Bibliographic record
Abstract
To the Editor: In their review, “Prevention and treatment of osteoporosis in inflammatory bowel disease,” Dr. Lichtenstein et al1 provide a guideline for the evaluation and consideration for treatment of osteoporosis in patients with inflammatory bowel disease (IBD). In their overview of pharmacological therapies for osteoporosis, the authors summarize the results of systematic reviews and meta-analyses of the bisphosphonates in the postmenopausal population, as there is limited literature evaluating the usefulness of these agents in the IBD population. In the studies that are available in the IBD population, it is unfortunate that only bone mineral density (BMD), a surrogate endpoint, has been investigated. Although the authors summarize the results of the studies in patients with Crohn's disease and ulcerative colitis, I believe there is another study that should have been included. Siffledeen et al2 conducted a randomized trial of etidronate (plus calcium and vitamin D) for the treatment of low BMD in Crohn's disease. One hundred fifty-four patients with Crohn's disease with decreased BMD were randomly assigned to receive etidronate 400 mg or no etidronate for 14 days. For the next 76 days both groups were supplemented with calcium 500 mg and vitamin D 400 IU daily. This cycle was repeated 8 times for a total duration of 24 months, twice the duration of the other studies in the IBD population. After 24 months the BMD significantly increased from baseline in both the etidronate and the nonetidronate-treated groups at the lumbar spine (P < 0.001), ultradistal radius (P < 0.001), and trochanter sites (P = 0.004), with similar increases in both treatment groups. No significant increase was seen in either group at the total hip. The authors concluded that supplementation with daily calcium and vitamin D was associated with beneficial changes in BMD, but that the addition of etidronate did not add to that benefit. These results, together with the absence of evidence of a benefit with etidronate on nonvertebral fractures in the postmenopausal population, suggest that etidronate may not be the drug of choice in the IBD population.3
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.135 | 0.412 |
| Meta-epidemiology (narrow) | 0.002 | 0.002 |
| Meta-epidemiology (broad) | 0.006 | 0.004 |
| Bibliometrics | 0.002 | 0.002 |
| Science and technology studies | 0.007 | 0.020 |
| Scholarly communication | 0.013 | 0.019 |
| Open science | 0.008 | 0.007 |
| Research integrity | 0.157 | 0.105 |
| Insufficient payload (model declined to judge) | 0.026 | 0.011 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".