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: Vitamin D insufficiency and low calcium intake contribute to increase parathyroid function and bone fragility in elderly people .  Calcium and vitamin D supplements can reverse secondary hyperparathyroidism thus preventing hip fractures , as proved by Decalyos I. Decalyos II is a 2-year , multicenter , r and omized , double-masked , placebo-controlled confirmatory study . The intention-to-treat population consisted of 583 ambulatory institutionalized women ( mean age 85.2 years , SD = 7.1 ) r and omized to the  calcium – vitamin D3  fixed combination group ( n= 199 ) ; the calcium plus vitamin D3 separate combination group ( n= 190 ) and the placebo group ( n= 194 ) . Fixed and separate combination groups received the same daily amount of calcium ( 1200 mg ) and vitamin D3 ( 800 IU ) , which had similar pharmacodynamic effects . Both types of calcium-vitamin D3 regimens increased serum 25-hydroxyvitamin D and decreased serum intact parathyroid hormone to a similar extent , with levels returning within the normal range after 6 months . In a subgroup of 114 patients  , femoral neck bone mineral density ( BMD ) decreased in the placebo group ( mean = –2.36 % per year , SD = 4.92 ) , while remaining unchanged in women treated with calcium-vitamin D3 ( mean = 0.29 % per year , SD = 8.63 ) . The difference between the two groups was 2.65 % ( 95 % CI = –0.44 , 5.75 % ) with a trend in favor of the active treatment group . No significant difference between groups was found for changes in distal radius BMD and quantitative ultrasonic parameters at the os calcis . The relative risk ( RR ) of HF in the placebo group compared with the active treatment group was 1.69 ( 95 % CI = 0.96 , 3.0 ) , which is similar to that found in Decalyos I ( RR = 1.7 ; 95 % CI = 1.0 , 2.8 ) . Thus , these data are in agreement with those of Decalyos I and indicate that calcium and vitamin D3 in combination reverse senile secondary hyperparathyroidism and reduce both hip bone loss and the risk of hip fracture  in elderly institutionalized women The effects of calcium supplementation ( as calcium citrate malate , 1000 mg elemental Ca/d ) with and without the addition of zinc ( 15.0 mg/d ) , manganese ( 5.0 mg/d ) and copper ( 2.5 mg/d ) on spinal bone loss ( L2-L4 vertebrae ) was evaluated in healthy older postmenopausal women ( n = 59 , mean age 66 y ) in a 2-y , double-blind , placebo-controlled trial . Changes ( mean + /- SEM ) in bone density were -3.53 + /- 1.24 % ( placebo ) , -1.89 + /- 1.40 % ( trace minerals only ) , -1.25 + /- 1.46 % ( calcium only ) and 1.48 + /- 1.40 % ( calcium plus trace minerals ) . Bone loss relative to base-line value was significant ( P = 0.0061 ) in the placebo group but not in the groups receiving trace minerals alone , calcium alone , or calcium plus trace minerals . The only significant group difference occurred between the placebo group and the group receiving calcium plus trace minerals ( P = 0.0099 ) . These data suggest that bone loss in calcium-supplemented , older postmenopausal women can be further arrested by concomitant increases in trace mineral intake BACKGROUND Low-energy fractures of the hip , forearm , shoulder , and spine are known consequences of osteoporosis . OBJECTIVE We evaluated the effect of 1 y of treatment with calcium and vitamin D on bone mineral density ( BMD ) and bone markers in patients with a recent low-energy fracture . DESIGN In a double-blinded design , patients with fracture of the hip ( lower-extremity fracture , or LEF ) or upper extremity ( UEF ) were r and omly assigned to receive 3000 mg calcium carbonate + 1400 IU cholecalciferol or placebo ( 200 IU cholecalciferol ) . BMD of the hip ( HBMD ) and lumbar spine ( LBMD ) were evaluated by dual-energy X-ray absorptiometry , and physical performance was assessed by the timed Up & Go test . Serum concentrations of 25-hydroxycholecalciferol , parathyroid hormone ( PTH ) , telepeptide of type I collagen ( ICTP ) , osteocalcin , and N-terminal propeptide of collagen type I were measured . RESULTS A total of 122 patients were included ( 84 % women ; x + /- SD age : 70 + /- 11 y ) ; 68 % completed the study . In an intention-to-treat analysis , LBMD increased in the intervention group and decreased in the placebo group , and the difference between the groups was significant after 12 mo : 0.931 + /- 0.211 compared with 0.848 + /- 0.194 ( P<0.05 ) . No significant change was shown for HBMD . The effect of treatment was more pronounced in patients aged < 70 y. The intervention decreased bone turnover . PTH was significantly lower in the intervention group ( P<0.01 ) for the LEF patients . ICTP and change in LBMD were significantly related to physical performance . CONCLUSIONS A 1-y intervention with calcium and vitamin D reduced bone turnover , significantly increased BMD in patients younger than 70 y , and decreased bone loss  in older patients . The effect of treatment was related to physical performance Three hundred ten normal postmenopausal volunteers were invited to enter a controlled trial of the effects of calcium supplementation on forearm mineral content ( FMC ) ; 269 entered the study and 210 completed it . Of those who completed the study , 158 were allocated to one of three calcium-supplemented treatment regimes and 52 were allocated to a control group . Twenty-two of the subjects allocated to the treatment group were unable to take supplementary calcium but agreed to remain in the study as additional controls . There were therefore 136 treated subjects , 52 strict controls and 74 controls altogether . During the initial observation period of 9 mo , there was a highly significant loss of bone in all groups ( P less than 0.001 ) . During the 9-mo period of treatment , there was a highly significant reduction in the rate of bone loss in the treated subjects ( P less than 0.001 ) , a just significant reduction in the strict controls ( P less than 0.05 ) and a nonsignificant reduction in the rate of loss in all controls . The difference between the treated and strict controls in the second period was not significant but the difference between the treated and all controls in the second period was significant ( P less than 0.025 ) . When the analysis was applied only to women within 10 yr of menopause , the difference between the treated and strict control groups in period 2 was significant ( P less than 0.025 ) and the difference between the treated and all controls was highly significant ( P less than 0.001 ) The purpose of this study was to ( 1 ) quantify the healing process of the human osteoporotic proximal humerus fracture ( PHF ) expressed in terms of callus formation over the fracture region using BMD scanning , and ( 2 ) quantify the impact of medical intervention with vitamin D3 and calcium on the healing process of the human osteoporotic fracture . The conservatively treated PHF was chosen in order to follow the genuine fracture healing without influence of osteosynthetic material s or casts . Thirty women ( mean age = 78 years ; range = 58–88 ) with a PHF , osteoporosis or osteopenia ( based on a hip scan , WHO criteria ) , and not taking any drugs related to bone formation , including calcium or vitamin D supplementation  , were r and omly assigned to either oral 800 IU vitamin D3 plus 1 g calcium or placebo , in a double-blind prospect i ve study . We measured biochemical , radiographic , and bone mineral density effect parameters to evaluate the impact on the healing process . Scanning procedures of the fractured shoulder included use of a fixation device to obtain the highest possible precision . Double scans of the fractured shoulder revealed a coefficient of variation ( CV ) on BMD measurements that improved from 2.8 % immediately after fracture occurrence to 1.7 % at 12 weeks ( P = 0.003 ) approaching the 1.2 % levels observed over the healthy shoulder . BMD was similar in the two groups at baseline ( active 0.534 g/cm2 vs. placebo 0.518 g/cm2 ) , and both increased over the 12-week observation period , with peak levels in week 6 . By week 6 BMD levels were higher in the active group ( 0.623 g/cm2 ) compared with the placebo group ( 0.570 g/cm2 , P = 0.006 ) . Thirty seven percent of the patients presented with vitamin D levels below 30 nmol/l , indicative of mild vitamin D insufficiency . In conclusion , we have demonstrated that it is possible to quantify callus formation of the PHF with sufficiently high precision to demonstrate the positive influence of vitamin D3 and calcium over the first 6 weeks after fracture . Whether this results in more stable fractures , extends to other fracture types , or applies to other osteogenic bone agents such as bisphosphonates remains to be examined Abstract : Trabecular bone density at the distal radius and cortical bone density at the midradius were measured in four r and omized groups of women before and after 4 months administration of AAACa , oyster shell heated under reduced pressure with addition of heated algal ingredient ( HAI ) ( group A ) ; AACa , the same preparation without HAI ( group B ) ; CaCO3 ( group C ) ; and placebo ( group D ) in a double-blind system using peripheral quantitative computed tomography ( pQCT ) with lumbar spine density measurement by dual-energy X-ray absorptiometry ( DXA ) . Groups A , B , and C received 900 mg/day elemental calcium and D received none . In subjects of group A , but not B , C , and D , radial trabecular bone density increased significantly , to 106.2 % ± 2.1 % of the initial value ( mean ± SEM ) . The increase of trabecular bone density was significantly different from the placebo group ( D ) only in AAACa ( group A ) and not in AACa ( group B ) and the calcium carbonate ( group C ) . Cortical bone density increase was also greater in group A ( but not in B and C ) than in D. Lumbar spine density did not change significantly . AAACa was apparently more effective , increasing trabecular bone density more than AACa and CaCO3 containing the same amount of elemental calcium Ca supplements are used for bone health ; however , they have been associated with increased cardiovascular risk , which may relate to their acute effects on serum Ca concentrations . Microcrystalline hydroxyapatite ( MCH ) could affect serum Ca concentrations less than conventional Ca supplements , but its effects on bone turnover are unclear . In the present study , we compared the acute and 3-month effects of MCH with conventional Ca supplements on concentrations of serum Ca , phosphate , parathyroid hormone and bone turnover markers . We r and omised 100 women ( mean age 71 years ) to 1 g/d of Ca as citrate or carbonate ( citrate-carbonate ) , one of two MCH preparations , or a placebo . Blood was sample d for 8 h after the first dose , and after 3 months of daily supplementation . To determine whether the acute effects changed over time , eight participants assigned to the citrate dose repeated 8 h of blood sampling at 3 months . There were no differences between the citrate and carbonate groups , or between the two MCH groups , so their results were pooled . The citrate-carbonate dose increased ionised and total Ca concentrations for up to 8 h , and this was not diminished after 3 months . MCH increased ionised Ca concentrations less than the citrate-carbonate dose ; however , it raised the concentrations of phosphate and the Ca-phosphate product . The citrate-carbonate and MCH doses produced comparable decreases in bone resorption ( measured as serum C-telopeptide ( CTX ) ) over 8 h and bone turnover ( CTX and procollagen type-I N-terminal propeptide ) at 3 months . These findings suggest that Ca preparations , in general , produce repeated sustained increases in serum Ca concentrations after ingestion of each dose and that Ca supplements with smaller effects on serum Ca concentrations may have equivalent efficacy in suppressing bone turnover Increased postmenopausal bone turnover leads to bone loss and fragility fracture risk . In the absence of osteoporosis , risk preventive measures , particularly those modifying nutritional lifestyle , are appropriate . We tested the hypothesis that milk supplementation affects bone turnover related to biochemical markers in a direction that , in the long term , may be expected to reduce  postmenopausal bone loss .  Thirty healthy postmenopausal women aged 59.3 ( SD 3.3 ) years were enrolled in a prospect i ve crossover trial of 16 weeks . After a 4-week period of adaptation with diet providing 600 mg calcium plus 300 mg ingested as 250 ml semi-skimmed milk , participants were maintained during 
    Output:
    
agent
Calcium supplements  increased BMD by 0.7 - 1.8 % at all five skeletal sites at one , two , and over two and a half years , but the size of the increase in BMD at later time points was similar to the increase at one year .
Increasing calcium intake from dietary sources or by taking calcium supplements produces small non-progressive increases in BMD , which are unlikely to lead to a clinical ly significant reduction in risk of fracture
***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: Vitamin D insufficiency and low calcium intake contribute to increase parathyroid function and bone fragility in elderly people .  Calcium and vitamin D supplements can reverse secondary hyperparathyroidism thus preventing hip fractures , as proved by Decalyos I. Decalyos II is a 2-year , multicenter , r and omized , double-masked , placebo-controlled confirmatory study . The intention-to-treat population consisted of 583 ambulatory institutionalized women ( mean age 85.2 years , SD = 7.1 ) r and omized to the  calcium – vitamin D3  fixed combination group ( n= 199 ) ; the calcium plus vitamin D3 separate combination group ( n= 190 ) and the placebo group ( n= 194 ) . Fixed and separate combination groups received the same daily amount of calcium ( 1200 mg ) and vitamin D3 ( 800 IU ) , which had similar pharmacodynamic effects . Both types of calcium-vitamin D3 regimens increased serum 25-hydroxyvitamin D and decreased serum intact parathyroid hormone to a similar extent , with levels returning within the normal range after 6 months . In a subgroup of 114 patients  , femoral neck bone mineral density ( BMD ) decreased in the placebo group ( mean = –2.36 % per year , SD = 4.92 ) , while remaining unchanged in women treated with calcium-vitamin D3 ( mean = 0.29 % per year , SD = 8.63 ) . The difference between the two groups was 2.65 % ( 95 % CI = –0.44 , 5.75 % ) with a trend in favor of the active treatment group . No significant difference between groups was found for changes in distal radius BMD and quantitative ultrasonic parameters at the os calcis . The relative risk ( RR ) of HF in the placebo group compared with the active treatment group was 1.69 ( 95 % CI = 0.96 , 3.0 ) , which is similar to that found in Decalyos I ( RR = 1.7 ; 95 % CI = 1.0 , 2.8 ) . Thus , these data are in agreement with those of Decalyos I and indicate that calcium and vitamin D3 in combination reverse senile secondary hyperparathyroidism and reduce both hip bone loss and the risk of hip fracture  in elderly institutionalized women The effects of calcium supplementation ( as calcium citrate malate , 1000 mg elemental Ca/d ) with and without the addition of zinc ( 15.0 mg/d ) , manganese ( 5.0 mg/d ) and copper ( 2.5 mg/d ) on spinal bone loss ( L2-L4 vertebrae ) was evaluated in healthy older postmenopausal women ( n = 59 , mean age 66 y ) in a 2-y , double-blind , placebo-controlled trial . Changes ( mean + /- SEM ) in bone density were -3.53 + /- 1.24 % ( placebo ) , -1.89 + /- 1.40 % ( trace minerals only ) , -1.25 + /- 1.46 % ( calcium only ) and 1.48 + /- 1.40 % ( calcium plus trace minerals ) . Bone loss relative to base-line value was significant ( P = 0.0061 ) in the placebo group but not in the groups receiving trace minerals alone , calcium alone , or calcium plus trace minerals . The only significant group difference occurred between the placebo group and the group receiving calcium plus trace minerals ( P = 0.0099 ) . These data suggest that bone loss in calcium-supplemented , older postmenopausal women can be further arrested by concomitant increases in trace mineral intake BACKGROUND Low-energy fractures of the hip , forearm , shoulder , and spine are known consequences of osteoporosis . OBJECTIVE We evaluated the effect of 1 y of treatment with calcium and vitamin D on bone mineral density ( BMD ) and bone markers in patients with a recent low-energy fracture . DESIGN In a double-blinded design , patients with fracture of the hip ( lower-extremity fracture , or LEF ) or upper extremity ( UEF ) were r and omly assigned to receive 3000 mg calcium carbonate + 1400 IU cholecalciferol or placebo ( 200 IU cholecalciferol ) . BMD of the hip ( HBMD ) and lumbar spine ( LBMD ) were evaluated by dual-energy X-ray absorptiometry , and physical performance was assessed by the timed Up & Go test . Serum concentrations of 25-hydroxycholecalciferol , parathyroid hormone ( PTH ) , telepeptide of type I collagen ( ICTP ) , osteocalcin , and N-terminal propeptide of collagen type I were measured . RESULTS A total of 122 patients were included ( 84 % women ; x + /- SD age : 70 + /- 11 y ) ; 68 % completed the study . In an intention-to-treat analysis , LBMD increased in the intervention group and decreased in the placebo group , and the difference between the groups was significant after 12 mo : 0.931 + /- 0.211 compared with 0.848 + /- 0.194 ( P<0.05 ) . No significant change was shown for HBMD . The effect of treatment was more pronounced in patients aged < 70 y. The intervention decreased bone turnover . PTH was significantly lower in the intervention group ( P<0.01 ) for the LEF patients . ICTP and change in LBMD were significantly related to physical performance . CONCLUSIONS A 1-y intervention with calcium and vitamin D reduced bone turnover , significantly increased BMD in patients younger than 70 y , and decreased bone loss  in older patients . The effect of treatment was related to physical performance Three hundred ten normal postmenopausal volunteers were invited to enter a controlled trial of the effects of calcium supplementation on forearm mineral content ( FMC ) ; 269 entered the study and 210 completed it . Of those who completed the study , 158 were allocated to one of three calcium-supplemented treatment regimes and 52 were allocated to a control group . Twenty-two of the subjects allocated to the treatment group were unable to take supplementary calcium but agreed to remain in the study as additional controls . There were therefore 136 treated subjects , 52 strict controls and 74 controls altogether . During the initial observation period of 9 mo , there was a highly significant loss of bone in all groups ( P less than 0.001 ) . During the 9-mo period of treatment , there was a highly significant reduction in the rate of bone loss in the treated subjects ( P less than 0.001 ) , a just significant reduction in the strict controls ( P less than 0.05 ) and a nonsignificant reduction in the rate of loss in all controls . The difference between the treated and strict controls in the second period was not significant but the difference between the treated and all controls in the second period was significant ( P less than 0.025 ) . When the analysis was applied only to women within 10 yr of menopause , the difference between the treated and strict control groups in period 2 was significant ( P less than 0.025 ) and the difference between the treated and all controls was highly significant ( P less than 0.001 ) The purpose of this study was to ( 1 ) quantify the healing process of the human osteoporotic proximal humerus fracture ( PHF ) expressed in terms of callus formation over the fracture region using BMD scanning , and ( 2 ) quantify the impact of medical intervention with vitamin D3 and calcium on the healing process of the human osteoporotic fracture . The conservatively treated PHF was chosen in order to follow the genuine fracture healing without influence of osteosynthetic material s or casts . Thirty women ( mean age = 78 years ; range = 58–88 ) with a PHF , osteoporosis or osteopenia ( based on a hip scan , WHO criteria ) , and not taking any drugs related to bone formation , including calcium or vitamin D supplementation  , were r and omly assigned to either oral 800 IU vitamin D3 plus 1 g calcium or placebo , in a double-blind prospect i ve study . We measured biochemical , radiographic , and bone mineral density effect parameters to evaluate the impact on the healing process . Scanning procedures of the fractured shoulder included use of a fixation device to obtain the highest possible precision . Double scans of the fractured shoulder revealed a coefficient of variation ( CV ) on BMD measurements that improved from 2.8 % immediately after fracture occurrence to 1.7 % at 12 weeks ( P = 0.003 ) approaching the 1.2 % levels observed over the healthy shoulder . BMD was similar in the two groups at baseline ( active 0.534 g/cm2 vs. placebo 0.518 g/cm2 ) , and both increased over the 12-week observation period , with peak levels in week 6 . By week 6 BMD levels were higher in the active group ( 0.623 g/cm2 ) compared with the placebo group ( 0.570 g/cm2 , P = 0.006 ) . Thirty seven percent of the patients presented with vitamin D levels below 30 nmol/l , indicative of mild vitamin D insufficiency . In conclusion , we have demonstrated that it is possible to quantify callus formation of the PHF with sufficiently high precision to demonstrate the positive influence of vitamin D3 and calcium over the first 6 weeks after fracture . Whether this results in more stable fractures , extends to other fracture types , or applies to other osteogenic bone agents such as bisphosphonates remains to be examined Abstract : Trabecular bone density at the distal radius and cortical bone density at the midradius were measured in four r and omized groups of women before and after 4 months administration of AAACa , oyster shell heated under reduced pressure with addition of heated algal ingredient ( HAI ) ( group A ) ; AACa , the same preparation without HAI ( group B ) ; CaCO3 ( group C ) ; and placebo ( group D ) in a double-blind system using peripheral quantitative computed tomography ( pQCT ) with lumbar spine density measurement by dual-energy X-ray absorptiometry ( DXA ) . Groups A , B , and C received 900 mg/day elemental calcium and D received none . In subjects of group A , but not B , C , and D , radial trabecular bone density increased significantly , to 106.2 % ± 2.1 % of the initial value ( mean ± SEM ) . The increase of trabecular bone density was significantly different from the placebo group ( D ) only in AAACa ( group A ) and not in AACa ( group B ) and the calcium carbonate ( group C ) . Cortical bone density increase was also greater in group A ( but not in B and C ) than in D. Lumbar spine density did not change significantly . AAACa was apparently more effective , increasing trabecular bone density more than AACa and CaCO3 containing the same amount of elemental calcium Ca supplements are used for bone health ; however , they have been associated with increased cardiovascular risk , which may relate to their acute effects on serum Ca concentrations . Microcrystalline hydroxyapatite ( MCH ) could affect serum Ca concentrations less than conventional Ca supplements , but its effects on bone turnover are unclear . In the present study , we compared the acute and 3-month effects of MCH with conventional Ca supplements on concentrations of serum Ca , phosphate , parathyroid hormone and bone turnover markers . We r and omised 100 women ( mean age 71 years ) to 1 g/d of Ca as citrate or carbonate ( citrate-carbonate ) , one of two MCH preparations , or a placebo . Blood was sample d for 8 h after the first dose , and after 3 months of daily supplementation . To determine whether the acute effects changed over time , eight participants assigned to the citrate dose repeated 8 h of blood sampling at 3 months . There were no differences between the citrate and carbonate groups , or between the two MCH groups , so their results were pooled . The citrate-carbonate dose increased ionised and total Ca concentrations for up to 8 h , and this was not diminished after 3 months . MCH increased ionised Ca concentrations less than the citrate-carbonate dose ; however , it raised the concentrations of phosphate and the Ca-phosphate product . The citrate-carbonate and MCH doses produced comparable decreases in bone resorption ( measured as serum C-telopeptide ( CTX ) ) over 8 h and bone turnover ( CTX and procollagen type-I N-terminal propeptide ) at 3 months . These findings suggest that Ca preparations , in general , produce repeated sustained increases in serum Ca concentrations after ingestion of each dose and that Ca supplements with smaller effects on serum Ca concentrations may have equivalent efficacy in suppressing bone turnover Increased postmenopausal bone turnover leads to bone loss and fragility fracture risk . In the absence of osteoporosis , risk preventive measures , particularly those modifying nutritional lifestyle , are appropriate . We tested the hypothesis that milk supplementation affects bone turnover related to biochemical markers in a direction that , in the long term , may be expected to reduce  postmenopausal bone loss .  Thirty healthy postmenopausal women aged 59.3 ( SD 3.3 ) years were enrolled in a prospect i ve crossover trial of 16 weeks . After a 4-week period of adaptation with diet providing 600 mg calcium plus 300 mg ingested as 250 ml semi-skimmed milk , participants were maintained during 
    Output:
    