Older women who use bisphosphonate for longer than 5 years may have increased odds of a subtrochanteric or femoral shaft fracture, but absolute risk is low
Bibliographic record
Abstract
Commentary on: Park-Wyllie LY, Mamdani MM, Juurlink DN, et al. Bisphosphonate use and the risk of subtrochanteric or femoral shaft fractures in older women. JAMA 2011;305:783–9.[OpenUrl][1][CrossRef][2][PubMed][3][Web of Science][4] It is now recognised that fractures of the subtrochanteric femur or femoral shaft (ST/FS fractures) can be divided radiologically into (1) typical fractures and (2) atypical fractures. The latter appear to be rare in patients untreated by bisphosphonates. In this new study, Park-Wyllie et al used Ontario claims data to investigate the association between the amount of bisphosphonates taken and the risk of ST/FS fractures. The study was a nested 5:1 case-control study, linking prescriptions with hospitalisations, physician service claims and death certificates. Women aged 68 years or older who filled prescriptions for bisphosphonates at least once over a 6-year period were included. Those with malignant disease in the past 10 years, specific bone diseases or secondary causes of osteoporosis (past 5 years) and osteoporosis treatment in the past year were excluded, providing 205 466 women for study. Cases were defined as first ST/FS fracture, excluding fractures treated … [1]: {openurl}?query=rft.jtitle%253DJAMA%26rft.stitle%253DJAMA%26rft.issn%253D0002-9955%26rft.aulast%253DPark-Wyllie%26rft.auinit1%253DL.%2BY.%26rft.volume%253D305%26rft.issue%253D8%26rft.spage%253D783%26rft.epage%253D789%26rft.atitle%253DBisphosphonate%2BUse%2Band%2Bthe%2BRisk%2Bof%2BSubtrochanteric%2Bor%2BFemoral%2BShaft%2BFractures%2Bin%2BOlder%2BWomen%26rft_id%253Dinfo%253Adoi%252F10.1001%252Fjama.2011.190%26rft_id%253Dinfo%253Apmid%252F21343577%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [2]: /lookup/external-ref?access_num=10.1001/jama.2011.190&link_type=DOI [3]: /lookup/external-ref?access_num=21343577&link_type=MED&atom=%2Febmed%2F16%2F6%2F168.atom [4]: /lookup/external-ref?access_num=000287594300021&link_type=ISI
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
Direct model labels (unvalidated)
Per-model category and study-design labels from the labeling rounds. They are machine output, unvalidated, and the disagreement between models ships as data. No study design here is MEDLINE-validated yet.
| Model arm | Categories | Study design | Confidence |
|---|---|---|---|
| gemma | no category Domain: not available · Genre: Commentary About the Canadian research system: no · About a Canadian topic: no | Not applicable | low |
| gpt | no category Domain: not available · Genre: Commentary About the Canadian research system: no · About a Canadian topic: no | Observational | medium |
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 | 0.004 | 0.034 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.002 | 0.002 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.002 |
| Open science | 0.003 | 0.000 |
| Research integrity | 0.010 | 0.009 |
| Insufficient payload (model declined to judge) | 0.015 | 0.008 |
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, unvalidatedLabeled directly by 2 models reading the full record.
The models disagree on parts of this classification; every voice is preserved in the section at the end of the page.
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".