Title: The impact of diabetes, anemia, and renal function in the relationship between
osteoporosis and fasting blood glucose among Taiwanese women: a cross-sectional study
Version: 0 Date: 13 Oct 2023
Reviewer:  Hsien-Wen Kuo
Reviewer's report:
The study is clear and concise in explaining the study's objective and its importance to
examine the association between fasting blood glucose and osteoporosis in women, particularly
those with different combinations of diabetes, anemia, and renal insufficiency. This research
is valuable because it can enhance our understanding of how various diabetes-related
complications might impact bone metabolism, which can be beneficial for clinicians in treating
female patients with diabetes. However, several questions are needed to clarify.
1. "Establishing causation between osteoporosis and fasting blood glucose is challenging due
to the limitations of cross-sectional studies. Furthermore, fasting blood glucose is significantly
correlated with conditions such as diabetes, anemia, and renal function. It is therefore difficult
to pinpoint the specific factors contributing to osteoporosis.
2. The author should provide a more comprehensive exploration of the correlations between
diabetes, anemia, and renal function with osteoporosis. Subsequently, they should propose and
test a theoretical mechanism based on biological principles. It is essential to include a discussion
of the potential associations between diabetes, anemia, and renal function with osteoporosis in
the article and to illustrate and assess these relationships in a diagram."
3. Based on the findings from Table 5, the hypothesis of the study should be related to examining
the interaction of diabetes, anemia, and renal function on osteoporosis.
4. The significance of Table 6 lies in its potential to reveal whether the observed associations
between these variables (diabetes, anemia, renal function) and osteoporosis support or contradict
the study's initial hypothesis. If the findings in Table 5 do not align with the hypothesis, it might
suggest that the hypothesis is not supported or requires further investigation.
5. The authors likely tested the association between fasting blood glucose (FBG) and
osteoporosis using the three hierarchical variables (diabetes, anemia, renal function) to explore
the complex interplay between these factors. FBG can be influenced by diabetes, anemia, and
renal function, and these conditions may also contribute to osteoporosis. By considering all
these variables together, the authors aim to provide a more comprehensive understanding of the
relationship between them and osteoporosis.
6. If there is a high association between FBG, diabetes, anemia, and renal function, it could
indeed complicate the interpretation of Table 6. This high association might make it challenging
to isolate the specific effects of each variable on osteoporosis. Therefore, it becomes crucial to
employ statistical methods or models that can disentangle these associations and determine their
individual contributions to osteoporosis.
7. Regarding the relationship between diabetes and bone mineral density (BMD) being
inconclusive in previous studies, it's important to note that the present study's findings don't
offer a clear conclusion on this association either. This highlights the complexity of the issue
and suggests that further research is needed to elucidate the relationship between diabetes
and osteoporosis or BMD. The inconclusiveness from prior studies and the present study may
indicate the need for more extensive investigation or possibly a different approach to studying
this relationship.