Title: The Lower Basal Metabolic Rate is Associated with Increased Risk of Osteosarcopenia
in Postmenopausal Women
Version: 1 Date: 01 Mar 2022
Reviewer's report:
Thank you for the work you put into this study and manuscript entitled “The Lower Basal
Metabolic Rate is Associated with Increased Risk of Osteosarcopenia in Postmenopausal
Women”.  Please see my comments below.
Abstract
1. In methods, you considered 305 postmenopausal women; but some adjusting variables had
less than 305 observations (25 (OH) D (ng/mL)) when you model the outcome. So, the total
sample was not considered for the association you are interested in. I suggest changing the
sample size to the one used for the association analysis, or not considering variables with
incomplete data. In addition, age and menopausal age were not mentioned as confounding
variables in this section.
2. You concluded that low BMR might be a predictor for concordance of osteoporosis and
sarcopenia. The cross-sectional study design does not allow the conclusion that it could be a
predictor. It could provide evidence to strengthen the hypothesis that low BMR may be an early
predictor of osteosarcopenia in postmenopausal women.
Background
1) In general, the background is clear and introduces the contents that will be discussed later;
however, it needs to review more about what is known between BMR and osteosarcopenia.
In particular because it was the factor that was found to be associated with the highest risk of
osteosarcopenia.
Methods
1) To improve the comprehensibility of the results, it would be interesting to add a flow chart
of the sample. At the very least, explain the reason for the losses and the differences in sample
size between the 488 participants previously reported and the current one.
2) It is unclear which multivariate model was used to consider common risk factors for both
disorders. If logistic regression (outcome: osteosarcopenia (yes/no)) or multiple linear regression
was performed (outcome: muscle mass and bone density in lumbar spine and hip), it is essential
to report the resulting model (the association with the 95% confidence interval). In addition,
explain the method of inclusion of the adjustment variables in the final model. It is also important
to mention if the goodness-of-fit test was performed and the result of the test. Finally, report
whether odds ratios were calculated as a measure of risk for osteosarcopenia.
3) It is suggested that a statistician review the association model.
Results
It seems that only correlations were made between the variables and not models to measure the
association.
Discussion
1) Under the previously published article [ref. 9], women with a history of smoking or
alcohol consumption were excluded from the study. Moreover, it is well known that smoking
significantly increases the risk of developing sarcopenia. So, the authors should indicate that the
results of this study only consider women without a history of smoking.
Tables
S1. Review the reported observations number. For example:
1) Osteopenia (N=158) but Vitamin D supplement reports 37/160.
2) The number of participants with physical activity data was 305. However, when adding the
number of each category (normal=82, osteopenia=149, and osteoporosis=61), the result is 292.
T1.  The parametric and nonparametric tests performed are not detailed and are mentioned at
the end of Table 1.