence of first ( initial ) fracture and incidence of subsequent fracture according to sex , age group , and time since first fracture . Relative risk was determined by comparing risk of subsequent fracture with risk of initial fracture . RESULTS There were 905 women and 337 men with an initial fracture , of whom 253 women and 71 men experienced a subsequent fracture . Relative risk ( RR ) of subsequent fracture in women was 1.95 ( 95 % confidence interval [ CI ] , 1.70 - 2.25 ) and in men was 3.47 ( 95 % CI , 2.68 - 4.48 ) . As a result , absolute risk of subsequent fracture was similar in women and men and at least as great as the initial fracture risk for a woman 10 years older . Thus , women and men aged 60 to 69 years had absolute refracture rates of 36/1000 person-years ( 95 % CI , 26 - 48/1000 ) and 37/1000 person-years ( 95 % CI , 23 - 59/1000 ) , respectively . The increase in absolute fracture risk remained for up to 10 years , by which time 40 % to 60 % of surviving women and men experienced a subsequent fracture . All fracture locations apart from rib ( men ) and ankle ( women ) result ed in increased subsequent fracture risk , with highest RRs following hip ( RR , 9.97 ; 95 % CI , 1.38 - 71.98 ) and clinical vertebral ( RR , 15.12 ; 95 % CI , 6.06 - 37.69 ) fractures in younger men . In multivariate analyses , femoral neck bone mineral density , age , and smoking were predictors of subsequent fracture in women and femoral neck bone mineral density , physical activity , and calcium intake were predictors in men . CONCLUSION After an initial low-trauma fracture , absolute risk of subsequent fracture was similar for men and women . This increased risk occurred for virtually all clinical fractures and persisted for up to 10 years Summary In the present prospect i ve controlled observational study , we investigated the effect of a coordinated intervention program on 4-year refracture rates in patients with recent osteoporotic fractures . Compared to st and ard care , targeted identification , and management significantly reduced the risk of refracture by more than 80 % . Introduction The risk of refracture following an incident osteoporotic fracture is high . Despite the availability of treatments that reduce refracture and mortality rates , most patients with minimal trauma fracture ( MTF ) are not managed appropriately . The present prospect i ve controlled observational study investigated the effect of a coordinated intervention program on 4-year refracture rates and time to refracture in patients with recent osteoporotic fractures . Methods 
    Output:
    
agent
Vertebral fracture caused the greatest health burden , but hip fracture patients were the main users of informal care after hospital discharge .
There was an increased risk of a subsequent fracture after a primary fracture compared with the control group , a cohort comparison , or the general population .
Osteoporotic fractures , especially hip fractures , are associated with higher mortality rate despite the advances in the management of osteoporotic fracture cases .
There is strong evidence to show that after hospital discharge , osteoporotic fracture patients are faced with higher morbidity , subsequent fractures , and mortality
***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: CONTEXT There are few data on long-term mortality following  osteoporotic fracture and fewer following subsequent fracture . OBJECTIVES To examine long-term mortality risk in women and men following all osteoporotic fractures  and to assess the association of subsequent fracture with that risk . DESIGN , SETTING , AND PARTICIPANTS Prospect i ve cohort from the Dubbo Osteoporosis Epidemiology Study of community-dwelling women and men aged 60 years and older from Dubbo , Australia , who sustained a fracture between April 1989 and May 2007 . MAIN OUTCOME MEASURES Age- and sex-specific st and ardized mortality ratios ( SMRs ) compared with the overall Dubbo population for hip , vertebral , major , and minor fractures . RESULTS In women , there were 952 low-trauma fractures followed by 461 deaths , and in men , 343 fractures were followed by 197 deaths .  Age-adjusted SMRs were increased following hip fractures ( SMRs , 2.43 [ 95 % confidence interval [ CI ] , 2.02 - 2.93 ] and 3.51 [ 95 % CI , 2.65 - 4.66 ] ) , vertebral fractures ( SMRs , 1.82 [ 95 % CI , 1.52 - 2.17 ] and 2.12 [ 95 % CI , 1.66 - 2.72 ] ) , major fractures ( SMRs , 1.65 [ 95 % CI , 1.31 - 2.08 ] and 1.70 [ 95 % CI , 1.23 - 2.36 ] ) , and minor fractures ( SMRs , 1.42 [ 95 % CI , 1.19 - 1.70 ] and 1.33 [ 95 % CI , 0.99 - 1.80 ] ) for both women and men , respectively . Mortality was increased for all ages for all fractures except minor fractures for which increased mortality was only apparent for those older than 75 years . Increased mortality risk persisted for 5 years for all fractures and up to 10 years for hip fractures . Increases in absolute mortality that were above expected , for 5 years after fracture , ranged from 1.3 to 13.2 per 100 person-years in women and from 2.7 to 22.3 per 100 person-years in men , depending on fracture type . Subsequent fracture was associated with an increased mortality hazard ratio of 1.91 ( 95 % CI , 1.54 - 2.37 ) in women and 2.99 ( 95 % CI , 2.11 - 4.24 ) in men . Mortality risk following a subsequent fracture then declined but beyond 5 years still remained higher than in the general population ( SMR , 1.41 [ 95 % CI , 1.01 - 1.97 ] and SMR , 1.78 [ 95 % CI , 0.96 - 3.31 ] for women and men , respectively ) . Predictors of mortality after any fragility fracture for both men and women included age , quadriceps weakness , and subsequent fracture but not comorbidities . Low bone mineral density , having smoked , and sway were also predictors for women and less physical activity for men . CONCLUSIONS In a sample of older women and men , all low-trauma fractures were associated with increased mortality risk for 5 to 10 years . Subsequent fracture was associated with increased mortality risk for an additional 5 years OBJECTIVE --To study the mortality and morbidity associated with proximal femoral fractures with reference to fracture type ( intracapsular and extracapsular )  . DESIGN --Consecutive prospect i ve study with 12 month follow ups . SETTING --Two British trauma receiving centres . PATIENTS --1000 consecutive acute proximal femoral fractures ( fractured necks of femur ) in 972 patients . RESULTS --Significantly higher mortality at one year was seen in patients with extracapsular fractures ( 188/490 ; 38 % ) than in those with intracapsular fractures ( 147/510 ; 29 % ; p < 0.01 ) . Greater morbidity was experienced during the study period by patients with extracapsular fractures , who were less mobile and less independent at the time of their injury . CONCLUSIONS --The rise in average age of presentation with proximal femoral fracture is associated with a persistently high mortality ( 33 % ) and morbidity , greater in patients with an extracapsular fracture . Comparison with other studies , principally from outside Britain , is difficult , but despite advancing st and ards of care the mortality and morbidity of femoral neck fractures remains high , placing an ever increasing burden on the health service 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 OBJECTIVES To evaluate the incremental cost in the year after hip fracture . DESIGN Prospect i ve cohort study . SETTING Baltimore , Maryl and . PARTICIPANTS 759 community dwelling older patients who sustained a hip fracture and participated in the Baltimore Hip Fracture Study . MEASUREMENTS Re source use for direct medical care , formal nonmedical care , and informal care in the 6 months before and the year after fracture was estimated from interviews with patients or proxy respondents .  Costs in 1993 dollars were estimated by multiplying re sources times national unit cost estimates . RESULTS The annualized costs in the year before the fracture ranged between $ 18,523 and $ 20,928 . The costs in the year after the fracture equaled $ 37,250 . The incremental costs in the year after the fracture , compared with the costs in the year before the fracture , ranged between $ 16,322 and $ 18,727 . The largest cost differences were attributable to hospitalizations , nursing home stays , and rehabilitation services . CONCLUSIONS Because we compared the costs after a fracture with costs before , our estimates of the incremental cost of a hip fracture are lower than others in the literature . These results , obtained from interviews with patients enrolled in a cohort study , or their proxies , provide the best data available to date on the economic cost of hip fractures among community-dwelling older persons BACKGROUND underst and ing the determinants of health burden after a fracture in ageing population s is important . OBJECTIVE assess the effect of clinical vertebral and other osteoporotic fractures on function and the subsequent risk of hospitalisation . DESIGN individuals from the prospect i ve population -based cohort study Age , Gene/Environment Susceptibility (AGES)-Reykjavik study were examined between 2002 and 2006 and followed up for 5.4 years . SUBJECTS a total of 5,764 individuals , 57.7 % women , born 1907 - 35 , mean age 77 . METHOD four groups with a verified fracture status were used ; vertebral fractures , other osteoporotic fractures excluding vertebral , non-osteoporotic fractures and not-fractured were compared and analysed for the effect on mobility , strength , QoL , ADL , co-morbidity and hospitalisation . RESULTS worst performance on functional tests was in the vertebral fracture group for women ( P < 0.0001 ) and the other osteoporotic fractures group for men ( P < 0.05 ) . Both vertebral and other osteoporotic fractures , showed an increased risk of hospitalisation , HR = 1.4 ( 95 % CI : 1.3 - 1.7 ) and 1.2 ( 95 % CI : 1.1 - 1.2 ) respectively ( P < 0.0001 ) . Individuals with vertebral fractures had 50 % ( P < 0.0001 ) longer hospitalisation than not-fractured and 33 % ( P < 0.002 ) longer than the other osteoporotic fractures group . CONCLUSION individuals with a history of clinical vertebral fracture seem to carry the greatest health burden compared with other fracture groups , emphasising the attention which should be given to those individuals CONTEXT There are few published long-term data on absolute risk of subsequent fracture ( refracture ) following initial low-trauma fracture in women and fewer in men . OBJECTIVE To examine long-term risk of subsequent fracture  following initial osteoporotic fracture in men and women . DESIGN , SETTING , AND PARTICIPANTS Prospect i ve cohort study ( Dubbo Osteoporosis Epidemiology Study ) in Australia of 2245 community-dwelling women and 1760 men aged 60 years or older followed up for 16 years from July 1989 through April 2005 . MAIN OUTCOME MEASURE Incidence of first ( initial ) fracture and incidence of subsequent fracture according to sex , age group , and time since first fracture . Relative risk was determined by comparing risk of subsequent fracture with risk of initial fracture . RESULTS There were 905 women and 337 men with an initial fracture , of whom 253 women and 71 men experienced a subsequent fracture . Relative risk ( RR ) of subsequent fracture in women was 1.95 ( 95 % confidence interval [ CI ] , 1.70 - 2.25 ) and in men was 3.47 ( 95 % CI , 2.68 - 4.48 ) . As a result , absolute risk of subsequent fracture was similar in women and men and at least as great as the initial fracture risk for a woman 10 years older . Thus , women and men aged 60 to 69 years had absolute refracture rates of 36/1000 person-years ( 95 % CI , 26 - 48/1000 ) and 37/1000 person-years ( 95 % CI , 23 - 59/1000 ) , respectively . The increase in absolute fracture risk remained for up to 10 years , by which time 40 % to 60 % of surviving women and men experienced a subsequent fracture . All fracture locations apart from rib ( men ) and ankle ( women ) result ed in increased subsequent fracture risk , with highest RRs following hip ( RR , 9.97 ; 95 % CI , 1.38 - 71.98 ) and clinical vertebral ( RR , 15.12 ; 95 % CI , 6.06 - 37.69 ) fractures in younger men . In multivariate analyses , femoral neck bone mineral density , age , and smoking were predictors of subsequent fracture in women and femoral neck bone mineral density , physical activity , and calcium intake were predictors in men . CONCLUSION After an initial low-trauma fracture , absolute risk of subsequent fracture was similar for men and women . This increased risk occurred for virtually all clinical fractures and persisted for up to 10 years Summary In the present prospect i ve controlled observational study , we investigated the effect of a coordinated intervention program on 4-year refracture rates in patients with recent osteoporotic fractures . Compared to st and ard care , targeted identification , and management significantly reduced the risk of refracture by more than 80 % . Introduction The risk of refracture following an incident osteoporotic fracture is high . Despite the availability of treatments that reduce refracture and mortality rates , most patients with minimal trauma fracture ( MTF ) are not managed appropriately . The present prospect i ve controlled observational study investigated the effect of a coordinated intervention program on 4-year refracture rates and time to refracture in patients with recent osteoporotic fractures . Methods 
    Output:
    