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: Objective To describe the prevalence and treatment of hot flushes in premenopausal and postmenopausal women from the 1960s to the 1990s . Design This prospect i ve study , based on a r and om sample of the total female population of 430,000 in Gothenburg , Sweden , was started in 1968 , with follow-ups in 1974 , 1980 , and 1992 . The participants were 1,462 women born in 1930 , 1922 , 1918 , 1914 , and 1908 ( participation rate 90.1 % ) who were representative of women of the same age in the general population . For the purpose of analyzing secular trends , we included 122 participants who were 38 years old and 47 who were 50 years old in 1980–1981 .  Results The prevalence of hot flushes increased from ∼11 % at 38 years to a maximal prevalence of ∼60 % at 52 to 54 years of age , then declined successively from ∼30 % at 60 years of age to ∼15 % at 66 years of age , and then to ∼9 % at 72 years of age . The predominant type of medication being prescribed changed during the observation period from sedatives/anticholinergic drugs in the 1960s to hormone replacement therapy in the 1980s . Hormone replacement therapy was considered to be an effective form of treatment for hot flushes by 70 % to 87 % of the women . Conclusions Hot flushes were a common symptom , with a maximal prevalence of 64 % at 54 years of age . Medical consultation and treatment did not increase in 50-year-old women from 1968–1969 to 1980–1981 . Treatment changed and became more effective during the observation period Changes in the level of biochemical markers of bone resorption with risedronate treatment for osteoporosis were examined as a surrogate for the decrease in fracture risk . Greater decreases in bone resorption markers were associated with greater decreases in vertebral ( and nonvertebral ) fractures . Antifracture efficacy of antiresorptive therapies is only partially explained by increases in bone mineral density . Early decreases in bone resorption may also play a role . We tested this hypothesis by measuring two bone resorption markers , the C-telopeptide of type I collagen ( CTX ) and the N-telopeptide of type I collagen ( NTX ) , in osteoporotic patients in risedronate vertebral fracture trials . We studied 693 women with at least one vertebral deformity ( mean age , 69 + /- 7 years ) who received calcium ( and vitamin D if required ) and placebo or risedronate 5 mg daily for 3 years . The reductions in urinary CTX ( median , 60 % ) and NTX ( 51 % ) at 3 - 6 months with risedronate therapy were significantly associated ( p < 0.05 ) with the reduction in vertebral fracture risk ( 75 % over 1 year and 50 % over 3 years ) . The changes in both CTX and NTX accounted for approximately one-half ( CTX , 55 % ; NTX , 49 % ) of risedronate 's effect in reducing the risk of vertebral fractures in the first year and approximately two-thirds ( CTX , 67 % ; NTX , 66 % ) over 3 years compared with placebo . The changes in CTX and NTX accounted for 77 % and 54 % , respectively , of risedronate 's effect in reducing the risk of nonvertebral fractures over 3 years compared with placebo . The relationships between vertebral fracture risk and changes from baseline in CTX and NTX were not linear ( p < 0.05 ) . There was little further improvement in fracture benefit below a decrease of 55 - 60 % for CTX and 35 - 40 % for NTX . The decrease in bone resorption in patients taking risedronate accounts for a large proportion of the reduction in fracture risk . There may be a level of bone resorption reduction below which there is no further fracture benefit A  telephone survey of a r and om sample of 594 perimenopausal women was done to study the prevalence of hot flashes , use of estrogen , age of menopause onset , and , among those subjects experiencing hot flashes , the frequency of occurrence and number of years of hot flashes . The prevalence of hot flashes was 88 % . Surgical menopause women had a prevalence rate of 92 % and had the highest estrogen utilization rate . The median age of onset for natural menopause women was 49 years . The frequency of occurrence and number of years of hot flash experience was variable across all groups The transdermal and oral administration of estrogens for one year were compared with respect to the effects on lipid metabolism .  Eighty-one postmenopausal women ( 1.5 - 3 years after menopause ) were r and omly divided into three groups . The first two groups received sequential estrogen treatment with either transdermal estradiol ( Estraderm TTS , Ciba Geigy ; 50 micrograms/day ; 24 women ) or 0.625 mg/day conjugated estrogens ( Premarin , Wyeth ; 20 subjects ) , respectively . In both groups medroxyprogesterone ( 10 mg/day per os ) was added for 12 days of each cycle . Thirty-five subjects served as control group without therapy  . No significant changes in the lipid profile was observed in control subjects after 1 year of follow-up . Serum triglycerides decreased significantly ( -10.9 + /- 26 % S.D. ; P < 0.05 ) in transdermal treated women , whereas it slightly rose in oral estrogen group . Comparable significant decreases in total and low density lipoprotein ( LDL ) cholesterol ( mean range -6.5/-18.0 % ) were observed in women on estrogen replacement therapy . High density lipoprotein ( HDL ) cholesterol significantly diminished in transdermal estradiol group , but it rose slightly in the oral estrogen group . Thus the fraction of HDL cholesterol over LDL cholesterol did not change in the transdermal group whereas it significantly rose in subjects treated with oral estrogens . It remains to be established to what extent these differences on lipid metabolism are relevant for the prevention of cardiovascular diseases UNLABELLED We used data from the Fracture Intervention Trial to assess the relationship change in bone turnover after 1 year of alendronate or placebo treatment and subsequent hip , non-spine , and spine fracture risk among 6186 postmenopausal women . In the alendronate group ( n = 3105 ) , greater reductions in one or more biochemical marker were associated with a lower risk of fracture . INTRODUCTION There are few data on the relationship between short-term change in biochemical markers of bone turnover and non-spine fracture risk among bisphosphonate-treated women , and the clinical use of such measurements is unknown . MATERIAL S AND METHODS We measured biochemical markers of bone turnover ( bone-specific alkaline phosphatase [ bone ALP ] , intact N-terminal propeptide of type I collagen , and C-terminal crosslinked telopeptide of type 1 collagen ) and BMD of the spine and hip at baseline and after 1 year of alendronate or placebo . During a mean follow-up of 3.6 years , 72 hip , 786 non-spine , and 336 vertebral fractures were documented . RESULTS AND CONCLUSIONS Each 1 SD reduction in 1-year change in bone ALP was associated with fewer spine ( odds ratio = 0.74 ; CI : 0.63 , 0.87 ) , non-spine ( relative hazard [ RH ] = 0.89 ; CI : 0.78 , 1.00 ; p < 0.050 ) , and hip fractures ( RH = 0.61 ; CI : 0.46 , 0.78 ) . Alendronate-treated women with at least a 30 % reduction in bone ALP had a lower risk of non-spine ( RH = 0.72 ; CI : 0.55 , 0.92 ) and hip fractures ( RH = 0.26 ; CI : 0.08 , 0.83 ) relative to those with reductions < 30 % . We conclude that greater reductions in bone turnover with alendronate therapy are associated with fewer hip , non-spine , and vertebral fractures , and the effect is at least as strong as that observed with 1-year change in BMD OBJECTIVE To survey the prevalence of 18 menopausal symptoms in nine ethnic groups of Asian women . To evaluate responsiveness of symptoms to three estrogen/progestin doses in Asian women . DESIGN A prospect i ve , r and omized , double-blind multinational clinical trial in 1028 healthy postmenopausal women from 11 Asian countries/regions . Following 2 weeks of baseline observations , the women received one of three conjugated estrogens (CE)/medroxyprogesterone acetate ( MPA ) doses ( in mg ) daily for 24 weeks : 0.625/2.5 ; 0.45/1.5 ; or 0.3/1.5 . At baseline and throughout the study period , the women were asked to record each symptom daily on diary cards translated into 10 language s. RESULTS The number of women in the different ethnic groups ranged from 24 ( Malay ) to 248 ( Chinese ) . The overall prevalence of symptoms differed among the groups , with Vietnamese women generally reporting the highest rates . Within each ethnic group , the prevalence of individual symptoms varied substantially . Only 5 % of Indonesian women , for example , reported hot flushes but 93 % complained of body or joint aches/pains . Overall , body or joint aches/pains was the most prevalent symptom , ranging from 76 % in Korean women to 96 % in Vietnamese women . Therapy result ed in a significant decline in all symptoms . The decline was observed with all three doses after 4 weeks of treatment and continued throughout the 6-month study period . CONCLUSION The prevalence of individual menopausal symptoms differed among ethnic groups of Asian women . Within each ethnic group the percentage of women reporting each symptom varied substantially . Symptoms declined after 4 weeks of hormone therapy and thereafter throughout the study . The effect of the lowest dose of CE/MPA ( 0.3/1.5 mg/day ) was comparable to that of the higher doses Objective To evaluate the effects of the tissue selective estrogen complex ( TSEC ) pairing bazedoxifene ( BZA ) with conjugated estrogens ( CE ) on sexual function and quality of life in postmenopausal women . Methods In this 12-week , double-blind , placebo-controlled study , postmenopausal , non-hysterectomized women ( n = 652 ) with symptoms of moderate to severe vulvar/vaginal atrophy were r and omized to once-daily treatment with BZA 20 mg/CE 0.45 or 0.625 mg , BZA 20 mg , or placebo . The Arizona Sexual Experiences ( ASEX ) Scale , Menopause-Specific Quality of Life ( MENQOL ) question naire , and Menopause Symptoms Treatment Satisfaction Question naire ( MS-TSQ ) were secondary measures used to assess the effects of BZA/CE on sexual function , menopausal symptoms , and satisfaction with treatment , respectively . Results At week 12 , both BZA/CE doses were associated with significant improvement in ease of lubrication score from baseline compared with placebo ( p < 0.05 ) on the ASEX scale , although there was no difference in the change in total score . The MENQOL question naire results at week 12 showed significant improvements in vasomotor function , sexual function and total scores with both BZA/CE doses vs. placebo or BZA 20 mg ( p < 0.001 ) . The MS-TSQ results showed that BZA/CE-treated subjects reported significantly greater overall satisfaction with treatment , as well as satisfaction with control of hot flushes during the day and night , effect on quality of sleep , and effect on mood or emotions , compared with subjects treated with placebo or BZA 20 mg ( all p < 0.05 ) . Conclusion Treatment with BZA/CE for 12 weeks was shown to significantly improve sexual function and quality -of-life measures in symptomatic postmenopausal women OBJECTIVE To determine the relation between estrogen replacement therapy and fractures . DESIGN Prospect i ve cohort study . SETTING Four clinical centers in Baltimore County , Maryl and ; Minneapolis , Minnesota ; Portl and , Oregon ; and the Monongahela Valley , Pennsylvania . PARTICIPANTS 9704 ambulatory , nonblack women 65 years of age or older . MEASUREMENTS  Estrogen use , medical history , and anthropometric data  were obtained by question naire , interview , and examination . Appendicular bone mass was measured by single-photon absorptiometry .  Incident fractures were vali date d by radiographic report . RESULTS After adjustment for potential confounders , current estrogen use was associated with a decrease in the risk for wrist fractures ( relative risk [ RR ] , 0.39 ; 95 % CI , 0.24 to 0.64 ) and for all nonspinal fractures ( RR , 0.66 ; CI ,  
    Output:
    
agent
Results of systematic review s and meta-analyses of r and omized controlled trials have shown that both systemic estrogen therapy or hormone therapy ( estrogen combined with a progestin ) are useful to prevent bone loss , and they are the most effective treatment for such climacteric symptoms as hot flushes , sweating , vaginal dryness , and dyspareunia .
The combination of a SERM with estrogen as a tissue selective estrogen complex ( TSEC ) is a new strategy for the prevention of bone loss and the treatment of climacteric symptoms .
This combination is particularly interesting from a clinical point of view , taking into account that estrogen alone did not increase breast cancer risk by the Women 's Health Initiative .
TSEC is hypothesized to provide the benefits of estrogen-alone therapy , with an improved tolerability profile because the SERM component can make possible the elimination of progestin .
The conclusion is that effectively , the combination of bazedoxifene and conjugated estrogens may be a promising alternative to hormone therapy for the prevention of osteoporosis and the treatment of postmenopausal symptoms in non-hysterectomized postmenopausal women
***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: Objective To describe the prevalence and treatment of hot flushes in premenopausal and postmenopausal women from the 1960s to the 1990s . Design This prospect i ve study , based on a r and om sample of the total female population of 430,000 in Gothenburg , Sweden , was started in 1968 , with follow-ups in 1974 , 1980 , and 1992 . The participants were 1,462 women born in 1930 , 1922 , 1918 , 1914 , and 1908 ( participation rate 90.1 % ) who were representative of women of the same age in the general population . For the purpose of analyzing secular trends , we included 122 participants who were 38 years old and 47 who were 50 years old in 1980–1981 .  Results The prevalence of hot flushes increased from ∼11 % at 38 years to a maximal prevalence of ∼60 % at 52 to 54 years of age , then declined successively from ∼30 % at 60 years of age to ∼15 % at 66 years of age , and then to ∼9 % at 72 years of age . The predominant type of medication being prescribed changed during the observation period from sedatives/anticholinergic drugs in the 1960s to hormone replacement therapy in the 1980s . Hormone replacement therapy was considered to be an effective form of treatment for hot flushes by 70 % to 87 % of the women . Conclusions Hot flushes were a common symptom , with a maximal prevalence of 64 % at 54 years of age . Medical consultation and treatment did not increase in 50-year-old women from 1968–1969 to 1980–1981 . Treatment changed and became more effective during the observation period Changes in the level of biochemical markers of bone resorption with risedronate treatment for osteoporosis were examined as a surrogate for the decrease in fracture risk . Greater decreases in bone resorption markers were associated with greater decreases in vertebral ( and nonvertebral ) fractures . Antifracture efficacy of antiresorptive therapies is only partially explained by increases in bone mineral density . Early decreases in bone resorption may also play a role . We tested this hypothesis by measuring two bone resorption markers , the C-telopeptide of type I collagen ( CTX ) and the N-telopeptide of type I collagen ( NTX ) , in osteoporotic patients in risedronate vertebral fracture trials . We studied 693 women with at least one vertebral deformity ( mean age , 69 + /- 7 years ) who received calcium ( and vitamin D if required ) and placebo or risedronate 5 mg daily for 3 years . The reductions in urinary CTX ( median , 60 % ) and NTX ( 51 % ) at 3 - 6 months with risedronate therapy were significantly associated ( p < 0.05 ) with the reduction in vertebral fracture risk ( 75 % over 1 year and 50 % over 3 years ) . The changes in both CTX and NTX accounted for approximately one-half ( CTX , 55 % ; NTX , 49 % ) of risedronate 's effect in reducing the risk of vertebral fractures in the first year and approximately two-thirds ( CTX , 67 % ; NTX , 66 % ) over 3 years compared with placebo . The changes in CTX and NTX accounted for 77 % and 54 % , respectively , of risedronate 's effect in reducing the risk of nonvertebral fractures over 3 years compared with placebo . The relationships between vertebral fracture risk and changes from baseline in CTX and NTX were not linear ( p < 0.05 ) . There was little further improvement in fracture benefit below a decrease of 55 - 60 % for CTX and 35 - 40 % for NTX . The decrease in bone resorption in patients taking risedronate accounts for a large proportion of the reduction in fracture risk . There may be a level of bone resorption reduction below which there is no further fracture benefit A  telephone survey of a r and om sample of 594 perimenopausal women was done to study the prevalence of hot flashes , use of estrogen , age of menopause onset , and , among those subjects experiencing hot flashes , the frequency of occurrence and number of years of hot flashes . The prevalence of hot flashes was 88 % . Surgical menopause women had a prevalence rate of 92 % and had the highest estrogen utilization rate . The median age of onset for natural menopause women was 49 years . The frequency of occurrence and number of years of hot flash experience was variable across all groups The transdermal and oral administration of estrogens for one year were compared with respect to the effects on lipid metabolism .  Eighty-one postmenopausal women ( 1.5 - 3 years after menopause ) were r and omly divided into three groups . The first two groups received sequential estrogen treatment with either transdermal estradiol ( Estraderm TTS , Ciba Geigy ; 50 micrograms/day ; 24 women ) or 0.625 mg/day conjugated estrogens ( Premarin , Wyeth ; 20 subjects ) , respectively . In both groups medroxyprogesterone ( 10 mg/day per os ) was added for 12 days of each cycle . Thirty-five subjects served as control group without therapy  . No significant changes in the lipid profile was observed in control subjects after 1 year of follow-up . Serum triglycerides decreased significantly ( -10.9 + /- 26 % S.D. ; P < 0.05 ) in transdermal treated women , whereas it slightly rose in oral estrogen group . Comparable significant decreases in total and low density lipoprotein ( LDL ) cholesterol ( mean range -6.5/-18.0 % ) were observed in women on estrogen replacement therapy . High density lipoprotein ( HDL ) cholesterol significantly diminished in transdermal estradiol group , but it rose slightly in the oral estrogen group . Thus the fraction of HDL cholesterol over LDL cholesterol did not change in the transdermal group whereas it significantly rose in subjects treated with oral estrogens . It remains to be established to what extent these differences on lipid metabolism are relevant for the prevention of cardiovascular diseases UNLABELLED We used data from the Fracture Intervention Trial to assess the relationship change in bone turnover after 1 year of alendronate or placebo treatment and subsequent hip , non-spine , and spine fracture risk among 6186 postmenopausal women . In the alendronate group ( n = 3105 ) , greater reductions in one or more biochemical marker were associated with a lower risk of fracture . INTRODUCTION There are few data on the relationship between short-term change in biochemical markers of bone turnover and non-spine fracture risk among bisphosphonate-treated women , and the clinical use of such measurements is unknown . MATERIAL S AND METHODS We measured biochemical markers of bone turnover ( bone-specific alkaline phosphatase [ bone ALP ] , intact N-terminal propeptide of type I collagen , and C-terminal crosslinked telopeptide of type 1 collagen ) and BMD of the spine and hip at baseline and after 1 year of alendronate or placebo . During a mean follow-up of 3.6 years , 72 hip , 786 non-spine , and 336 vertebral fractures were documented . RESULTS AND CONCLUSIONS Each 1 SD reduction in 1-year change in bone ALP was associated with fewer spine ( odds ratio = 0.74 ; CI : 0.63 , 0.87 ) , non-spine ( relative hazard [ RH ] = 0.89 ; CI : 0.78 , 1.00 ; p < 0.050 ) , and hip fractures ( RH = 0.61 ; CI : 0.46 , 0.78 ) . Alendronate-treated women with at least a 30 % reduction in bone ALP had a lower risk of non-spine ( RH = 0.72 ; CI : 0.55 , 0.92 ) and hip fractures ( RH = 0.26 ; CI : 0.08 , 0.83 ) relative to those with reductions < 30 % . We conclude that greater reductions in bone turnover with alendronate therapy are associated with fewer hip , non-spine , and vertebral fractures , and the effect is at least as strong as that observed with 1-year change in BMD OBJECTIVE To survey the prevalence of 18 menopausal symptoms in nine ethnic groups of Asian women . To evaluate responsiveness of symptoms to three estrogen/progestin doses in Asian women . DESIGN A prospect i ve , r and omized , double-blind multinational clinical trial in 1028 healthy postmenopausal women from 11 Asian countries/regions . Following 2 weeks of baseline observations , the women received one of three conjugated estrogens (CE)/medroxyprogesterone acetate ( MPA ) doses ( in mg ) daily for 24 weeks : 0.625/2.5 ; 0.45/1.5 ; or 0.3/1.5 . At baseline and throughout the study period , the women were asked to record each symptom daily on diary cards translated into 10 language s. RESULTS The number of women in the different ethnic groups ranged from 24 ( Malay ) to 248 ( Chinese ) . The overall prevalence of symptoms differed among the groups , with Vietnamese women generally reporting the highest rates . Within each ethnic group , the prevalence of individual symptoms varied substantially . Only 5 % of Indonesian women , for example , reported hot flushes but 93 % complained of body or joint aches/pains . Overall , body or joint aches/pains was the most prevalent symptom , ranging from 76 % in Korean women to 96 % in Vietnamese women . Therapy result ed in a significant decline in all symptoms . The decline was observed with all three doses after 4 weeks of treatment and continued throughout the 6-month study period . CONCLUSION The prevalence of individual menopausal symptoms differed among ethnic groups of Asian women . Within each ethnic group the percentage of women reporting each symptom varied substantially . Symptoms declined after 4 weeks of hormone therapy and thereafter throughout the study . The effect of the lowest dose of CE/MPA ( 0.3/1.5 mg/day ) was comparable to that of the higher doses Objective To evaluate the effects of the tissue selective estrogen complex ( TSEC ) pairing bazedoxifene ( BZA ) with conjugated estrogens ( CE ) on sexual function and quality of life in postmenopausal women . Methods In this 12-week , double-blind , placebo-controlled study , postmenopausal , non-hysterectomized women ( n = 652 ) with symptoms of moderate to severe vulvar/vaginal atrophy were r and omized to once-daily treatment with BZA 20 mg/CE 0.45 or 0.625 mg , BZA 20 mg , or placebo . The Arizona Sexual Experiences ( ASEX ) Scale , Menopause-Specific Quality of Life ( MENQOL ) question naire , and Menopause Symptoms Treatment Satisfaction Question naire ( MS-TSQ ) were secondary measures used to assess the effects of BZA/CE on sexual function , menopausal symptoms , and satisfaction with treatment , respectively . Results At week 12 , both BZA/CE doses were associated with significant improvement in ease of lubrication score from baseline compared with placebo ( p < 0.05 ) on the ASEX scale , although there was no difference in the change in total score . The MENQOL question naire results at week 12 showed significant improvements in vasomotor function , sexual function and total scores with both BZA/CE doses vs. placebo or BZA 20 mg ( p < 0.001 ) . The MS-TSQ results showed that BZA/CE-treated subjects reported significantly greater overall satisfaction with treatment , as well as satisfaction with control of hot flushes during the day and night , effect on quality of sleep , and effect on mood or emotions , compared with subjects treated with placebo or BZA 20 mg ( all p < 0.05 ) . Conclusion Treatment with BZA/CE for 12 weeks was shown to significantly improve sexual function and quality -of-life measures in symptomatic postmenopausal women OBJECTIVE To determine the relation between estrogen replacement therapy and fractures . DESIGN Prospect i ve cohort study . SETTING Four clinical centers in Baltimore County , Maryl and ; Minneapolis , Minnesota ; Portl and , Oregon ; and the Monongahela Valley , Pennsylvania . PARTICIPANTS 9704 ambulatory , nonblack women 65 years of age or older . MEASUREMENTS  Estrogen use , medical history , and anthropometric data  were obtained by question naire , interview , and examination . Appendicular bone mass was measured by single-photon absorptiometry .  Incident fractures were vali date d by radiographic report . RESULTS After adjustment for potential confounders , current estrogen use was associated with a decrease in the risk for wrist fractures ( relative risk [ RR ] , 0.39 ; 95 % CI , 0.24 to 0.64 ) and for all nonspinal fractures ( RR , 0.66 ; CI ,  
    Output:
    