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: Background Adherence to anti-osteoporosis treatments is poor , exposing treated women to increased fracture risk . Determinants of poor adherence are poorly understood . The study aims to determine physician- and patient- rated treatment compliance with osteoporosis treatments and to evaluate factors influencing compliance . Methods This was an observational , cross-sectional pharmacoepidemiological study with a r and omly-selected sample of 420 GPs , 154 rheumatologists and 110 gynaecologists practicing in France . Investigators included post-menopausal women with a diagnosis of osteoporosis and a treatment initiated in the previous six months . Investigators completed a question naire on clinical features , treatments and medical history , and on patient compliance . Patients completed a question naire on sociodemographic features , lifestyle , attitudes and knowledge about osteoporosis , treatment compliance , treatment satisfaction and quality of life .  Treatment compliance was evaluated with the  Morisky Medication-taking Adherence Scale . Variables collected in the question naires were evaluated for association with compliance using multivariate logistic regression analysis . Results 785 women were evaluated . Physicians considered 95.4 % of the sample to be compliant , but only 65.5 % of women considered themselves compliant . The correlation between patient and physician perceptions of compliance was low ( κ : 0.11 [ 95 % CI : 0.06 to 0.16 ] ) . Patient-rated compliance was highest for monthly bisphosphonates ( 79.7 % ) and lowest for hormone substitution therapy ( 50.0 % ) . Six variables were associated with compliance : treatment administration frequency , perceptions of long-term treatment acceptability , perceptions of health consequences of osteoporosis , perceptions of knowledge about osteoporosis , exercise and mental quality of life . Conclusion Compliance to anti-osteoporosis treatments is poor . Reduction of dosing regimen frequency and patient education may be useful ways of improving compliance Introduction : Specific pharmacological treatment reduces the incidence of fractures significantly in patients with osteoporosis . Unfortunately , compliance with such therapy is low in clinical practice and is inversely related to educational level . We hypothesized that patients '  knowledge of osteoporosis may be increased by a group-based multidisciplinary education programme . Methods : Three hundred patients , aged 45—81 years , recently diagnosed with osteoporosis and started on specific treatment  , were r and omized to either the " school ' ' or " control ' ' group . Teaching was performed by nurses , physiotherapists , dieticians , and doctors , and design ed to increase the patient 's empowerment . The patient 's knowledge of osteoporosis was tested at study entry and at 3 months using a vali date d question naire . Results : At study entry , no differences in age or score ( 22 ( 18—24 ) ( median ( 25—75 percentiles ) ) vs. 22 ( 18—24 ) ) were seen between the school and control groups . The change in knowledge during the study , however , differed significantly between the two groups ( p<0.001 ) . In the school group , the increase in knowledge score correlated inversely with the level of education ; that is , the lower the education level , the higher the gain in knowledge during the course ( Rho=-0.25 , p<0.01 ) . Conclusions : A group-based multidisciplinary education programme significantly increases patients ' knowledge of the disease Summary European observational 1-year study assessed osteoporosis and fracture patterns in 3,402 postmenopausal women prescribed osteoporosis medication .  Almost 40 % of patients had a previous fracture , while 25 % had neither fracture nor dual energy X-ray absorptiometry ( DXA ) diagnosis and were prescribed medication , probably due to other risk factors . Introduction This analysis assessed osteoporosis and fracture prevalence in postmenopausal women prescribed osteoporosis treatment in the Prospect i ve Observational Study Investigating Bone Loss Experience in Europe(POSSIBLE EU ® ) . Methods Women in this observational , multicenter 1-year study were categorized by fracture history and location at baseline . Baseline characteristics were analyzed according to no DXA and DXA diagnosis ( osteoporosis or osteopenia ) . Fractures occurring during the 1-year follow-up period were recorded . Results Of the 3,402 women enrolled , 39 % had a previous fracture , of whom 30 % had ≥2 fractures . One thous and seven hundred and eighty-four ( 52 % ) patients had a DXA diagnosis ( osteoporosis 68 % , osteopenia 31 % , and unknown 1 % ) . Among the osteoporosis patients , 37 % had a previous fracture ( hip 2.9 % , vertebral 8.8 % , and non-hip , non-vertebral 25 % ) and 35 % had fractures associated with major trauma . Of the 3,402 women , 1,476 ( 43 % ) had no DXA diagnosis ; of these , 57 % had no fracture ( 25 % of all women ) . Risk factors varied across patients with and without DXA diagnosis . During the 1-year follow-up period , the fracture incidence in patients with or without a previous fracture at baseline was 4.7 % and 1.6 % , respectively . Conclusion Almost 40 % of patients prescribed osteoporosis medication had a previous fracture , highlighting a population with advanced disease . In contrast , 25 % of patients had neither a previous fracture nor DXA diagnosis and were prescribed treatment , probably due to other risk factors . There is a need for continued improvement of disease management in European women Background Osteoporosis-related fractures are a significant public health concern . Interventions that increase detection and treatment of osteoporosis are underutilized . This pragmatic r and omised study was done to evaluate the impact of a multifaceted community-based care program aim ed at optimizing evidence -based management in patients at risk for osteoporosis and fractures . Methods This was a 12-month r and omized trial performed in Ontario , Canada . Eligible patients were community-dwelling , aged ≥55 years , and identified to be at risk for osteoporosis-related fractures . Two hundred and one patients were allocated to the intervention group or to usual care . Components of the intervention were directed towards primary care physicians and patients and included facilitated bone mineral density testing , patient education and patient-specific recommendations for osteoporosis treatment . The primary outcome was the implementation of appropriate osteoporosis management . Results 101 patients were allocated to intervention and 100 to control . Mean age of participants was 71.9 ± 7.2 years and 94 % were women . Pharmacological treatment ( alendronate , risedronate , or raloxifene ) for osteoporosis was increased by 29 % compared to usual care ( 56 % [ 29/52 ] vs. 27 % [ 16/60 ] ; relative risk [ RR ] 2.09 , 95 % confidence interval [ CI ] 1.29 to 3.40 ) . More individuals in the intervention group were taking calcium ( 54 % [ 54/101 ] vs. 20 % [ 20/100 ] ; RR 2.67 , 95 % CI 1.74 to 4.12 ) and vitamin D ( 33 % [ 33/101 ] vs. 20 % [ 20/100 ] ; RR 1.63 , 95 % CI 1.01 to 2.65 ) . Conclusions A multi-faceted community-based intervention improved management of osteoporosis in high risk patients compared with usual care . Trial Registration This trial has been registered with clinical trials.gov ( ID : NCT00465387 Alp A , Kanat E , Yurtkuran M : Efficacy of a self-management program for osteoporotic subjects . Am J Phys Med Rehabil 2007;86:633–640 . Objective : This study is based on whether the self-management program choices For Better Bone Health is effective to promote behavioral strategies for improving bone health , life quality , pain perception , physical function , and balance in osteoporotic subjects . Design : In this single-blind , r and omized controlled study , a total of 50 sedentary women with postmenopausal and idiopathic osteoporosis were selected from the out patients of Atatürk Balneotherapy and Rehabilitation Center according to their physical activity level and T scores of dual-energy x-ray absorptiometry as the inclusion criteria . Fifty sedentary women with BMD T scores of −2.5 or lower were r and omized into two groups ( self-management group : group 1 ; and control group : group 2 ) and enrolled in a 6-mo study . Participants attended self-management class once a week for 5 wks . Evaluations were done at baseline , at the end of the fifth week , and at the sixth month . Pain-intensity evaluation by Visual Analogue Scale ( VAS ) , life- quality assessment s by SF-36 , balance testing by Sensitized Romberg Test ( SRT ) , and functional assessment by Timed Sit to St and test ( TSS ) and a simple question naire were the outcome measures . Results : When the groups were compared by change scores and percentages of change , improvements observed in pain intensity by VAS ( P < 0.001 ) , SF-36 Physical Function ( P < 0.001 ) , SF-36 Physical Role Limitations ( P < 0.001 ) , SF-36 Social Function ( P < 0.001 ) , SF-36 Mental Health ( P < 0.001 ) , SF-36 Vitality ( P < 0.01 ) , SF-36 Pain ( P < 0.001 ) , SF-36 General Health Perceptions ( P < 0.05 ) , SF-36 Emotional Role Limitations ( P < 0.01 ) , SRT eyes open ( P < 0.001 ) , SRT eyes closed ( P < 0.001 ) , and TSS ( P < 0.001 ) were determined to be superior in group 1 at the end of the sixth month . Seventy-four percent of patients in group 1 engaged in regular physical activities , and 92 % of them declared that they understood the purpose and benefits of medications and  dietary calcium intake . Fifty-seven percent of them formed personal plans for preventing traumas , whereas 8 % of the subjects in group 2 experienced new falls but no fractures . Conclusion : It is determined that the self-management class led to improvements in functional , balance , and life- quality outcomes and to reductions in pain perception Adequate reporting of r and omized , controlled trials ( RCTs ) is necessary to allow accurate critical appraisal of the validity and applicability of the results . The CONSORT ( Consoli date d St and ards of Reporting Trials ) Statement , a 22-item checklist and flow diagram , is intended to address this problem by improving the reporting of RCTs . However , some specific issues that apply to trials of nonpharmacologic treatments ( for example , surgery , technical interventions , devices , rehabilitation , psychotherapy , and behavioral intervention ) are not specifically addressed in the CONSORT Statement . Furthermore , considerable evidence suggests that the reporting of nonpharmacologic trials still needs improvement . Therefore , the CONSORT group developed an extension of the CONSORT Statement for trials assessing nonpharmacologic treatments . A consensus meeting of 33 experts was organized in Paris , France , in February 2006 , to develop an extension of the CONSORT Statement for trials of nonpharmacologic treatments . The participants extended 11 items from the CONSORT Statement , added 1 item , and developed a modified flow diagram . To allow adequate underst and ing and implementation of the CONSORT extension , the CONSORT group developed this elaboration and explanation document from a review of the literature to provide examples of adequate reporting . This extension , in conjunction with the main CONSORT Statement and other CONSORT extensions , should help to improve the reporting of RCTs performed in this field Objective To assess whether osteoporosis education , with and without bone mineral density ( BMD ) testing , increases the initiation of lifestyle changes and pharmaceutical treatment to prevent osteoporosis . Design A total of 508 women , aged 54–65 , from a large managed care organization who were not on osteoporosis prevention therapy participated in an intervention study . Participants were r and omly assigned to either an education class on osteoporosis ( n = 301 ) or education plus BMD ( n = 207 ) . A control group of 187 women receiving no intervention were also surveyed to serve as comparison . Group differences and differences based on BMD test result were compared 6 months after education regarding self-reported changes in health behaviors using & khgr;2 tests and logistic regression analyses . Results Of the 508 intervention participants , 455 ( 90 % ) responded to the follow-up survey . Initiation of hormone replacement therapy was reported by 9 % , with 5 % reporting starting alendronate . More than half reported changes in diet , exercise , or calcium intake . Forty-three percent increased their vitamin D intake . There were no significant group differences in behavior except with regard to pharmaceutical therapy ; subjects with education plus BMD were three times more likely than those receiving education only to report starting hormone replacement therapy ( p = 0.004 ) . Low BMD scores were associated with increasing vitamin D intake ( p = 0.03 ) and starting medication ( p = 0.001 ) . Women in the intervention groups were significantly more likely to report modifying their diet ( p < 
    Output:
    
agent
Conclusions This review indicates that it is still unclear whether patient education is beneficial and whether it has a significant and clinical ly relevant impact on osteoporosis management results .
***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: Background Adherence to anti-osteoporosis treatments is poor , exposing treated women to increased fracture risk . Determinants of poor adherence are poorly understood . The study aims to determine physician- and patient- rated treatment compliance with osteoporosis treatments and to evaluate factors influencing compliance . Methods This was an observational , cross-sectional pharmacoepidemiological study with a r and omly-selected sample of 420 GPs , 154 rheumatologists and 110 gynaecologists practicing in France . Investigators included post-menopausal women with a diagnosis of osteoporosis and a treatment initiated in the previous six months . Investigators completed a question naire on clinical features , treatments and medical history , and on patient compliance . Patients completed a question naire on sociodemographic features , lifestyle , attitudes and knowledge about osteoporosis , treatment compliance , treatment satisfaction and quality of life .  Treatment compliance was evaluated with the  Morisky Medication-taking Adherence Scale . Variables collected in the question naires were evaluated for association with compliance using multivariate logistic regression analysis . Results 785 women were evaluated . Physicians considered 95.4 % of the sample to be compliant , but only 65.5 % of women considered themselves compliant . The correlation between patient and physician perceptions of compliance was low ( κ : 0.11 [ 95 % CI : 0.06 to 0.16 ] ) . Patient-rated compliance was highest for monthly bisphosphonates ( 79.7 % ) and lowest for hormone substitution therapy ( 50.0 % ) . Six variables were associated with compliance : treatment administration frequency , perceptions of long-term treatment acceptability , perceptions of health consequences of osteoporosis , perceptions of knowledge about osteoporosis , exercise and mental quality of life . Conclusion Compliance to anti-osteoporosis treatments is poor . Reduction of dosing regimen frequency and patient education may be useful ways of improving compliance Introduction : Specific pharmacological treatment reduces the incidence of fractures significantly in patients with osteoporosis . Unfortunately , compliance with such therapy is low in clinical practice and is inversely related to educational level . We hypothesized that patients '  knowledge of osteoporosis may be increased by a group-based multidisciplinary education programme . Methods : Three hundred patients , aged 45—81 years , recently diagnosed with osteoporosis and started on specific treatment  , were r and omized to either the " school ' ' or " control ' ' group . Teaching was performed by nurses , physiotherapists , dieticians , and doctors , and design ed to increase the patient 's empowerment . The patient 's knowledge of osteoporosis was tested at study entry and at 3 months using a vali date d question naire . Results : At study entry , no differences in age or score ( 22 ( 18—24 ) ( median ( 25—75 percentiles ) ) vs. 22 ( 18—24 ) ) were seen between the school and control groups . The change in knowledge during the study , however , differed significantly between the two groups ( p<0.001 ) . In the school group , the increase in knowledge score correlated inversely with the level of education ; that is , the lower the education level , the higher the gain in knowledge during the course ( Rho=-0.25 , p<0.01 ) . Conclusions : A group-based multidisciplinary education programme significantly increases patients ' knowledge of the disease Summary European observational 1-year study assessed osteoporosis and fracture patterns in 3,402 postmenopausal women prescribed osteoporosis medication .  Almost 40 % of patients had a previous fracture , while 25 % had neither fracture nor dual energy X-ray absorptiometry ( DXA ) diagnosis and were prescribed medication , probably due to other risk factors . Introduction This analysis assessed osteoporosis and fracture prevalence in postmenopausal women prescribed osteoporosis treatment in the Prospect i ve Observational Study Investigating Bone Loss Experience in Europe(POSSIBLE EU ® ) . Methods Women in this observational , multicenter 1-year study were categorized by fracture history and location at baseline . Baseline characteristics were analyzed according to no DXA and DXA diagnosis ( osteoporosis or osteopenia ) . Fractures occurring during the 1-year follow-up period were recorded . Results Of the 3,402 women enrolled , 39 % had a previous fracture , of whom 30 % had ≥2 fractures . One thous and seven hundred and eighty-four ( 52 % ) patients had a DXA diagnosis ( osteoporosis 68 % , osteopenia 31 % , and unknown 1 % ) . Among the osteoporosis patients , 37 % had a previous fracture ( hip 2.9 % , vertebral 8.8 % , and non-hip , non-vertebral 25 % ) and 35 % had fractures associated with major trauma . Of the 3,402 women , 1,476 ( 43 % ) had no DXA diagnosis ; of these , 57 % had no fracture ( 25 % of all women ) . Risk factors varied across patients with and without DXA diagnosis . During the 1-year follow-up period , the fracture incidence in patients with or without a previous fracture at baseline was 4.7 % and 1.6 % , respectively . Conclusion Almost 40 % of patients prescribed osteoporosis medication had a previous fracture , highlighting a population with advanced disease . In contrast , 25 % of patients had neither a previous fracture nor DXA diagnosis and were prescribed treatment , probably due to other risk factors . There is a need for continued improvement of disease management in European women Background Osteoporosis-related fractures are a significant public health concern . Interventions that increase detection and treatment of osteoporosis are underutilized . This pragmatic r and omised study was done to evaluate the impact of a multifaceted community-based care program aim ed at optimizing evidence -based management in patients at risk for osteoporosis and fractures . Methods This was a 12-month r and omized trial performed in Ontario , Canada . Eligible patients were community-dwelling , aged ≥55 years , and identified to be at risk for osteoporosis-related fractures . Two hundred and one patients were allocated to the intervention group or to usual care . Components of the intervention were directed towards primary care physicians and patients and included facilitated bone mineral density testing , patient education and patient-specific recommendations for osteoporosis treatment . The primary outcome was the implementation of appropriate osteoporosis management . Results 101 patients were allocated to intervention and 100 to control . Mean age of participants was 71.9 ± 7.2 years and 94 % were women . Pharmacological treatment ( alendronate , risedronate , or raloxifene ) for osteoporosis was increased by 29 % compared to usual care ( 56 % [ 29/52 ] vs. 27 % [ 16/60 ] ; relative risk [ RR ] 2.09 , 95 % confidence interval [ CI ] 1.29 to 3.40 ) . More individuals in the intervention group were taking calcium ( 54 % [ 54/101 ] vs. 20 % [ 20/100 ] ; RR 2.67 , 95 % CI 1.74 to 4.12 ) and vitamin D ( 33 % [ 33/101 ] vs. 20 % [ 20/100 ] ; RR 1.63 , 95 % CI 1.01 to 2.65 ) . Conclusions A multi-faceted community-based intervention improved management of osteoporosis in high risk patients compared with usual care . Trial Registration This trial has been registered with clinical trials.gov ( ID : NCT00465387 Alp A , Kanat E , Yurtkuran M : Efficacy of a self-management program for osteoporotic subjects . Am J Phys Med Rehabil 2007;86:633–640 . Objective : This study is based on whether the self-management program choices For Better Bone Health is effective to promote behavioral strategies for improving bone health , life quality , pain perception , physical function , and balance in osteoporotic subjects . Design : In this single-blind , r and omized controlled study , a total of 50 sedentary women with postmenopausal and idiopathic osteoporosis were selected from the out patients of Atatürk Balneotherapy and Rehabilitation Center according to their physical activity level and T scores of dual-energy x-ray absorptiometry as the inclusion criteria . Fifty sedentary women with BMD T scores of −2.5 or lower were r and omized into two groups ( self-management group : group 1 ; and control group : group 2 ) and enrolled in a 6-mo study . Participants attended self-management class once a week for 5 wks . Evaluations were done at baseline , at the end of the fifth week , and at the sixth month . Pain-intensity evaluation by Visual Analogue Scale ( VAS ) , life- quality assessment s by SF-36 , balance testing by Sensitized Romberg Test ( SRT ) , and functional assessment by Timed Sit to St and test ( TSS ) and a simple question naire were the outcome measures . Results : When the groups were compared by change scores and percentages of change , improvements observed in pain intensity by VAS ( P < 0.001 ) , SF-36 Physical Function ( P < 0.001 ) , SF-36 Physical Role Limitations ( P < 0.001 ) , SF-36 Social Function ( P < 0.001 ) , SF-36 Mental Health ( P < 0.001 ) , SF-36 Vitality ( P < 0.01 ) , SF-36 Pain ( P < 0.001 ) , SF-36 General Health Perceptions ( P < 0.05 ) , SF-36 Emotional Role Limitations ( P < 0.01 ) , SRT eyes open ( P < 0.001 ) , SRT eyes closed ( P < 0.001 ) , and TSS ( P < 0.001 ) were determined to be superior in group 1 at the end of the sixth month . Seventy-four percent of patients in group 1 engaged in regular physical activities , and 92 % of them declared that they understood the purpose and benefits of medications and  dietary calcium intake . Fifty-seven percent of them formed personal plans for preventing traumas , whereas 8 % of the subjects in group 2 experienced new falls but no fractures . Conclusion : It is determined that the self-management class led to improvements in functional , balance , and life- quality outcomes and to reductions in pain perception Adequate reporting of r and omized , controlled trials ( RCTs ) is necessary to allow accurate critical appraisal of the validity and applicability of the results . The CONSORT ( Consoli date d St and ards of Reporting Trials ) Statement , a 22-item checklist and flow diagram , is intended to address this problem by improving the reporting of RCTs . However , some specific issues that apply to trials of nonpharmacologic treatments ( for example , surgery , technical interventions , devices , rehabilitation , psychotherapy , and behavioral intervention ) are not specifically addressed in the CONSORT Statement . Furthermore , considerable evidence suggests that the reporting of nonpharmacologic trials still needs improvement . Therefore , the CONSORT group developed an extension of the CONSORT Statement for trials assessing nonpharmacologic treatments . A consensus meeting of 33 experts was organized in Paris , France , in February 2006 , to develop an extension of the CONSORT Statement for trials of nonpharmacologic treatments . The participants extended 11 items from the CONSORT Statement , added 1 item , and developed a modified flow diagram . To allow adequate underst and ing and implementation of the CONSORT extension , the CONSORT group developed this elaboration and explanation document from a review of the literature to provide examples of adequate reporting . This extension , in conjunction with the main CONSORT Statement and other CONSORT extensions , should help to improve the reporting of RCTs performed in this field Objective To assess whether osteoporosis education , with and without bone mineral density ( BMD ) testing , increases the initiation of lifestyle changes and pharmaceutical treatment to prevent osteoporosis . Design A total of 508 women , aged 54–65 , from a large managed care organization who were not on osteoporosis prevention therapy participated in an intervention study . Participants were r and omly assigned to either an education class on osteoporosis ( n = 301 ) or education plus BMD ( n = 207 ) . A control group of 187 women receiving no intervention were also surveyed to serve as comparison . Group differences and differences based on BMD test result were compared 6 months after education regarding self-reported changes in health behaviors using & khgr;2 tests and logistic regression analyses . Results Of the 508 intervention participants , 455 ( 90 % ) responded to the follow-up survey . Initiation of hormone replacement therapy was reported by 9 % , with 5 % reporting starting alendronate . More than half reported changes in diet , exercise , or calcium intake . Forty-three percent increased their vitamin D intake . There were no significant group differences in behavior except with regard to pharmaceutical therapy ; subjects with education plus BMD were three times more likely than those receiving education only to report starting hormone replacement therapy ( p = 0.004 ) . Low BMD scores were associated with increasing vitamin D intake ( p = 0.03 ) and starting medication ( p = 0.001 ) . Women in the intervention groups were significantly more likely to report modifying their diet ( p < 
    Output:
    