Title: Risk factors of primary and recurrent fractures in postmenopausal osteoporotic Chinese
patients: A retrospective analysis study
Version: 0 Date: 21 Jul 2022
Reviewer:  Raid M. Al-ani
Reviewer's report:
Dear Authors,
Thank you for conducting this interesting study entitled "Analysis of related factors of primary
and recurrent fractures in postmenopausal osteoporotic patients: A Retrospective Study" for
possible publication in the esteemed journal "BMC Women's Health". The following comments
need to be addressed to improve the presentation of the article:
1. Minor editing and language corrections are needed.
2. Title: It is not supported by the methods in the abstract and the text."
3. Abstract:
a. You should start the abstract with a background.
b. It is necessary to mention the design of the study in the materials and methods subheading.
c. Please avoid the numbering process in the results section.
d. Other modifications are needed according to the notes in the main file.
4. Introduction:
a. You missed the title of this section.
b. The challenging part of the introduction is deficient. Please, give an overview of your project
clearly and rationally. What do you want to fill in the gap in the knowledge?.
c. This sentence "In this study, we selected patients with PMOP who were diagnosed at Shanghai
General Hospital from January 2007 to December 2016 as the subjects of this study and made
a first systematic and comprehensive retrospective analysis of the similarities and differences
in clinical characteristics, comorbidities, and bone mineral density and bone metabolic markers
between patients with primary fractures and those with recurrent fractures." belongs to the
materials and methods section. I think it is better to remove it from this section.
5. Materials and methods:
a. The design of the study is not clear, i.e. I don't understand from where you collected the
data from the patients or their medical records. Please clarify it. If your study is retrospective in
nature, therefore, there is no need for consent from the patients.
b. Replace it with "Methods and materials" as per journal style (line 70).
c. Please write a section about how you calculate the sample size for your study.
d. No need for the numbering of this section, subheadings in the section, and subsequent sections
(results and discussion). You must bold the subheading titles to be easily followed by the readers.
e. Avoid repetition like this sentence "who were first diagnosed in our hospital from January
2007 to December 2016." (lines 81 and 82)
f. Inclusion and exclusion criteria: please put them in one place as well as they need more detail,
for example, what about those patients who refused to participate in the study.
g. Please remove this "This study investigated the risk factors associated with primary
and recurrent fractures in patients with PMOP by comparing the clinical characteristics,
comorbidities, bone mineral density, and bone metabolic markers of patients with PMOP." (lines
72-75).
h. It is better to move Figure 1 to the results section.
i. This sentence "Diagnosis of osteoporosis was based on the diagnostic criteria of the Chinese
2017 guidelines for the management of primary osteoporosis." (Lines 83-84) needs a reference.
6. Results
a. "The subjects were divided into five subgroups according to the type of comorbidities (with
or without diabetes, with or without cardio-cerebrovascular diseases, with or without chronic
liver and kidney disease, with or without chronic gastric disease, and with other comorbidities),
and the differences in BMD and bone metabolic markers were analyzed when the primary
fracture group was combined with different diseases.' (lines 150-155) This sentence belongs to
the materials and methods section.
b. There are only 4 groups in tables 3, 4, and 5, not as you mentioned 5 groups (line 150).
a. Line 192, I think this is incorrect P<0.1, please correct it.
b. Lines 196-203 " It can be concluded that age (OR=1.050, P=0.000), weight (OR=1.019,
P=0.002)# and chronic liver and kidney disease (OR=1.415, P=0.046) were risk factors for
primary fractures in patients with PMOP; L1-4 BMD (OR=0.119, P=0.000) and total hip
(OR=0.085, P= 0.004) were protective factors for primary fractures. This means that PMOP
patients have an increased risk of primary fractures with increasing age and weight and with
combined chronic liver and kidney diseases; the higher the L1-4 BMD and total hip BMD, the
lower the risk of primary fractures." I think this belongs to the discussion section.
7. Discussion:
a. I think you should mention the strength or the main outcomes of the study in the first
paragraph.
b. The second paragraph should be split into two paragraphs, one for discussing the age variable
and the second one for the BMI variable.
c. Lines 231-234 "which may be because hip fractures account for a smaller proportion of
primary and recurrent fractures in PMOP patients, and fractures at sites such as the vertebrae
and ankle are more prevalent." This sentence is not a clear explanation.
d. This sentence (lines 280 and 281) "Bone remodeling is regulated not only by bone metabolism
but also by other metabolic pathways and factors within the body." needs a reference.
e. The limitations of the study and the conclusion should be separated into two isolated
paragraphs as per journal style.
8. References
a. "Reference:" changed to References.
b. Should be revised according to the journal style.