Risk factors for hip fracture among elderly patients with Alzheimer's disease
Authors: Kei Satoh
Tomohiro Kanoko
Yoshihiro Sato
Jun Iwamoto
Journal: Journal of the Neurological Sciences (2004)
Discipline: NEUROSCIENCE & BEHAVIOR
Keywords: hip fracture; Alzheimer's disease; elderly female patients; risk factors; body mass index
Affiliations: Department of Neurology, Mitate Hospital, 3237 Yugeta, Tagawa 826-0041, Japan. 

Abstract:  Incidence of hip fracture among patients with Alzheimer's disease (AD), especially in elderly patients, is high. To analyze risk factors of hip fracture, we prospectively studied a cohort of elderly female patients with AD. Subjects studied were 225 female patients with AD, and the average age was 76 years old. At baseline, we recorded body mass index (BMI), a score of Mini-Mental State Examination (MMSE) and bone mineral density (BMD), and measured serum concentrations of ionized calcium, intact parathyroid hormone (PTH), pyridinoline cross-linked carboxyterminal telopeptide of type I collagen (ICTP), intact bone Gla protein (BGP), 25-hydroxyvitamin (25-OHD) and 1, 25-dihydroxyvitamin D (1, 25-[OH]2D). The patients were followed for 2 years. During the 2-year study, hip fractures occurred in 29 patients. We compared baseline variables between the 29 patients with and 176 patients without hip fracture. AD patients with lower BMD, low concentrations of serum ionized calcium and 25-OHD (mean 3.0 ng/ml) with compensatory hyperparathyroidism were found to have an increased risk of hip fracture. Also, concentrations of serum ICTP and BGP were higher in the fracture group than in the nonfracture group. Elderly female AD patients with low BMD and serum 25-OHD concentrations &lt;5 ng/ml with secondary hyperparathyroidism have a high risk of hip fracture, and the risk may be reduced by vitamin D supplementation. 

Retracted: No

PubPeer comments:
 This paper should be retracted. There is a context of multiple ( 90) retractions of work by this group of researchers for a wide range of reasons that include fabrication, authorship misconduct, duplicate data reporting, plagiarism, unethical research practices, unresolved concerns about data integrity and scientific misconduct (http: retractionwatch.com the-retraction-watch-leaderboard ). The journal and its publisher were notified about the concerns with this paper in May 2018 Concerns: Ethics The study was reported to be conducted at Futase Hospital between January 1999 and December 2000, and to have been approved by the u2018local ethics committeeu2019. However, recent retractions of papers by Dr Sato and colleagues by Stroke and Bone indicate that Futase Hospital did not have an ethics committee at the time the work reported in J Neurol Sci was supposedly conducted. Thus, this work is unethical. Evaluation of the patients u2018was performed by the Chairman of the Human Clinical Study Committee of the Futase Social Insurance Hospitalu2019. The chairman is not named. Was this Dr Sato? If so, how can he chair the committee that considered the ethics of a study for which he was the principal investigator? Authorship misconduct Drs Sato and Iwamoto engaged in systematic reciprocal authorship misconduct between 2002 and late 2013. Dr Iwamoto has publicly acknowledged that he did not participate in Dr Satou2019s studies (Acta Scand 2018; 2018;138:263). Drs Kanoko and Satoh were u2018honorary authorsu2019 on several retracted papers. Study conduct The study was performed at Futase Social Insurance Hospital. That institution has only 55 beds and 4 physicians. It is highly implausible that recruitment of a cohort of 225 women 70y with Alzheimeru2019s disease, no cardiac, renal or thyroid dysfunction, and no treatment with several medications including calcium and vitamin D could be recruited at such a small institution. Participants were 225 women 70y with Alzheimeru2019s disease, and during the 2 year study they were reviewed every 2 weeks = 26 visits per participant per year = 11,700 study visits over 2 years, a rate of 16 participant study visits per day. That is highly implausible, particularly as only 1 co-author (Dr Sato) was affiliated to Futase Social Insurance Hospital. Biochemical measurements including serum 25-OHD were carried out at the u2018Creative Research Hormone Reference Laboratory at the Futase Social Insurance Hospitalu2019. It is extremely unlikely that an institution as small as Futase Hospital would have a hormone reference laboratory. We can find no evidence on internet searches of such an entity. Participant numbers The Abstract states that there were 225 participants, yet Figure 1 reports 270 participants Extensive data duplication and highly implausible data Compare the Results section of this paper with the Results section of Sato et al, J Neurol Sci 2001;182;89-93 a.tData duplication In Tables 1 and 2 in the 2004 paper, the mean and or SD values of several variables in the control group and the Alzheimeru2019s disease non-fracture group are identical to those in the control group and the Parkinsonu2019s disease group, respectively, in Table 2 in the 2001 paper (see bold text in table, below) ![file] Data are mean u00b1 SD * results reported in the paper as meq L, data converted to mmol L (1 meq L = 0.5mmol L) It is simply not possible that results for these variables would be identical in groups with different numbers of participants, and of different ages, gender composition and disease. b.tData errors In Table 3, the numbers of participants in the non-fracture group (86) and fracture group (18) differ from those reported in the text and in Tables 1 and 2 (176 and 29 respectively). They are identical to the numbers of participants in the non-fracture and fracture groups of patients with Parkinsonu2019s disease in the 2001 paper c.tSelf-plagiarism Please compare the Introduction and Discussion sections of this paper with those of Sato et al, J Neurol Sci 2001;182;89-93 Software designed to assess textual similarities (http: splat.cs.arizona.edu ) reveals that 41% of the sentences in the Introduction and Discussion sections of the 2004 paper shared at least 50% of the words with a sentence in the 2001 paper. , 
 On 14 June 2020 the publisher informed us that this paper was to be retracted. 9 months later, it has not been. In that time, it has been cited another 3 times (total of 49 citations now on Scopus). Lengthy delays in publication of retraction notices are not in the best interests of readers. , 
 It is now 21 months since Elsevier communicated, via COPE, its undertaking to retract this paper. Recent requests for an update on the retraction to Elsevier, COPE, and the journal did not receive a response. The society associated with the journal, the World Federation of Neurology, responded but was unable to provide any information. ,