Prevalence and Predictors of Osteoporosis Among the Chinese Population in Klang Valley, Malaysia

Round 1

Reviewer 1 Report

This manuscript investigates the prevalence and risk factors for osteoporosis in the middle-aged and elderly Chinese population in Malaysia. From the information of the questionnaire survey, the authors concluded that age, education level, low monthly income, and body weight are negative predictors of the osteoporosis Chinese population in Malaysia. The manuscript is easy to follow and the conclusions are convincing and interesting. The data will be useful for the government in developing preventive measures to prevent the development of osteoporosis in high-risk populations.

 

Mini error:

In table 2, in the body Anthropometry column, the Height is Height (cm), not Height (m).

Author Response

Response to comments of Reviewer 1

Manuscript title: Prevalence and Predictors of Osteoporosis among Chinese Population in Klang Valley, Malaysia

Manuscript ID: applsci-475904

Thank you for reviewing our manuscript. We appreciated your comments, and our replies are listed below:

This manuscript investigates the prevalence and risk factors for osteoporosis in the middle-aged and elderly Chinese population in Malaysia. From the information of the questionnaire survey, the authors concluded that age, education level, low monthly income, and body weight are negative predictors of the osteoporosis Chinese population in Malaysia. The manuscript is easy to follow and the conclusions are convincing and interesting. The data will be useful for the government in developing preventive measures to prevent the development of osteoporosis in high-risk populations.

Comment: In table 2, in the body Anthropometry column, the Height is Height (cm), not Height (m).

Thank you for your comment. We have amended the SI unit for Height into cm.

Thank you for your time. We look forward to receiving your favourable reply. 

Author Response File: Author Response.docx

Reviewer 2 Report

This is an interesting paper about the prevalence of osteoporosis in a poorly investigated geographical region. The Introduction comprehensively illustrates the knowledge about this topic. The aim of the study is well illustrated. I have a few comments:

MAJOR POINTS

1. The recruiting methods are not entirely clear. Please report how many patients were soliceted and their rate of acceptance to partecipate to this study

2. A MULTIVARIABLE logistic regression analysis would be helpful to identify the INDEPENDENT predictors of osteoporosis and should be performed.

MINOR POINTS

"Osteoporosis, also known as the ‘silent disease’...": Silent disease is a cliché which is used for almost every disease, ranging from liver steatosis to HIV infection. Please remove this expression as it is not appropriate in a scientific context.

"Currently, measurement of bone mineral density (BMD) using dual-energy X-ray absorptiometry (DXA) remained as the gold standard for osteoporosis diagnosis". Please check English language here

Table 1: Inclusion criteria: please remove the last criterion (it is redundant as it is explained by exclusion criteria). Exclusion criteria. Please check English language here

"95.6% had an estimated monthly income < RM 7640". The entity of this income is not easy to figure out for readers outside tha Malaysian are. Please add a conversion to USD or describe whether this is considered high or not (for instance, which working classes earn a similar income?).

Author Response

Response to comments of Reviewer 2

Manuscript title: Prevalence and Predictors of Osteoporosis among Chinese Population in Klang Valley, Malaysia

Manuscript ID: applsci-475904

Thank you for reviewing our manuscript. We appreciated your comments, and our replies are listed below:

Comment 1: The recruiting methods are not entirely clear. Please report how many patients were solicited and their rate of acceptance to participate to this study

Thank you for your comment. We have used quota sampling method to recruit the subjects. The number of subjects recruited and excluded has been added in the Materials and Methods section (line 84 - line 88).

Comment 2: A multivariable logistic regression analysis would be helpful to identify the independent predictors of osteoporosis and should be performed.

Thank you for your comment. The results depicted in Table 4 were obtained using multivariate logistic regression and the predictors were adjusted to each other. We have added the ‘multivariate’ in the Statistical Analysis and Result sections. We have also added the regression method as the footnote of Table 4.

Comment 3: "Osteoporosis, also known as the ‘silent disease’...": Silent disease is a cliché which is used for almost every disease, ranging from liver steatosis to HIV infection. Please remove this expression as it is not appropriate in a scientific context.

Thank you for your suggestion. We have removed the phrase ‘silent disease’.

Comment 4: "Currently, measurement of bone mineral density (BMD) using dual-energy X-ray absorptiometry (DXA) remained as the gold standard for osteoporosis diagnosis". Please check English language here

Thank you for your comment. We have edited sentence to ‘Currently, bone mineral density (BMD) determination using dual-energy X-ray absorptiometry (DXA) remains as the gold standard in the diagnosis of osteoporosis.

Comment 5: Table 1: Inclusion criteria: please remove the last criterion (it is redundant as it is explained by exclusion criteria). Exclusion criteria. Please check English language here

Thank you for your comment. The last inclusion criterion has been removed and the language has been revised.

Comment 6: "95.6% had an estimated monthly income < RM 7640". The entity of this income is not easy to figure out for readers outside the Malaysian are. Please add a conversion to USD or describe whether this is considered high or not (for instance, which working classes earn a similar income?).

Thank you for your suggestion. We have added the conversion of MYR to USD. We have indicated in the manuscript that this group belongs to the bottom 40% household income group of Malaysia.

Thank you for your time. We look forward to receiving your favourable reply. 

Author Response File: Author Response.docx

Reviewer 3 Report

To:

Editorial Board

Applied Sciences

 

 

Title: “Prevalence and Predictors of Osteoporosis among Chinese Population in Klang Valley, Malaysia”

 

 

Dear Editor,

I read this manuscript and I think that:

-          The novelty of this paper should be better expressed in relation to literature.

-          All of the clinical characteristics (pharmacological treatments, for example), should be listed in table 1

-          A multivariate regression analysis should be considered and should include all the characteristics of the study population, in order to evaluate the role of confounding factors on final results.

-          The role of diet and nutraceuticals on health should be considered. The authors can consider the paper from Scicchitano P et al Journal of Functional Foods 2014;6:11-32.

Author Response

Response to comments of Reviewer 3

Manuscript title: Prevalence and Predictors of Osteoporosis among Chinese Population in Klang Valley, Malaysia

Manuscript ID: applsci-475904

Thank you for reviewing our manuscript. We appreciated your comments, and our replies are listed below:

Comment 1: The novelty of this paper should be better expressed in relation to literature.

 

Thank you for your comment. We have highlighted the novelty of our study as below:

Line 71-74: This study is novel because both Chinese men and women were recruited, allowing comparison of prevalence and risk factors between sexes to be made. It is among the few studies in Malaysia which use DXA to determine the bone health of the population.

 

Line 258-262: However, to the best of our knowledge, this is the first study to report on the prevalence and predictors of osteoporosis defined by DXA among middle-aged and elderly Malaysian Chinese in Klang Valley. Other similar studies have been conducted in Malaysia, but they used quantitative ultrasonometry to determine bone health of the subjects (Chin et al 2012; Chin et al. 2016; Chin et al. 2017).

 

Comment 2: All of the clinical characteristics (pharmacological treatments, for example), should be listed in table 1

 

Thank you for your comment. We have indicated the medical conditions of the subjects in Table 2.

 

Comment 3: A multivariate regression analysis should be considered and should include all the characteristics of the study population, in order to evaluate the role of confounding factors on final results.

 

Thank you for your comment. The results depicted in Table 4 were obtained using multivariate logistic regression and predictors are adjusted to each other. We have added the term ‘multivariate’ in the Statistical Analysis and Results section. We have also added the regression method as the footnote of Table 4.

 

We included all the characteristics of the subjects during analysis but the selection of predictors was based on a stepwise procedure. Thus, characteristics or confounding factors not selected were not significant.

 

Comment 4: The role of diet and nutraceuticals on health should be considered. The authors can consider the paper from Scicchitano P et al Journal of Functional Foods 2014;6:11-32.

 

Thank you for the suggestion. We acknowledge that data on diet and nutraceuticals were limited for the subjects included in this study. We have listed this limitation in the Discussion section as below:

Line 255-257: We also did not determine the dietary and supplementation pattern of the subjects in details, hence the relationship between macro and micro-nutrients and bone health was not investigated.

Thank you for your time. We look forward to receiving your favourable reply

Author Response File: Author Response.docx

Round 2

Reviewer 2 Report

I have read the revised version of the manuscript. 

I think that all of the raised points have been adequately addressed  and that the quality of the manuscript has clearly improved.

Therefore I reccomend this paper for publication.

Reviewer 3 Report

To:

Editorial Board

Applied Sciences

 

 

Title: “Prevalence and Predictors of Osteoporosis among Chinese Population in Klang Valley, Malaysia”

 

 

Dear Editor,

I read the revised version of this manuscript and I think that the authors well addressed the previous comments. The paper improved very much.