Review for 10.1186/1471-230X-12-47 (2012)

Reviewer's report
Title:Vertebral fractures in patients with inflammatory bowel disease compared
with healthy population
Version: 1Date:16 February 2012
Reviewer: Pal Miheller
Reviewer's report:
Review
Vertebral fractures in patients with inflammatory bowel disease compared with
healthy population
This is a case control study regarding the risk of fractures among IBD patients
compared to healthy controls.
A valuable amount of IBD patients and healthy controls were evaluated with
DEXA and X-ray to find the non-clinical fractures.
1. Major compulsory revisions
Lots of uncommon results and conclusions were provided based on the gained
data. The most important is that risk of fracture is independent form the bone
mineral density and corticosteroid use.
Generally, I feel that these uncommon results should be commented (or
explained, if it is possible) more accurately. I tried to list all of my comments
below.
This study could provide some novel and interesting data on this field, but it
needs a major revision.
In detail:
Abstract:
It would be more favorable to indicate the results as percentages in the result
section of the abstract in my opinion.
I recommend to show the CD/UC/healthy ratio, also.
Major results, like lack of the correlation between fractures and BMD or steroid
use should be confirmed with data in the result section of the abstract.
Hypovitaminosis D was stated to be high as 45% in the abstract, but I have no
found this numerical data in the results section of the manuscript (55.14% was
indicated in the result section of the manuscript).
Methods:
Demographical data are shown in the text, these are repeated in table 1.One of
them is abundant. Ages are indicated as mean and SD, however, there are a
valuable percent of female subjects were postmenopausal in each groups.
Median of age would be more appropriate.
Localization and behavior of the disease should be detailed regarding IBD cases
due to the Montreal classification. Ratio of B3/B3p patients should be indicated.
Short bowel syndrome should be exclusion criteria also.
Term “rheumatic osteoporosis” is not appropriate.
Section “Data complied…. also included” should be joined to the previous one.
Those data are patients data and not methods.
Diagnosis of lactose intolerance is not easy in IBD group. It can be secondary
due to small bowel involvement of the basic disease. Basis of the diagnosis
should be clarified briefly. There was nil patients with lactose intolerance in the
control group. It is hardly imaginable – but depends on the method of the
diagnosis (H2 breathing test or plane clinical data?)
Abbreviations “P-A”, “L” and “T” should be explained.
Sample storage is extremely important regarding measurement of 25-OH D3.
Were the samples measured immediately? If not, the method of the storage
should be signed.
Results:
Forty nine patients with IBD has had a HISTORY of fractures as it is stated. Are
there any clinically manifest fractures? What is the ratio of the clinically manifest
and morphometric fractures in these patients. This is crucial from the viewpoint of
the conclusions.
There was no correlation between fractures and low BMD in this study.
Compressed vertebras may increase the density of the bones, so the net BMD
could be higher. Were the compressed vertebras excluded from the BMD
measurement? This is an other crucial question for the appropriate interpretation
of the results.
DEXA findings of pre-menopausla woman were evaluated separately, but all the
other parameters (fractures, etc.) were calculated in the whole IBD group. It
would be interesting to see those data separately also. Comparison of these data
to pre-menopausal controls should be performed.
Vitamin D level is stated to be “within the normal limits” in the first sentence of
chapter about the biochemical parameters, which contradict the 55.14%
hypovitaminosis stated in the next paragraph.
PCR is CRP? I think it is a miss-spelling - more times in this section.
Osteocalcin is listed in the methods section, but there is no data about it in the
result section.
Discussion
This section is repetition of the previous sections in essence. Authors do not try
to explain, nor comment their novel finding detailed (except effects of
corticosteroid).
Clinical relevance of these novel data should be emphasized. Do the authors
offer to screen IBD patients with X-ray to diagnose the subclinical vertebral
crushes even the DEXA is normal? Do these results influence the DEXA
screening strategy or the anti-osteoporotic therapy?
Table 1:
BMIs unit is not a %, but kg/m2
Ratio of the genders of IBD and control seems to be very different (69/38 vs.
21/30), however it is signed to be not significant statistically. It should be
recalculated.
2. Minor compulsory revisions:
The english language of the manuscript needs correction. E.g.: „pathological
population” is not a conventional term;
There are some abundant repetition of words and sentences, these should be
canceled.
Abbreviations are not used consequently: E.g. Fx was signed as fracture, but it
was not used, but others, like CRP were used inconsequential also.
Level of interest: An article of importance in its field
Quality of written English: Not suitable for publication unless extensively edited
Statistical review: No, the manuscript does not need to be seen by a
statistician.
Declaration of competing interests:
I declare I have no competing interests.