Bibliographic record
Abstract
To the Editor: We would like to thank Drs Rovner and Zamel for their valued comments. We agree that there are several limitations to our study, as identified in the discussion (1) and accompanying editorial (2). Although several adult studies suggest that self-reporting on fractures is reasonably accurate (3,4), this has not, to our knowledge, been validated in children. Other data dependent on recall, including age at time of fracture, weight, height, and estimated level of physical activity at time of fracture occurrence, were not obtained. These are well-known risk factors for fractures and would be best estimated in a prospective multicenter study. Because this is a retrospective study, the data available are obviously limited. None of the sibling controls had dual-energy x-ray absorptiometry scans; therefore, we are not able to comment on bone mass density (BMD) in controls. When we looked at those patients with inflammatory bowel disease (IBD) who had sustained a fracture in their lifetime, 17 (58.6%) had abnormal BMD; however, when we reviewed the patients with abnormal BMD among our patients with IBD, only 17 of 70 (24%) had sustained fractures. This was not statistically significant when compared with the non-IBD group. Furthermore, we recognized in our discussion that the numbers were relatively small and therefore limited the value of subgroup analysis. There are clearly many ways to statistically evaluate data. We felt that our simple approach was sufficient to demonstrate the prevalence of fractures among children with IBD and to identify the lack of association with abnormal BMD. As Drs Rovner and Zamel point out, the data collected may have a time lag factor. If the variables collected can change with time (eg, BMD), then interpretation may be difficult (5). It is important to recognize that bone densitometry is a routine investigation in many tertiary centers that care for children with IBD. Children who are identified as having low BMD are often asked to take calcium and vitamin D supplements, despite a lack of evidence that doing so changes outcome. In this group of children who are already taking several medications including 5-ASA, immunosuppressants, antibiotics, iron, and others, the risk of noncompliance increases. The clinical significance of these measurements as defined by lifetime fracture occurrence is unknown. In adult studies there appears to be some discrepancy, with a modest increase in fracture rate identified (6–8). Our study is 1 of the first in children with IBD. A well-designed prospective study will likely be required to clarify the issues raised by Drs Rovner and Zamel.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
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 | 0.006 | 0.060 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.002 | 0.002 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.003 | 0.003 |
| Scholarly communication | 0.005 | 0.004 |
| Open science | 0.004 | 0.002 |
| Research integrity | 0.033 | 0.033 |
| Insufficient payload (model declined to judge) | 0.030 | 0.023 |
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".