osteoporosis is a common metabolic disease in the elderly and is closely associated with 
 patient age .
recent studies have shown that an age - related decrease in intestinal calcium 
 absorption is closely related to senile osteoporosis and bone loss1 .
a lack of exercise among the elderly is also an important 
 factor in promoting osteoporosis2 .
here we 
 report on the beneficial effects of a combination of aerobic exercise and raloxifene therapy 
 for patients with senile osteoporosis .
this study included 70 elderly patients with osteoporosis treated at our hospital between 
 april 2013 and august 2014 . patients with renal disease , liver disease , and secondary 
 osteoporosis ; those who had not visited a doctor in 3 months ; and those taking drugs known 
 to affect bone metabolism were excluded . patients were divided into observation and control 
 groups according to the treatment received ( n=35 for each group ) .
the control group included 
 24 female and 11 male patients , with a mean age of 64.7  3.2  years ( range , 5176  years ) . 

the control group included 12 female and 23 male patients , with a mean age of 65.3  
 4.1  years ( range , 5078  years ) .
both patient groups would normally be prescribed a chewable d2 calcium hydrogen phosphate 
 tablet ( guangxi wuzhou pharmaceutical group co. , ltd . ; approval h45021454 , 2010 - 09 - 20 ) once 
 per day .
the control group patients were also prescribed 60  mg raloxifene hydrochloride 
 ( spanish eli lilly nederland b.v .
; registration card number h20120499 , 2012 - 11 - 29 ) once per 
 day .
patients 
 were offered choices among tai chi , walking , jogging , running , and sports .
the exercise 
 intensity was advised to be based on patient tolerance . with increasing patient fitness
, the 
 workout was gradually increased to a duration of approximately 30 minutes , distance of 
 approximately 3  km , or tai chi duration of approximately 30 minutes3 .
data included : 1 ) bone mineral density measurements , including the lumbar spine 
 ( l2l4 intervertebral ) and proximal femur ; 2 ) serum calcitonin levels measured using 
 commercial bone gla protein ( bgp ) kits ( metra , usa ) based on an enzyme - linked immunosorbent 
 assay ( elisa ) method ; and 3 ) urine pyridine / creatinine ratios ( u - pyd / cr ) , with urine 
 pyridine and cr measured using elisa pyd and a biochemical method , respectively ( metra , 
 usa ) . in this study ,
the data were collected and processed by personnel of a specialized data 
 processing center to ensure authenticity and appropriate scientific technique4 .
ibm spss 
 statistics for windows , version 22.0 ( armonk , ny , usa ) was used to analyze bone mineral 
 density , resorption , and formation data using student s t - test ; values of p<0.05 were 
 considered statistically significant5 .
patients in both groups showed varying degrees of improved bone mineral density after 
 treatment ( table 1table 1.comparison of pre- and post - treatment bone density changes between the 
 observation and control groups ( n ; g / m)groupnumber of casesl2l4proximal femurbefore treatmentafter treatmentbefore treatmentafter treatmentobservation 350.80  0.090.92  0.11 * 0.61  0.090.66  0.10*control 350.78  0.080.83  0.100.60  0.080.61  0.09*differences were statistically significant ( p<0.05 ) . and fig . 1fig .
( b ) hematoxylin and eosin ( he ) staining of a sample of 
 the normal lumbar spine ( 300  300 ) ; ( c ) lumbar spine x - ray slice representative of 
 the observation group ( arrow , osteoporosis ) ; ( d ) he staining of a representative 
 observation group sample ( 300  200 ) ; ( e ) representative x - ray film of the lumbar 
 spine of the control group ; ( f ) he - stained sample representative of the control group 
 ( 300  400 ) . ) .
( b ) hematoxylin and eosin ( he ) staining of a sample of 
 the normal lumbar spine ( 300  300 ) ; ( c ) lumbar spine x - ray slice representative of 
 the observation group ( arrow , osteoporosis ) ; ( d ) he staining of a representative 
 observation group sample ( 300  200 ) ; ( e ) representative x - ray film of the lumbar 
 spine of the control group ; ( f ) he - stained sample representative of the control group 
 ( 300  400 ) .
u - pyd / cr was significantly decreased and serum calcitonin level was significantly increased 
 in the observation group ( table 2table 2.comparison of the pre- versus post - treatment u - pyd / cr ratio and bgp level in the 
 observation and control groups ( n ;  nm / mm ; ng / ml)groupnu - pyd / crbgpbefore treatmentafter treatmentbefore treatmentafter treatmentobservation 3538.5  3.923.1  2.7 * 1.8  0.35.7  0.4*control 3537.5  3.136.9  3.11.8  0.34.9  0.4u - pyd / cr : urine pyridine / creatinine ratios ; bgp : bone gla protein .
u - pyd / cr : urine pyridine / creatinine ratios ; bgp : bone gla protein .
osteoporosis is caused by a variety of factors related to bone strength , including bone 
 mineral density and quality as well as microstructural damage . increased osteopsathyrosis 
 results in easy bone fracture6,7,8 .
primary osteoporosis can be classified as postmenopausal ( pmop ; type 
 i ) , senile ( type ii ) , or idiopathic ( also seen in teenagers ) .
pmop typically occurs 
 510  years after menopause ; senile osteoporosis generally refers to osteoporosis in older 
 men aged > 70  years ; and idiopathic osteoporosis , while known to occur mainly in 
 adolescents , has unknown etiology .
pmop occurs mainly due to decreasing estrogen levels , 
 which increases bone conversion and absorption , causes trabecular bone perforation and 
 rupture , and increases osteopsathyrosis , with a loss of mainly cancellous bone9 .
senile osteoporosis is associated with 
 oxidative stress ; it is characterized by increased rheological bone loss and reduced bone 
 cell and osteoblast function .
because osteoclast function is normal or reduced , bone resorption may not be 
 active ; therefore , cortical bone loss is slightly greater than cancellous bone loss .
senile osteoporosis has direct reference to the age of patients with primary osteoporosis , 
 who may have various types of osteoporosis concurrently10 .
for example , a female osteoporosis patient who is 65  years of age 
 may have idiopathic osteoporosis or pmop based on age , previous treatment for postmenopausal 
 osteoporosis , and bone transformation condition .
if osteoporosis had previously been under 
 control , senile osteoporosis would be the most likely diagnosis or at least given priority . 

similarly , a single male patient > 65  years with senile osteoporosis may have a history of 
 cured idiopathic juvenile osteoporosis .
osteoporosis is a common chronic disease , ranking sixth among causes of morbidity and 
 mortality in the elderly11,12,13 . 

osteoporosis - related fracture outranked the incidence of stroke , heart attack , and all 
 breast cancers from 2004 to 2006 .
a woman s lifetime risk of osteoporotic fracture is higher 
 than that of breast cancer , endometrial cancer , and ovarian cancer combined . in men , the 
 risk of osteoporotic fracture is greater than the risk of prostate cancer .
as this is a 
 common and dangerous disease in the elderly , clinicians should attach great importance to 
 the diagnosis and treatment of osteoporosis .
therefore , clinicians should strive for early screening , 
 prevention , diagnosis , and treatment .
the ultimate goals of osteoporosis prevention and treatment are to reduce the occurrence of 
 osteoporosis fracture and improve quality of life in the elderly .
doctor and 
 patient awareness of osteoporosis degree are insufficient , as bone hydrophobic pine disease 
 is underdiagnosed , treatment rates are low , and adequate treatment is often not completed . 
 additionally , osteoporosis fracture is correlated with no prior treatment for 
 osteoporosis14 .
a retrospective study in the united states reported 300 fractures in 
 > 50 women , more than half of whom did not receive anti - osteoporosis treatment .
a women s 
 community survey of another 60 patients with > 165 recent hip fractures found that only 
 13% of patients received sufficient osteoporosis treatment in accordance with the guidelines 
 of the international osteoporosis foundation : 47% of women were insufficiently treated and 
 40% received no treatment .
assessment of male osteoporosis patients after fracture revealed 
 a lower probability of prior osteoporosis treatment .
current clinical research on osteoporosis treatments tends to compare the curative effects 
 of single drugs and observe the effects of drug treatments combined with aerobic exercise . 

the diagnosis and treatment of primary osteoporosis guide ( 2011 ) , from a branch of the 
 chinese medical association of osteoporosis and bone mineral salt disease , advises against 
 treating osteoporosis simultaneously with bone formation promoters and bone resorption 
 inhibitors that use the same mechanism of action15 .
however , existing studies have shown that compared with the use of 
 a single drug , a combination of two kinds of bone resorption inhibitors can significantly 
 improve bone absorption , which in turn significantly increases bone mineral density16 . a complementary decrease in fracture 
 risk , however , is yet to be confirmed .
raloxifene belongs to a category of selective estrogen regulators that interfere with some 
 aspects of estrogen activity and thereby simulate other functions .
the minimum concentration is 60% ; it has a bioavailability of 
 2% and a plasma half - life of approximately 27.7 hours17 .
a number of clinical studies have shown that raloxifene has an 
 obvious preventive effect on postmenopausal osteoporosis since it can supplement estrogen 
 levels in patients to improve bone density18 .
the current study shows that raloxifene treatment well before the 
 bone mineral density in the treatment of patients with l2l4 ( 0.780.08 ) for 
 g / m , after treatment for ( 0.83 + 0.10  g / m , change obviously before 
 and after treatment .
previous research has demonstrated the curative effects of raloxifene 
 for the treatment of senile osteoporosis , which resulted in improved patient bone density . 

aerobic exercise , also referred to as green therapy , can 
 achieve results beyond what drug treatment alone can achieve .
regular , systemic , and 
 feasible aerobic exercise can maintain nerve cell integrity and accelerate lipid metabolism . 

long - term regular aerobic exercise can reduce the incidence of viscera - related diseases and 
 improve physical and mental health in the elderly20 . in the current study ,
the observation and control groups differed significantly in lumbar 
 spine and femoral bone mineral density levels after treatment ( p<0.05 ) .
these results 
 confirmed that combined treatment with raloxifene and aerobic exercise can significantly 
 improve bone mineral density in patients with senile osteoporosis .
as shown in table 2 , u - pyd / cr differed significantly between the 
 two groups ( p<0.01 ) , while bgp measurements in the observation group were significantly 
 higher than those in the control group ( p<0.01 ) .
these findings confirmed that raloxifene 
 and aerobic exercise combined can reduce bone absorption rate and promote bone 
 formation .
in conclusion , a combination of raloxifene and aerobic exercise in patients with senile 
 osteoporosis can significantly improve bone mineral density and promote physical and mental 
 health .
 [ purpose ] this study assessed the effects of combined application of raloxifene and 
 aerobic exercise on senile osteoporosis . [ subjects and methods ] a total of 70 elderly 
 patients with osteoporosis , who treated at our hospital between april 2013 and august 
 2014 , were divided into equal - sized observation and control groups . 
 the control group was 
 administered raloxifene , whereas the observation group received raloxifene treatment plus 
 aerobic exercise . 
 [ results ] outpatient outcomes were considered dependent variables . 
 after 
 treatment , the two groups differed significantly in terms of lumbar spine ( l2l4 ) and 
 proximal femoral bone mineral density . 
 the urine pyridine / creatinine ratio decreased 
 significantly and serum calcitonin level increased significantly in the observation group . 
 
 these differences were statistically significant . 
 [ conclusion ] raloxifene combined with 
 aerobic exercise therapy significantly improves bone density and promotes bone formation 
 in patients with senile osteoporosis . 
INTRODUCTION
SUBJECTS AND METHODS
RESULTS
DISCUSSION