Disease-related Risk of Vertebral Fracture During Glucocorticoid Treatment of Collagen Vascular Diseases
Bibliographic record
Abstract
To the Editor: Collagen vascular diseases, including systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), Sjögren’s syndrome (SS), systemic sclerosis (SSc)/mixed connective tissue disease (MCTD), polymyositis/dermatomyositis (PM/DM), and microscopic polyangiitis, are chronic and sometimes involve multiple organs, and are thus occasionally life-threatening. Immunosuppressive treatment with longterm high-dose glucocorticoids is necessary, but the treatment causes a high incidence of osteoporosis1,2,3. Recently, we demonstrated that patients treated with longterm high-dose glucocorticoids have a high risk of symptomatic vertebral fractures in collagen vascular diseases, based on the analysis of the Chiba-Shimoshizu Rheumatic Cohort4,5. The chronic and systemic inflammation in patients with RA and SLE has been recognized as causing secondary osteoporosis independently of glucocorticoids6, and many studies demonstrated that patients with RA have lower bone mineral density (BMD) and an increased risk of fracture7,8,9. However, it was not known whether there is a disease-specific or disease-related risk of osteoporotic fracture under glucocorticoid treatment among the collagen vascular diseases. We investigated the disease-specific or disease-related risk for osteoporotic symptomatic vertebral fracture by focusing on women treated with high-dose glucocorticoids for the long term for collagen vascular diseases, subanalyzing a cohort at Shimoshizu National Hospital in Japan. The study subjects were newly treated with an initial dose of > 20 mg/day prednisolone (PSL) equivalent for at least 6 months without prior prophylactic treatment with bisphosphonate, hormone replacement therapy, or selective estrogen receptor modulator to prevent bone loss. We defined glucocorticoid dose increase as the reintroduction of ≥ 20 mg/day of glucocorticoid (PSL equivalent) due to increased disease activity in patients whose doses were once tapered to < 20 mg/day. Symptomatic vertebral fracture was defined as vertebral deformity that was confirmed … Address correspondence to Dr. I. Tatsuno, Department of Clinical Cell Biology, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan. E-mail: ichiro-tatsuno{at}faculty.chiba-u.jp
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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 | 0.002 | 0.009 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.000 |
| Research integrity | 0.004 | 0.003 |
| Insufficient payload (model declined to judge) | 0.003 | 0.001 |
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".