Title: Association of inflammatory markers with all-cause mortality and cardiovascular
mortality in postmenopausal women with osteoporosis or osteopenia
Version: 6 Date: 09 Aug 2023
Reviewer:  Camelia Vidita Gurban
Reviewer's report:
Good evening,
and the authors,
Analysing with attention and interest the Manuscript with ID: 8e0301e1-e88c-4b5e-9b39-
cf35cb14e05d, entitled "Association of inflammatory markers with all-cause mortality and
cardiovascular mortality in postmenopausal women with osteoporosis or osteopenia" for a
possible publication in the prestigious Journal - BMC Women's Health (ISSN: 1472-6874,
IF=2.75).
I consider that:
1. The authors of the article have proposed a much-discussed topic in today's medical scientific
world, namely: the evaluation of the levels of inflammatory markers characteristic of the
cardiovascular disease in postmenopausal osteoporosis.
2. The effort made by the authors was great right from the beginning of the study:
- These authors included in the initial study (retrospective cohort study) n=7339 postmenopausal
women aged >45 years with data drawn from NHANES. They aimed to assess the nutritional and
health status of general residents in the United States from the periods 2007-2010, 2013-2014,
and 2017-2018. Finally, n=2834 patients remained in this study. They had inclusion criteria
and exclusion criteria for patient selection (authors have clearly and concisely presented all this
information in the Chapter: Methods – sub-chapter: Study design and participants and Figure 1);
- In Chapter: Definitions and measurements – sub-chapters: BMD testing and Osteopenia and
osteoporosis, the authors present in detail the assessment of BMD using the DEXA technique to
assess T scores, the criterion that was the basis of the classification of the patients in the study;
- Sub-chapters: Measurements of inflammatory indices and Potential covariates they are well
structured and presented;
- For the determination of inflammatory markers in the medical analysis laboratory, all specific
international standards were followed (presented by the authors in the sub-chapter: Laboratory
quality control);
- For the statistical analysis of the data, the authors used the characteristic statistical parameters:
the mean and standard error (SE), associated credible interval (CI), Chi-square test, T-test, P
values, Cox regression and the hazard ratio (HR), curve AUC and ROC, and the concordance
index (C-index). Authors using the performances statistical software: SAS 9.4 version and R
version 4.2.0.
3. In the Chapter: Results, in the three sub-chapters the authors presented succinctly, coherently
and in detail all the data obtained by them in this study:
- In sub-chapter: Participant selection and baseline characteristics and Table 1;
- In sub-chapter: The associations of inflammatory markers with all-cause mortality and CVD
mortality in postmenopausal women with osteoporosis or osteopenia, Table 2 and Figure 1 and
2, supplementary Fig.1;
- In sub-chapter: Subgroup analysis of the associations of inflammatory markers with all-cause
mortality and CVD mortality in postmenopausal women with osteoporosis or osteopenia and
Figure 3.
4. In the Chapter Discussions, the authors exemplified the assessments of other authors according
to the bibliography for all the results of their study!
5. The Chapter Conclusion is presented clearly and concisely!
6. All authors had a fair contribution in the realization of the study.
As a result:
1. The article follows all the specific instructions of the journal presented in: aims and scope,
instructions for authors and other information about the journal.
2. The data presented in this manuscript are well structured and coherent.
3. The methods, statistical analysis and results are well presented and easy to understand.
4. The bibliography chosen by the authors corresponds to the requirements and refers to the
subject of the article.
In conclusion:
I accept as it is the article.
I recommend publishing the article in your prestigious journal.