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Song X, Shen L, Contreras JM, Liu Z, Ma K, Ma B, Liu X, Wang DO. New potential selective estrogen receptor modulators in traditional Chinese medicine for treating menopausal syndrome. Phytother Res 2024. [PMID: 39120263 DOI: 10.1002/ptr.8289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 05/19/2024] [Accepted: 06/23/2024] [Indexed: 08/10/2024]
Abstract
Women go through several predictable conditions and symptoms during menopause that are caused by age, changes in sex hormone levels, and other factors. Conventional menopause hormone therapy has raised serious concerns about the increased risks of cancers, blood clots, depression, etc. Selective estrogen receptor modulators (SERMs) that can be both agonists and antagonists of estrogen receptors in a tissue-specific manner are being developed to reduce the health concerns associated with menopause hormone therapy. Here, we have searched the Chinese national traditional Chinese medicine (TCM) patent database to identify potential SERM-like compounds with reduced health risks. TCM has been widely used for treating complex symptoms associated with menopause syndrome and thus can be a particularly rich source for pharmaceutical alternatives with SERM properties. After extensive literature review and molecular simulation, we conclude that protopanaxatriol, paeoniflorin, astragalin, catalpol, and hyperoside among others may be particularly promising as SERM-like compounds in treating the menopausal syndrome. Compounds in TCM hold promise in yielding comparable outcomes to hormone therapy but with reduced associated risks, thus presenting promising avenues for their clinical applications.
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Affiliation(s)
- Xintong Song
- Wuya College of Innovation, Shenyang Pharmaceutical University, Shenyang, China
| | - Lan Shen
- Wuya College of Innovation, Shenyang Pharmaceutical University, Shenyang, China
| | | | - Zhiyuan Liu
- Wuya College of Innovation, Shenyang Pharmaceutical University, Shenyang, China
| | - Kai Ma
- Wuya College of Innovation, Shenyang Pharmaceutical University, Shenyang, China
| | - Biao Ma
- RIKEN Center for Computational Science, Kobe, Japan
| | - Xiaoling Liu
- Wuya College of Innovation, Shenyang Pharmaceutical University, Shenyang, China
| | - Dan Ohtan Wang
- Wuya College of Innovation, Shenyang Pharmaceutical University, Shenyang, China
- Biology Program, New York University Abu Dhabi, Abu Dhabi, United Arab Emirates
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Tan EH, Rathod-Mistry T, Strauss VY, O'Kelly J, Giorgianni F, Baxter R, Brunetti VC, Pedersen AB, Ehrenstein V, Prieto-Alhambra D. Evaluating the comparability of osteoporosis treatments using propensity score and negative control outcome methods in UK and Denmark electronic health record databases. J Bone Miner Res 2024; 39:844-854. [PMID: 38619297 DOI: 10.1093/jbmr/zjae059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 03/05/2024] [Accepted: 04/08/2024] [Indexed: 04/16/2024]
Abstract
Evidence on the comparative effectiveness of osteoporosis treatments is heterogeneous. This may be attributed to different populations and clinical practice, but also to differing methodologies ensuring comparability of treatment groups before treatment effect estimation and the amount of residual confounding by indication. This study assessed the comparability of denosumab vs oral bisphosphonate (OBP) groups using propensity score (PS) methods and negative control outcome (NCO) analysis. A total of 280 288 women aged ≥50 yr initiating denosumab or OBP in 2011-2018 were included from the UK Clinical Practice Research Datalink (CPRD) and the Danish National Registries (DNR). Balance of observed covariates was assessed using absolute standardized mean difference (ASMD) before and after PS weighting, matching, and stratification, with ASMD >0.1 indicating imbalance. Residual confounding was assessed using NCOs with ≥100 events. Hazard ratio (HR) and 95%CI between treatment and NCO were estimated using Cox models. Presence of residual confounding was evaluated with 2 approaches (1) >5% of NCOs with 95% CI excluding 1, (2) >5% of NCOs with an upper CI <0.75 or lower CI >1.3. The number of imbalanced covariates before adjustment (CPRD 22/87; DNR 18/83) decreased, with 2%-11% imbalance remaining after weighting, matching, or stratification. Using approach 1, residual confounding was present for all PS methods in both databases (≥8% of NCOs), except for stratification in DNR (3.8%). Using approach 2, residual confounding was present in CPRD with PS matching (5.3%) and stratification (6.4%), but not with weighting (4.3%). Within DNR, no NCOs had HR estimates with upper or lower CI limits beyond the specified bounds indicating residual confounding for any PS method. Achievement of covariate balance and determination of residual bias were dependent upon several factors including the population under study, PS method, prevalence of NCO, and the threshold indicating residual confounding.
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Affiliation(s)
- Eng Hooi Tan
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Centre for Statistics in Medicine, University of Oxford, Oxford OX3 7LD, United Kingdom
| | - Trishna Rathod-Mistry
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Centre for Statistics in Medicine, University of Oxford, Oxford OX3 7LD, United Kingdom
| | - Victoria Y Strauss
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Centre for Statistics in Medicine, University of Oxford, Oxford OX3 7LD, United Kingdom
| | - James O'Kelly
- Center for Observantional Research, Amgen Ltd, Uxbridge UB8 1DH, United Kingdom
| | | | - Richard Baxter
- Center for Observantional Research, Amgen Ltd, Uxbridge UB8 1DH, United Kingdom
| | - Vanessa C Brunetti
- Center for Observantional Research, Amgen Ltd, Uxbridge UB8 1DH, United Kingdom
| | - Alma Becic Pedersen
- Department of Clinical Epidemiology, Aarhus University Hospital and Aarhus University, Aarhus 8200, Denmark
| | - Vera Ehrenstein
- Department of Clinical Epidemiology, Aarhus University Hospital and Aarhus University, Aarhus 8200, Denmark
| | - Daniel Prieto-Alhambra
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Centre for Statistics in Medicine, University of Oxford, Oxford OX3 7LD, United Kingdom
- Department of Medical Informatics, Erasmus University Medical Centre, Rotterdam 3015 GD, The Netherlands
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Zafari Z, Park JE, Shah CH, dosReis S, Gorman EF, Hua W, Ma Y, Tian F. The State of Use and Utility of Negative Controls in Pharmacoepidemiologic Studies. Am J Epidemiol 2024; 193:426-453. [PMID: 37851862 DOI: 10.1093/aje/kwad201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 07/27/2023] [Accepted: 10/06/2023] [Indexed: 10/20/2023] Open
Abstract
Uses of real-world data in drug safety and effectiveness studies are often challenged by various sources of bias. We undertook a systematic search of the published literature through September 2020 to evaluate the state of use and utility of negative controls to address bias in pharmacoepidemiologic studies. Two reviewers independently evaluated study eligibility and abstracted data. Our search identified 184 eligible studies for inclusion. Cohort studies (115, 63%) and administrative data (114, 62%) were, respectively, the most common study design and data type used. Most studies used negative control outcomes (91, 50%), and for most studies the target source of bias was unmeasured confounding (93, 51%). We identified 4 utility domains of negative controls: 1) bias detection (149, 81%), 2) bias correction (16, 9%), 3) P-value calibration (8, 4%), and 4) performance assessment of different methods used in drug safety studies (31, 17%). The most popular methodologies used were the 95% confidence interval and P-value calibration. In addition, we identified 2 reference sets with structured steps to check the causality assumption of the negative control. While negative controls are powerful tools in bias detection, we found many studies lacked checking the underlying assumptions. This article is part of a Special Collection on Pharmacoepidemiology.
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Ma B, Lu Y. Racial Disparities in the Clinical Prognosis of Gastrointestinal Cancer Patients with COVID-19: a Retrospective Study in UC CORDS. J Racial Ethn Health Disparities 2024; 11:216-225. [PMID: 36637614 PMCID: PMC9838534 DOI: 10.1007/s40615-023-01512-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 12/27/2022] [Accepted: 12/31/2022] [Indexed: 01/14/2023]
Abstract
BACKGROUND Cancer patients are highly vulnerable to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Few studies have examined racial disparities of clinical prognosis among gastrointestinal (GI) cancer patients with COVID-19, especially after the approval of COVID-19 vaccines. METHODS We conducted a retrospective study based on the University of California COVID Research Data Set (UC CORDS). Patients aged ≥ 18 with GI cancer as well as SARS-CoV-2 infection between March 10, 2020, and May 8, 2022, were included. We examined racial disparities using multivariable logistic regression. RESULTS Among the 1054 GI cancer cases included, 117 (11.1%) patients were Asian and Pacific Islander, 51 (4.8%) were Black patients, 377 (35.8%) were Hispanic patients, 403 (38.2%) were White patients, and 106 (10.1%) belonged to other or unknown races. Fully adjusted logistic models revealed a significantly increased risk of COVID-19-related hospitalization or emergency room visits among the Black (OR = 2.26, 95% CI = 1.08-4.70), the Hispanic (OR = 2.24, 95% CI = 1.48-3.39), and the patients of other or unknown races (OR = 1.80, 95% CI = 1.00-3.26) compared with the White patients. No significant racial disparities in 30-day all-cause mortality and mechanical ventilation rate were found. Vaccination, age, cancer type, recent cancer diagnoses in UC CORDS, metastatic cancer or secondary malignant neoplasm, and Charlson comorbidity index score were associated with the prognosis of GI cancer patients with COVID-19. CONCLUSIONS GI cancer patients belonging to racial minorities experience worse COVID-19 outcomes. Vaccination status is a crucial factor associated with GI cancer patients' prognosis among different race/ethnicity groups. Targeted communication in the context of cancer is needed to encourage vaccination uptake in this vulnerable population.
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Affiliation(s)
- Bingya Ma
- Department of Population Health and Disease Prevention, Program in Public Health, Susan and Henry Samueli College of Health Sciences, University of California, Irvine, CA, USA
| | - Yunxia Lu
- Department of Population Health and Disease Prevention, Program in Public Health, Susan and Henry Samueli College of Health Sciences, University of California, Irvine, CA, USA.
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Callahan A, Ashley E, Datta S, Desai P, Ferris TA, Fries JA, Halaas M, Langlotz CP, Mackey S, Posada JD, Pfeffer MA, Shah NH. The Stanford Medicine data science ecosystem for clinical and translational research. JAMIA Open 2023; 6:ooad054. [PMID: 37545984 PMCID: PMC10397535 DOI: 10.1093/jamiaopen/ooad054] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 03/14/2023] [Accepted: 07/19/2023] [Indexed: 08/08/2023] Open
Abstract
Objective To describe the infrastructure, tools, and services developed at Stanford Medicine to maintain its data science ecosystem and research patient data repository for clinical and translational research. Materials and Methods The data science ecosystem, dubbed the Stanford Data Science Resources (SDSR), includes infrastructure and tools to create, search, retrieve, and analyze patient data, as well as services for data deidentification, linkage, and processing to extract high-value information from healthcare IT systems. Data are made available via self-service and concierge access, on HIPAA compliant secure computing infrastructure supported by in-depth user training. Results The Stanford Medicine Research Data Repository (STARR) functions as the SDSR data integration point, and includes electronic medical records, clinical images, text, bedside monitoring data and HL7 messages. SDSR tools include tools for electronic phenotyping, cohort building, and a search engine for patient timelines. The SDSR supports patient data collection, reproducible research, and teaching using healthcare data, and facilitates industry collaborations and large-scale observational studies. Discussion Research patient data repositories and their underlying data science infrastructure are essential to realizing a learning health system and advancing the mission of academic medical centers. Challenges to maintaining the SDSR include ensuring sufficient financial support while providing researchers and clinicians with maximal access to data and digital infrastructure, balancing tool development with user training, and supporting the diverse needs of users. Conclusion Our experience maintaining the SDSR offers a case study for academic medical centers developing data science and research informatics infrastructure.
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Affiliation(s)
- Alison Callahan
- Stanford Center for Biomedical Informatics Research, Stanford University, Stanford, California, USA
| | - Euan Ashley
- Department of Medicine, School of Medicine, Stanford University, Stanford, California, USA
- Department of Genetics, School of Medicine, Stanford University, Stanford, California, USA
- Department of Biomedical Data Science, School of Medicine, Stanford University, Stanford, California, USA
| | - Somalee Datta
- Technology and Digital Solutions, Stanford Medicine, Stanford University, Stanford, California, USA
| | - Priyamvada Desai
- Technology and Digital Solutions, Stanford Medicine, Stanford University, Stanford, California, USA
| | - Todd A Ferris
- Technology and Digital Solutions, Stanford Medicine, Stanford University, Stanford, California, USA
| | - Jason A Fries
- Stanford Center for Biomedical Informatics Research, Stanford University, Stanford, California, USA
| | - Michael Halaas
- Technology and Digital Solutions, Stanford Medicine, Stanford University, Stanford, California, USA
| | - Curtis P Langlotz
- Department of Radiology, School of Medicine, Stanford University, Stanford, California, USA
| | - Sean Mackey
- Department of Anesthesia, School of Medicine, Stanford University, Stanford, California, USA
| | - José D Posada
- Technology and Digital Solutions, Stanford Medicine, Stanford University, Stanford, California, USA
| | - Michael A Pfeffer
- Technology and Digital Solutions, Stanford Medicine, Stanford University, Stanford, California, USA
| | - Nigam H Shah
- Stanford Center for Biomedical Informatics Research, Stanford University, Stanford, California, USA
- Technology and Digital Solutions, Stanford Medicine, Stanford University, Stanford, California, USA
- Clinical Excellence Research Center, School of Medicine, Stanford University, Stanford, California, USA
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Lee GH, Park J, Kim J, Kim Y, Choi B, Park RW, Rhee SY, Shin SY. Feasibility Study of Federated Learning on the Distributed Research Network of OMOP Common Data Model. Healthc Inform Res 2023; 29:168-173. [PMID: 37190741 DOI: 10.4258/hir.2023.29.2.168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 02/08/2023] [Indexed: 05/17/2023] Open
Abstract
OBJECTIVES Since protecting patients' privacy is a major concern in clinical research, there has been a growing need for privacy-preserving data analysis platforms. For this purpose, a federated learning (FL) method based on the Observational Medical Outcomes Partnership (OMOP) common data model (CDM) was implemented, and its feasibility was demonstrated. METHODS We implemented an FL platform on FeederNet, which is a distributed clinical data analysis platform based on the OMOP CDM in Korea. We trained it through an artificial neural network (ANN) using data from patients who received steroid prescriptions or injections, with the aim of predicting the occurrence of side effects depending on the prescribed dose. The ANN was trained using the FL platform with the OMOP CDMs of Kyung Hee University Medical Center (KHMC) and Ajou University Hospital (AUH). RESULTS The area under the receiver operating characteristic curves (AUROCs) for predicting bone fracture, osteonecrosis, and osteoporosis using only data from each hospital were 0.8426, 0.6920, and 0.7727 for KHMC and 0.7891, 0.7049, and 0.7544 for AUH, respectively. In contrast, when using FL, the corresponding AUROCs were 0.8260, 0.7001, and 0.7928 for KHMC and 0.7912, 0.8076, and 0.7441 for AUH, respectively. In particular, FL led to a 14% improvement in performance for osteonecrosis at AUH. CONCLUSIONS FL can be performed with the OMOP CDM, and FL often shows better performance than using only a single institution's data. Therefore, research using OMOP CDM has been expanded from statistical analysis to machine learning so that researchers can conduct more diverse research.
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Affiliation(s)
- Geun Hyeong Lee
- Department of Digital Health, SAIHST, Sungkyunkwan University, Seoul, Korea
- Department of Intelligent Precision Healthcare Convergence, Sungkyunkwan University, Suwon, Korea
| | | | | | - Yeesuk Kim
- Department of Orthopedic Surgery, Hanyang University College of Medicine, Seoul, Korea
| | - Byungjin Choi
- Department of Biomedical Informatics, Ajou University School of Medicine, Suwon, Korea
| | - Rae Woong Park
- Department of Biomedical Informatics, Ajou University School of Medicine, Suwon, Korea
- Department of Biomedical Sciences, Graduate School of Medicine, Ajou University, Suwon, Korea
| | - Sang Youl Rhee
- Department of Endocrinology and Metabolism, College of Medicine, Kyung Hee University, Seoul, Korea
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University Medical Center, Seoul, Korea
| | - Soo-Yong Shin
- Department of Digital Health, SAIHST, Sungkyunkwan University, Seoul, Korea
- Department of Intelligent Precision Healthcare Convergence, Sungkyunkwan University, Suwon, Korea
- Center for Research Resource Standardization, Samsung Medical Center, Seoul, Korea
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Ayers C, Kansagara D, Lazur B, Fu R, Kwon A, Harrod C. Effectiveness and Safety of Treatments to Prevent Fractures in People With Low Bone Mass or Primary Osteoporosis: A Living Systematic Review and Network Meta-analysis for the American College of Physicians. Ann Intern Med 2023; 176:182-195. [PMID: 36592455 DOI: 10.7326/m22-0684] [Citation(s) in RCA: 46] [Impact Index Per Article: 46.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND The prevalence of osteoporosis is increasing in the United States. PURPOSE To evaluate low bone mass and osteoporosis treatments to prevent fractures. DATA SOURCES Ovid MEDLINE ALL, Ovid Evidence Based Medicine Reviews: Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and ClinicalTrials.gov from 2014 through February 2022. STUDY SELECTION Adults receiving eligible interventions for low bone mass or osteoporosis. Randomized controlled trials (RCTs) for fracture outcomes, and RCTs and large observational studies (n ≥1000) for harms. DATA EXTRACTION Abstracted by 1 reviewer and verified by a second. Independent, dual assessments of risk of bias and certainty of evidence (CoE). DATA SYNTHESIS We included 34 RCTs (in 100 publications) and 36 observational studies. Bisphosphonates and denosumab reduced hip, clinical and radiographic vertebral, and other clinical fractures in postmenopausal females with osteoporosis (moderate to high CoE). Bisphosphonates for 36 months or more may increase the risk for atypical femoral fractures (AFFs) and osteonecrosis of the jaw (ONJ), but the absolute risks were low. Abaloparatide and teriparatide reduced clinical and radiographic vertebral fractures but increased the risk for withdrawals due to adverse events (WAEs; moderate to high CoE). Raloxifene and bazedoxifene for 36 months or more reduced radiographic vertebral but not clinical fractures (low to moderate CoE). Abaloparatide, teriparatide, and sequential romosozumab, then alendronate, may be more effective than bisphosphonates in reducing clinical fractures for 17 to 24 months in older postmenopausal females at very high fracture risk (low to moderate CoE). Bisphosphonates may reduce clinical fractures in older females with low bone mass (low CoE) and radiographic vertebral fractures in males with osteoporosis (low to moderate CoE). LIMITATION Few studies examined participants with low bone mass, males, or Black-identifying persons, sequential therapy, or treatment beyond 3 years. CONCLUSION Bisphosphonates, denosumab, abaloparatide, teriparatide, and romosozumab, followed by alendronate, reduce clinical fractures in postmenopausal females with osteoporosis. Abaloparatide and teriparatide increased WAEs; longer duration bisphosphonate use may increase AFF and ONJ risk though these events were rare. PRIMARY FUNDING SOURCE American College of Physicians. (PROSPERO: CRD42021236220).
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Affiliation(s)
- Chelsea Ayers
- Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, Portland, Oregon (C.A.)
| | - Devan Kansagara
- Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, Portland, and Division of General Internal Medicine & Geriatrics, Department of Medicine, Oregon Health & Science University, Portland, Oregon (D.K.)
| | - Brittany Lazur
- Center for Evidence-based Policy, Oregon Health & Science University, Portland, Oregon (B.L.)
| | - Rongwei Fu
- Oregon Health & Science University-Portland State University School of Public Health, Portland, Oregon (R.F.)
| | - Amy Kwon
- Division of General Internal Medicine & Geriatrics, Department of Medicine, Oregon Health & Science University, Portland, Oregon (A.K.)
| | - Curtis Harrod
- Division of General Internal Medicine & Geriatrics, Department of Medicine, and Center for Evidence-based Policy, Oregon Health & Science University, Portland, Oregon (C.H.)
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Sharma A, Michels LV, Pitsillides AA, Greeves J, Plotkin LI, Cardo V, Sims NA, Clarkin CE. Sexing Bones: Improving Transparency of Sex Reporting to Address Bias Within Preclinical Studies. J Bone Miner Res 2023; 38:5-13. [PMID: 36301601 PMCID: PMC10099537 DOI: 10.1002/jbmr.4729] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 10/11/2022] [Accepted: 10/20/2022] [Indexed: 01/10/2023]
Abstract
Despite knowledge that sexually dimorphic mechanisms regulate bone homeostasis, sex often remains unreported and unconsidered in preclinical experimental design. Failure to report sex could lead to inappropriate generalizations of research findings and less effective translation into clinical practice. Preclinical sex bias (preferential selection of one sex) is present across other fields, including neuroscience and immunology, but remains uninvestigated in skeletal research. For context, we first summarized key literature describing sexually dimorphic bone phenotypes in mice. We then investigated sex reporting practices in skeletal research, specifically how customary it is for murine sex to be included in journal article titles or abstracts and then determined whether any bias in sex reporting exists. Because sex hormones are important regulators of bone health (gonadectomy procedures, ie, ovariectomy [OVX] and orchidectomy [ORX], are common yet typically not reported with sex), we incorporated reporting of OVX and ORX terms, representing female and male mice, respectively, into our investigations around sex bias. Between 1999 and 2020, inclusion of sex in titles or abstracts was low in murine skeletal studies (2.6%-4.06%). Reporting of OVX and ORX terms was low (1.44%-2.64%) and reporting of OVX and ORX with sex uncommon (0.4%-0.3%). When studies were combined to include both sexes and OVX (representing female) and ORX terms (representing male), a bias toward reporting of female mice was evident. However, when the terms OVX and ORX were removed, a bias toward the use of male mice was identified. Thus, studies focusing on sex hormones are biased toward female reporting with all other studies biased in reporting of male mice. We now call upon journal editors to introduce consistent guidance for transparent and accessible reporting of murine sex in skeletal research to better monitor preclinical sex bias, to diversify development of treatments for bone health, and to enable global skeletal health equity. © 2022 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).
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Affiliation(s)
- Aikta Sharma
- School of Biological Sciences, University of Southampton, Southampton, UK
| | - Lysanne V Michels
- School of Biological Sciences, University of Southampton, Southampton, UK
| | - Andrew A Pitsillides
- Department of Comparative Biomedical Sciences, Royal Veterinary College, London, UK
| | - Julie Greeves
- Army Health and Performance Research, Ministry of Defence, Andover, UK
| | - Lillian I Plotkin
- Department of Anatomy, Cell Biology and Physiology, School of Medicine, Indiana University, Indianapolis, IN, USA
| | - Valentina Cardo
- Winchester School of Art, University of Southampton, Winchester, UK
| | - Natalie A Sims
- Department of Medicine at St. Vincent's Hospital, St. Vincent's Institute of Medical Research and The University of Melbourne, Fitzroy, Australia
| | - Claire E Clarkin
- School of Biological Sciences, University of Southampton, Southampton, UK
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Whitney DG, Clines GA, Leis AM, Caird MS, Hurvitz EA. Five-year risk of fracture and subsequent fractures among adults with cerebral palsy. Bone Rep 2022; 17:101613. [PMID: 36052289 PMCID: PMC9424353 DOI: 10.1016/j.bonr.2022.101613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 08/17/2022] [Accepted: 08/18/2022] [Indexed: 11/16/2022] Open
Abstract
Background Epidemiologic evidence documenting the incidence of fracture and subsequent fractures among adults with cerebral palsy (CP) is lacking, which could inform fracture prevention efforts. The objective was to characterize the 5-year rate of initial and subsequent fragility fractures among adults with CP. Methods This retrospective cohort study used Medicare claims from 01/01/2008–12/31/2019 from adults ≥18 years old with CP (n = 44,239) and elderly ≥65 years old without CP (n = 2,176,463) as a comparison. The incidence rate (IR), IR ratio (IRR), and site distribution were estimated for the initial and subsequent fragility fractures over 5-years by sex and age. Results The IR of fragility fracture at any site over the 5-year follow-up was similar for 18–30-year-old men with CP (IR = 5.2; 95%CI = 4.4–5.9) and 30–34-year-old women with CP (IR = 6.3; 95%CI = 5.3–7.2) compared to the same sex youngest-old (65–74 years old) without CP (IRR = 1.09 and 0.94, respectively, both P > 0.05), and increased with older age for those with CP. The number of fragility fractures and IR of subsequent fragility fractures was similar for young men and middle-aged women with CP compared to elderly without CP, and increased with older age for those with CP. The proportion of fragility fracture at the tibia/fibula decreased while the vertebral column and multiple simultaneous sites (most involved hip/lower extremities) increased with older age. Conclusion Young and middle-aged adults with CP had similar-to-worse initial and subsequent fragility fracture profiles compared to the general elderly population- a well characterized group for bone fragility. Findings emphasize the need for fracture prevention efforts at younger ages for CP, possibly by ~5 decades younger. Fracture prevention efforts are focused on the elderly and postmenopausal women. Fragility fracture risk is elevated for those with CP across the adult lifespan. For men, the risk for 18–29 year olds (CP) was on par with 65–74 year olds (no CP). For women, risk for 30–34 year olds (CP) was on par with 65–74 year olds (no CP). CP had a higher risk of subsequent fragility fractures that was also premature.
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Affiliation(s)
- Daniel G. Whitney
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
- Corresponding author at: Department of Physical Medicine and Rehabilitation, University of Michigan, 325 E. Eisenhower, Ann Arbor, MI, USA.
| | - Gregory A. Clines
- Division of Metabolism, Endocrinology & Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
- Endocrinology Section, Ann Arbor VA Medical Center, Ann Arbor, MI, USA
| | - Aleda M. Leis
- Epidemiology Department, University of Michigan, Ann Arbor, MI, USA
| | - Michelle S. Caird
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Edward A. Hurvitz
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA
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10
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Zhang L, Wang Y, Schuemie MJ, Blei DM, Hripcsak G. Adjusting for indirectly measured confounding using large-scale propensity score. J Biomed Inform 2022; 134:104204. [PMID: 36108816 DOI: 10.1016/j.jbi.2022.104204] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 08/16/2022] [Accepted: 09/06/2022] [Indexed: 11/15/2022]
Abstract
Confounding remains one of the major challenges to causal inference with observational data. This problem is paramount in medicine, where we would like to answer causal questions from large observational datasets like electronic health records (EHRs) and administrative claims. Modern medical data typically contain tens of thousands of covariates. Such a large set carries hope that many of the confounders are directly measured, and further hope that others are indirectly measured through their correlation with measured covariates. How can we exploit these large sets of covariates for causal inference? To help answer this question, this paper examines the performance of the large-scale propensity score (LSPS) approach on causal analysis of medical data. We demonstrate that LSPS may adjust for indirectly measured confounders by including tens of thousands of covariates that may be correlated with them. We present conditions under which LSPS removes bias due to indirectly measured confounders, and we show that LSPS may avoid bias when inadvertently adjusting for variables (like colliders) that otherwise can induce bias. We demonstrate the performance of LSPS with both simulated medical data and real medical data.
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Affiliation(s)
- Linying Zhang
- Department of Biomedical Informatics, Columbia University Irving Medical Center, 622 W. 168th Street, PH20, New York, 10032, NY, USA
| | - Yixin Wang
- Department of Statistics, University of Michigan, 1085 S University Ave, Ann Arbor, 48109, MI, USA
| | - Martijn J Schuemie
- Janssen Research and Development, 1125 Trenton-Harbourton Road, Titusville, 08560, NJ, USA
| | - David M Blei
- Department of Statistics, Columbia University, 1255 Amsterdam Ave, New York, 10027, NY, USA; Department of Computer Science, Columbia University, 500 West 120 Street, Room 450 MC0401, New York, 10027, NY, USA
| | - George Hripcsak
- Department of Biomedical Informatics, Columbia University Irving Medical Center, 622 W. 168th Street, PH20, New York, 10032, NY, USA; Medical Informatics Services, New York-Presbyterian Hospital, 622 W. 168th Street, PH20, New York, 10032, NY, USA.
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11
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Hwang H, Quiroz JC, Gallego B. Assessing the effectiveness of empirical calibration under different bias scenarios. BMC Med Res Methodol 2022; 22:208. [PMID: 35896966 PMCID: PMC9327283 DOI: 10.1186/s12874-022-01687-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 07/19/2022] [Indexed: 12/01/2022] Open
Abstract
Background Estimations of causal effects from observational data are subject to various sources of bias. One method for adjusting for the residual biases in the estimation of treatment effects is through the use of negative control outcomes, which are outcomes not believed to be affected by the treatment of interest. The empirical calibration procedure is a technique that uses negative control outcomes to calibrate p-values. An extension of this technique calibrates the coverage of the 95% confidence interval of a treatment effect estimate by using negative control outcomes as well as positive control outcomes, which are outcomes for which the treatment of interest has known effects. Although empirical calibration has been used in several large observational studies, there is no systematic examination of its effect under different bias scenarios. Methods The effect of empirical calibration of confidence intervals was analyzed using simulated datasets with known treatment effects. The simulations consisted of binary treatment and binary outcome, with biases resulting from unmeasured confounder, model misspecification, measurement error, and lack of positivity. The performance of the empirical calibration was evaluated by determining the change in the coverage of the confidence interval and the bias in the treatment effect estimate. Results Empirical calibration increased coverage of the 95% confidence interval of the treatment effect estimate under most bias scenarios but was inconsistent in adjusting the bias in the treatment effect estimate. Empirical calibration of confidence intervals was most effective when adjusting for the unmeasured confounding bias. Suitable negative controls had a large impact on the adjustment made by empirical calibration, but small improvements in the coverage of the outcome of interest were also observable when using unsuitable negative controls. Conclusions This work adds evidence to the efficacy of empirical calibration of the confidence intervals in observational studies. Calibration of confidence intervals is most effective where there are biases due to unmeasured confounding. Further research is needed on the selection of suitable negative controls. Supplementary Information The online version contains supplementary material available at 10.1186/s12874-022-01687-6.
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Affiliation(s)
- Hon Hwang
- Centre for Big Data Research in Health (CBDRH), University of New South Wales, Level 2, AGSM Building, G27, Botany St, Kensington NSW, Sydney, 2052, Australia
| | - Juan C Quiroz
- Centre for Big Data Research in Health (CBDRH), University of New South Wales, Level 2, AGSM Building, G27, Botany St, Kensington NSW, Sydney, 2052, Australia
| | - Blanca Gallego
- Centre for Big Data Research in Health (CBDRH), University of New South Wales, Level 2, AGSM Building, G27, Botany St, Kensington NSW, Sydney, 2052, Australia.
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12
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Kim R, Kim SW, Kim H, Ku SY. The impact of sex steroids on osteonecrosis of the jaw. Osteoporos Sarcopenia 2022; 8:58-67. [PMID: 35832420 PMCID: PMC9263170 DOI: 10.1016/j.afos.2022.05.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 04/24/2022] [Accepted: 05/18/2022] [Indexed: 12/30/2022] Open
Abstract
Sex steroid hormones play a major role in bone homeostasis. Therefore, the use of sex hormones or drugs may increase the risk of osteonecrosis of the jaw (ONJ), a complication caused by damaged bone homeostasis. However, few are known the impact of medications changing sex hormone levels on ONJ. The pathophysiology of ONJ is not clearly understood and many hypotheses exist: cessation of bone remodeling caused by its anti-resorptive effect on osteoclasts; compromised microcirculation due to medication affecting angiogenesis, including bisphosphonate; and impairment of defense mechanism toward local infection. The use of high-dose intravenous bisphosphonate in cancer patients is associated with a high prevalence of ONJ. Exogenous estrogen or androgen replacement was reported to be associated with ONJ. Polycystic ovarian syndrome (PCOS) patients demonstrate an androgen excess status, and androgen overproduction serves as a protective factor in the bone mineral density of young women. To date, there are no reports of ONJ occurrence due to androgen overproduction. In contrast, few reports on the occurrence of ONJ due to estrogen deficiency induced by drugs, such as selective estrogen receptor modulator (SERM), aromatase inhibitors, and gonadotropin-releasing hormone (GnRH) agonists, are available. Thus, the role of sex steroids in the development of ONJ is not known. Further studies are required to demonstrate the exact role of sex steroids in bone homeostasis and ONJ progression. In this review, we will discuss the relationship between medication associated with sex steroids and ONJ.
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13
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Taguchi A. Letter to the Editor From Taguchi: "Osteonecrosis of the Jaw and Antiresorptive Agents in Benign and Malignant Diseases: A Critical Review Organized by the ECTS". J Clin Endocrinol Metab 2022; 107:e2646. [PMID: 35213697 DOI: 10.1210/clinem/dgac109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Indexed: 12/17/2022]
Affiliation(s)
- Akira Taguchi
- Department of Oral and Maxillofacial Radiology, School of Dentistry, Matsumoto Dental University, Hirooka, Shiojiri, Nagano, 399-0781, Japan
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14
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Anastasilakis AD, Pepe J, Napoli N, Palermo A, Magopoulos C, Khan AA, Zillikens MC, Body JJ. Response to Letter to the Editor From Taguchi: "Osteonecrosis of the Jaw and Antiresorptive Agents in Benign and Malignant Diseases: A Critical Review Organized by the ECTS". J Clin Endocrinol Metab 2022; 107:e2651-e2652. [PMID: 35213729 PMCID: PMC9113816 DOI: 10.1210/clinem/dgac111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Indexed: 11/19/2022]
Affiliation(s)
- Athanasios D Anastasilakis
- Department of Endocrinology, 424 General Military Hospital, Thessaloniki 56429, Greece
- Correspondence: Dr. Athanasios Anastasilakis, Ring Road, 564 29 N. Efkarpia, Thessaloniki, Greece.
| | - Jessica Pepe
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, “Sapienza” University of Rome, 00185 Rome, Italy
| | - Nicola Napoli
- Unit of Endocrinology and Diabetes, Departmental Faculty of Medicine and Surgery, Campus Bio-Medico University of Rome, 00128 Rome, Italy
| | - Andrea Palermo
- Unit of Endocrinology and Diabetes, Departmental Faculty of Medicine and Surgery, Campus Bio-Medico University of Rome, 00128 Rome, Italy
| | - Christos Magopoulos
- Department of Oral and Maxillofacial Surgery, 424 General Military Hospital, Thessaloniki 56429, Greece
| | - Aliya A Khan
- Division of Endocrinology and Metabolism and Geriatrics, McMaster University, Hamilton, ON L8N 3Z5, Canada
| | - M Carola Zillikens
- Bone Center, Department of Internal Medicine, Erasmus MC, 2040 Rotterdam, The Netherlands
| | - Jean-Jacques Body
- Department of Medicine, CHU Brugmann, Université Libre de Bruxelles, 1050 Brussels, Belgium
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15
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Sinyani A, Idowu K, Shunmugam L, Kumalo HM, Khan R. A molecular dynamics perspective into estrogen receptor inhibition by selective flavonoids as alternative therapeutic options. J Biomol Struct Dyn 2022; 41:4093-4105. [PMID: 35477414 DOI: 10.1080/07391102.2022.2062786] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Zearalenone is an estrogenic mycotoxin which is a common food contaminant and has been implicated in increasing the incidence of carcinogenesis and other reproductive health ailments through the estrogen receptor alpha (ERα) pathway. Competitive ERα blockers such as 4-Hydroxytamoxifen (OHT), are synthetic FDA approved drugs which, albeit being an effective anticancer agent, induces life altering side effects. For this reason, there is an increased interest in the use of naturally occurring medicinal plant products such as flavonoids. This study aimed to identity flavonoid ERα inhibitors and provide insights into the mechanism of inhibition using computational techniques. The Molecular Mechanics/Generalized Born Surface Area calculations revealed that quercetrin, hesperidin, epigallocatechin 3-gallate and kaempferol 7-O-glucoside out of 14 flavonoids had higher binding affinity for ERα than OHT. The structural analysis revealed that the binding of the compounds to the receptor lead to dynamic alterations, which induced conformational shift in the structure and orientation of the receptor resulting in stabilised, compact and low energy systems. The results of this study provide imperative information that supports the use of flavonoids in the inhibition of ERα to prevent or ameliorate the consequential adverse effects associated with zearalenone exposure.Communicated by Ramaswamy H. Sarma.
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Affiliation(s)
- Angela Sinyani
- Discipline of Medical Biochemistry, School of Laboratory Medicine and Medical Science, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Kehinde Idowu
- KwaZulu-Natal Research, Innovation and Sequencing Platform (KRISP)/Genomics Unit, School of Laboratory Medicine and Medical Sciences, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Letitia Shunmugam
- Discipline of Medical Biochemistry, School of Laboratory Medicine and Medical Science, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Hezekiel Mathambo Kumalo
- Discipline of Medical Biochemistry, School of Laboratory Medicine and Medical Science, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Rene Khan
- Discipline of Medical Biochemistry, School of Laboratory Medicine and Medical Science, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
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16
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Huang Y, Liao L, Su H, Chen X, Jiang T, Liu J, Hou Q. Psoralen accelerates osteogenic differentiation of human bone marrow mesenchymal stem cells by activating the TGF-β/Smad3 pathway. Exp Ther Med 2021; 22:940. [PMID: 34306204 PMCID: PMC8281312 DOI: 10.3892/etm.2021.10372] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 05/07/2021] [Indexed: 12/18/2022] Open
Abstract
Psoralen, one of the active ingredients in Psoralea corylifolia, has been previously reported to regulate the osteogenic differentiation of bone marrow mesenchymal stem cells (BMSCs). A previous study revealed that psoralen can regulate the expression levels of microRNA-488 and runt-related transcription factor 2 (Runx2) to promote the osteogenic differentiation of BMSCs. However, the underlying signalling pathway in this process remains to be fully elucidated. BMSCs have also been confirmed to play a key role in the occurrence and development of osteoporosis, and are expected to be potential seed cells in the treatment of osteoporosis. In order to explore the potential signalling pathways of psoralen acting on BMSCs, in the present study, human BMSCs (hBMSCs) were treated with different concentrations of psoralen (0.1, 1, 10 and 100 µmol/l) and the TGF-β receptor I (RI) inhibitor SB431542 (5 µmol/l) in vitro for 3, 7 or 14 days. Cell Counting Kit-8 and MTT assays were used to measure cell proliferation and cell viability of hBMSCs following psoralen administration. Alkaline phosphatase (ALP) activity and alizarin red S staining were used to assess the osteogenic differentiation ability of hBMSCs. Reverse transcription-quantitative PCR and western blotting were used to measure the expression of osteogenic differentiation-related genes [bone morphogenetic protein 4 (BMP4), osteopontin (OPN), Runx2 and Osterix] and proteins associated with the TGF-β/Smad3 pathway [TGF-β1, TGF-β RI, phosphorylated (p-)Smad and Smad3]. Psoralen was found to increase the proliferation and viability of hBMSCs. Although different concentrations of psoralen enhanced ALP activity and the calcified nodule content in hBMSCs, the enhancement effects were more potent at lower concentrations (0.1, 1 and 10 µmol/l). The expression of BMP4, OPN, Osterix, Runx2, TGF-β1, TGF-β RI and p-Smad3 was also promoted by psoralen at lower concentrations (0.1, 1 and 10 µmol/l). In addition, whilst SB431542 could inhibit calcium deposition and osteogenic differentiation-related gene expression in hBMSCs, psoralen effectively reversed the inhibitory effects of SB431542. In conclusion, psoralen accelerates the osteogenic differentiation of hBMSCs by activating the TGF-β/Smad3 pathway, which may be valuable for the future clinical treatment of osteoporosis.
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Affiliation(s)
- Yongquan Huang
- Department of Orthopaedics, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong 510006, P.R. China.,Graduate School, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong 510405, P.R. China
| | - Liu Liao
- Graduate School, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong 510405, P.R. China
| | - Haitao Su
- Department of Orthopaedics, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong 510006, P.R. China
| | - Xinlin Chen
- Department of Preventive Medicine and Health Statistics, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong 510405, P.R. China
| | - Tao Jiang
- Department of Orthopaedics, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong 510006, P.R. China
| | - Jun Liu
- Department of Orthopaedics, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong 510006, P.R. China
| | - Qiuke Hou
- Department of Gastroenterology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong 510405, P.R. China
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