Still a blind spot for osteoporosis prevention and treatment for rheumatoid arthritis.
Bibliographic record
Abstract
In the September issue of The Journal, Drs. Zochling and March commented on our editorial in which we noted the absence of recommendations for the prevention and treatment of osteoporosis in patients with rheumatoid arthritis (RA). They referred to the American College of Rheumatology Subcommittee on Rheumatoid Arthritis Guidelines update 2002, which, they state, addressed the issue of osteoporosis prevention for patients with RA. However, these guidelines contain only the following sentence within the text of the article: “RA is associated with an increased risk of osteoporosis independently of glucocorticoid therapy.” There is a recommendation for bone mineral densitometry as well as vitamin D and calcium supplement only for RA patients who are taking glucocorticosteroid. But these recently published guidelines, like the 2 we reviewed, as well as the recent consensus statement on pharmacological management of early RA, failed to deal with the need for osteoporosis prevention in RA patients in general. Only the recent article of Haugeberg, et al also raised the question of identifying RA patients at high risk for osteoporosis, identifying 5 criteria: age, weight, inflammation, immobility, and ever-use of corticosteroids. The role of corticosteroids in RA was the principal focus of Drs. Zochling and March, and this was well described in this Guidelines update. However, every patient undergoing glucocorticoid treatment needs bone mineral densitometry evaluation and consideration of treatment for osteoporosis, as recently reiterated by Saag, et al, so this is not specific to patients with RA. This unfortunately reinforces our contention that the prevention and treatment of osteoporosis in patients with RA continues to be insufficiently addressed in published guidelines for management of RA. Our colleagues who work on the osteoporosis side are doing better — as evidenced by the Guidelines on Osteoporosis Management recently published by the Osteoporosis Society of Canada, which list RA as a risk factor for the development of osteoporosis. BRIGITTE M. JOLLES, MD, MSc, Hopital Orthopedique de la Suisse Romande, Centre Hospitalier Universitaire Vaudois, University of Lausanne, 4 Avenue Pierre Decker, 1005 Lausanne, Switzerland. (E-mail: Brigitte.Jolles@chuv.hospvd.ch); EARL R. BOGOCH, MD, MSc, FRCSC, Department of Surgery, University of Toronto, Martin Family Centre for Arthritis Care, Mobility Program, St. Michael’s Hospital, Suite 800, 55 Queen Street East, Toronto, Ontario M5C 1R6, Canada (E-mail: bogoch@sympatico.ca)
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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 | 0.009 | 0.030 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.002 | 0.002 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.003 | 0.004 |
| Scholarly communication | 0.006 | 0.008 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.020 | 0.038 |
| Insufficient payload (model declined to judge) | 0.019 | 0.014 |
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".