Reviewer ’s report  
 
Title: Clinical effects of switching from minodronate to denos umab treatment in patients with 
postmenopausal oste oporosis: A retrospective study  
 
Version: 0 Date: 14 Nov 20 19 
 
Reviewer: GABRIELA REZENDE  
 
Reviewer's report:  
 
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Abstract:  
In results we dont have any information of the data of N -terminal telopeptide dosag e, only about 
BAP.  
 
Article  
Background  
In the 1st paragraph the reasons of increasing number of patients with osteoporosis should be 
more explored, discussing about the risk factors of low bone mass. When are described the 
complications of osteoporosis, i s interesting to put some data about prevalence of hip fractures 
and prevalence of immobility, dependence, depression and other bad outcomes. Also, once your 
article analysed vertebral and femur bone density, you should describe better the vertebral 
compli cations: prevalence, outcomes like deformity and chronic pain.  
 
In  3rd paragraph is cited that denosumab is the 1st treatment option in Japan. Maybe is useful 
describe the reality in the world (as an abstract) - is a really effective drug, but in many cou ntries 
is not the 1st option because of limitations as price and public access . Maybe you can change for 
"Denosumab should be the first option of osteoporosis treatment because of .....". I think that this 
paragraph can be more useful if you just explain the action of this drug and show the evidences 
about denosumab and biphosphonates switch and isolated use.  
Literature shows that change of biphosphonates to denosumab is secure and prevents bone mass 
loss. Is important to give more value of this research in Japan, once that MIN and denosumab are 
drugs with high number of prescriptions and there are few studies describing this switch. Also, is 
important to describe studies that evaluate other switchs with MIN (like teriparatide x MIN; 
raloxifeno x MIN, etc). This review of other publications will make your introduction more rich.  
 
Methods  
We know that physiologic al menopause occurs between 40 and 55 years - there are any reason to 
establish the age of data beggining at 45 years old? Also, we know that BMD evaluation with 
DXA is not realized as a routine earlier than 65 years old, except in patients with high risk o f 
osteoporosis: how this evaluation was performed?  
Is known that surgical menopause (oopohorectomy) increases the risk of osteoporosis, and this 
should be considered at your analysis and in your discussion.  
Is not clear if the patients started the treatmen t with MIN in the beggining of the study or if this 
patients already had been using this drug before the inclusion in the research. Also, is not clear if 
they used other osteoporosis drugs before; also, if they were using drugs related with low bone 
mass, like corticosteroids.  
 
Discussion  
Once your article shows that denosumab is more effective than MIN, you should give more value 
of low incidence and absence of serious adverse events, explaining that with biphosphonates the 
adverse events can be associated  with more morbidity.  
When you describe other studies that analysed switching therapies, is important to reinforce the 
value of your research, showing the innovation and the importante in Japan scenario.  
 
I think this article should be published but the v alue of this findings should be further valued, 
based in the world literature, compairing the results and, this way, strengthening the conclusion.  
 
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
Yes 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
Yes 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the author s. 
 
Yes 
 
Are you able to assess any statistics in the manus cript or would you recommend an 
additional statistical review?  
If an additional statistical review is recommended, please speci fy what aspects require further 
assessment in your comments to the editors.  
 
I am able to assess the statistics  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Acceptable  
Declaration of competing interests  
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3. Do you hold or are you currently applying for any patents relating to th e content of the 
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4. Have you received reimbursements, fees, funding, or salary from an organization that 
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