Assessing the knowledge, attitude and practice of osteoporosis among Pakistani women: A national social-media based survey

Sibtain Ahmed; Arsala Jameel Farooqui; Nousheen Akber Pradhan; Nawazish Zehra; Hafsa Majid; Lena Jafri; Aysha Habib Khan

doi:10.1371/journal.pone.0288057

Peer Review History

Original SubmissionDecember 21, 2022
13 Mar 2023 Decision Letter - Tauqeer Hussain Mallhi, Editor PONE-D-22-34888Assessing the Knowledge, Attitude and Practice of Osteoporosis among Pakistani Women: A National Social-Media Based SurveyPLOS ONE Dear Dr. Ahmed, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. Please submit your revised manuscript by Apr 27 2023 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file. Please include the following items when submitting your revised manuscript: A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'. A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'. An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'. If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter. If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: https://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols. Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols. We look forward to receiving your revised manuscript. Kind regards, Tauqeer Hussain Mallhi, Ph.D Academic Editor PLOS ONE Journal Requirements: When submitting your revision, we need you to address these additional requirements. 1. Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. The PLOS ONE style templates can be found at https://journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf and https://journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf 2. We noticed you have some minor occurrence of overlapping text with the following previous publication(s), which needs to be addressed: http://www.smj.org.sg/sites/default/files/SMJ-62-190.pdf and https://cyberleninka.org/article/n/721573 In your revision ensure you cite all your sources (including your own works), and quote or rephrase any duplicated text outside the methods section. Further consideration is dependent on these concerns being addressed 3. Please provide additional details regarding participant consent. In the ethics statement in the Methods and online submission information, please ensure that you have specified what type you obtained (for instance, written or verbal, and if verbal, how it was documented and witnessed). If your study included minors, state whether you obtained consent from parents or guardians. If the need for consent was waived by the ethics committee, please include this information [Note: HTML markup is below. Please do not edit.] Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: Yes Reviewer #2: Yes Reviewer #3: Yes Reviewer #4: Yes ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes Reviewer #2: Yes Reviewer #3: Yes Reviewer #4: Yes ****** 3. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #1: Yes Reviewer #2: Yes Reviewer #3: Yes Reviewer #4: Yes ****** 4. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: Yes Reviewer #2: Yes Reviewer #3: Yes Reviewer #4: Yes ****** 5. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: 1. It would be better to define primary and secondary outcome variables in methods section in line with objectives. Results, discussion and conclusion need to follow the same in chain. 2. Methods sections is supposed to be core of any study. Here, methods section contains inadequate information. For example, following components for methods section need to be well described. i. Details of Study design ii. Setting iii. Sample size estimation iv. Sampling technique v. Participant vi. Primary and secondary outcome variables with working definition vii. Intervention/issue of interest (exposure) viii. Ethics and end point ix. Statistical analysis 3. The discussion section needs to be described scientifically. Kindly frame it along the following lines: a. Main findings of the present study b. Comparison with other studies c. Implication and explanation of findings d. Strengths and limitations e. Conclusion, recommendation and future directions Reviewer #2: This research found that adult Pakistani women have a fair understanding of osteoporosis, but the OPAAT tool clarifies some common misconceptions. There is a need to develop educational strategies to increase the knowledge of osteoporosis among Pakistani adults and to promote a bone-healthy lifestyle.This is an interesting and meaningful study, and I recommend accept. Reviewer #3: Thank you for the article. It was a nice read. Obviously, the effort was meant to highlight the issue and find out the misconceptions using validated outcome measure. The authors have just done that. In a survey, there will always be issues with demographics and how was the population selected. Urban Sindh being more tech advanced and educated obviously will sway the percentages in any survey. If the scores could be adjusted according to provinces, this would have been cherry on top. Best Regards Reviewer #4: Assessing the Knowledge, Attitude and Practice of Osteoporosis among Pakistani Women: A National Social-Media Based Survey Review Thank you for letting me review your article. This study assesses Pakistani women's knowledge, attitudes, practices about osteoporosis by using OPAAT. The content is useful for educating Pakistanis about osteoporosis in the future. Methods Line70-71 It is not clear on how you arrived at the sample size, please describe what you estimated the absolute precision and expected response rate to be. Data management is extremely important for research using social media, as in this study. Please describe in detail how you maintained the quality of the data. Results Line 78 What was the response rate? Does it mean it was 100%? Please state. Discussion Please provide more details on strength and limitation, such as how limitation may not apply to the general public. In terms of limitation, since the study participants were only social media users, the findings cannot be generalized to the general population. Please describe what proposed solution is possible based on the results of this study. It would be a very useful paper if specific solutions could be mentioned that would raise the level of knowledge of osteoporosis among the people of Pakistan. ****** 6. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy. Reviewer #1: Yes: Dr. Satish Prasad Barnawal Reviewer #2: No Reviewer #3: No Reviewer #4: No ******** [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.] While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step. <quillbot-extension-portal></quillbot-extension-portal> https://doi.org/10.1371/journal.pone.0288057.r001
Revision 1
19 Apr 2023 Author Response Response to Reviewers: Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: 1. It would be better to define primary and secondary outcome variables in methods section in line with objectives. Results, discussion and conclusion need to follow the same in chain. Response: Primary and secondary outcomes are now defined in the Methods. The rest of the sections also follow the same in chain. 2. Methods sections is supposed to be core of any study. Here, methods section contains inadequate information. For example, following components for methods section need to be well described. i. Details of Study design ii. Setting iii. Sample size estimation iv. Sampling technique v. Participant vi. Primary and secondary outcome variables with working definition vii. Intervention/issue of interest (exposure) viii. Ethics and end point ix. Statistical analysis Response: The methods are now well defined and in line with the format mentioned above. 3. The discussion section needs to be described scientifically. Kindly frame it along the following lines: a. Main findings of the present study b. Comparison with other studies c. Implication and explanation of findings d. Strengths and limitations e. Conclusion, recommendation and future directions Response: Thank you for your feedback. We have modified the section according to your guidance and made changed in the section in the revised manuscript. Reviewer #2: This research found that adult Pakistani women have a fair understanding of osteoporosis, but the OPAAT tool clarifies some common misconceptions. There is a need to develop educational strategies to increase the knowledge of osteoporosis among Pakistani adults and to promote a bone-healthy lifestyle. This is an interesting and meaningful study, and I recommend accept. Reviewer #3: Thank you for the article. It was a nice read. Obviously, the effort was meant to highlight the issue and find out the misconceptions using validated outcome measure. The authors have just done that. In a survey, there will always be issues with demographics and how was the population selected. Urban Sindh being more tech advanced and educated obviously will sway the percentages in any survey. If the scores could be adjusted according to provinces, this would have been cherry on top. Best Regards Response: Thank you for such a wonderful review, we have tried our best to highlight these disparities in our text, but it was not a focus of our objective hence it is too late to adjust our results now. We have mentioned it in the Limitations section. Reviewer #4: Assessing the Knowledge, Attitude and Practice of Osteoporosis among Pakistani Women: A National Social-Media Based Survey Review Thank you for letting me review your article. This study assesses Pakistani women's knowledge, attitudes, practices about osteoporosis by using OPAAT. The content is useful for educating Pakistanis about osteoporosis in the future. Methods Line70-71 It is not clear on how you arrived at the sample size, please describe what you estimated the absolute precision and expected response rate to be. Response: For sample size, an Open EPI calculator at 95% confidence interval was used which yielded a sample of 384. This sample size is calculated on the assumption that 50% of participants possess some knowledge of osteoporosis (6). However, for statistical convenience we recruited 400 subjects. 6. Lulla D, Teo CW, Shen X, Loi ZB, Quek KW, Lis HL, Koh SA, Chan ET, Lim SW, Low LL. Assessing the knowledge, attitude and practice of osteoporosis among Singaporean women aged 65 years and above at two SingHealth polyclinics. Singapore Medical Journal. 2021 Apr 1;62(4):190-4. Data management is extremely important for research using social media, as in this study. Please describe in detail how you maintained the quality of the data. Response: To ensure the quality of the data, we ensured that the following steps were undertaken. • Research question and survey question was well-defined prior to the collection of the data. • Easily comprehensible OPAAT tool was used. The other surveys in which this tool was used reported good understanding of the questions from the participants’ end. • The forms were disseminated ethically and transparently through social media where our target population was likely to be found, ensuring a variety of respondents. • The data was fully checked and assessed for inconsistencies, errors and incompletion. If found, this missing data was supposed to be removed from the data set, which did not happen in our case as all the responses were complete. • Data was protected and available only to the research team, primarily the principal investigator and statistician. • Appropriate data analysis techniques were used to answer the research question. Results Line 78 What was the response rate? Does it mean it was 100%? Please state. Response: Yes, the response rate was 100%. This is mentioned in the first line of the Results section. Discussion Please provide more details on strength and limitation, such as how limitation may not apply to the general public. In terms of limitation, since the study participants were only social media users, the findings cannot be generalized to the general population. Please describe what proposed solution is possible based on the results of this study. It would be a very useful paper if specific solutions could be mentioned that would raise the level of knowledge of osteoporosis among the people of Pakistan. Response: These are valid points and have been addressed in the manuscript. Thank you for your valuable review. Attachments Attachment Submitted filename: Response to Reviewers_18_April.docx https://doi.org/10.1371/journal.pone.0288057.r002
12 May 2023 Decision Letter - Tauqeer Hussain Mallhi, Editor PONE-D-22-34888R1Assessing the Knowledge, Attitude and Practice of Osteoporosis among Pakistani Women: A National Social-Media Based SurveyPLOS ONE Dear Dr. Ahmed, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. Please submit your revised manuscript by Jun 26 2023 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file. Please include the following items when submitting your revised manuscript: A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'. A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'. An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'. If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter. If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: https://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols. Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols. We look forward to receiving your revised manuscript. Kind regards, Tauqeer Hussain Mallhi, Ph.D Academic Editor PLOS ONE Journal Requirements: Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice. Additional Editor Comments: Dear Authors, thank you for addressing the comments of the reviewers. The manuscript needs further improvement as referees are not much satisfied with the previous round of revisions. [Note: HTML markup is below. Please do not edit.] Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation. Reviewer #1: (No Response) Reviewer #2: All comments have been addressed Reviewer #4: All comments have been addressed ******** 2. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: (No Response) Reviewer #2: Yes Reviewer #4: Yes ****** 3. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: (No Response) Reviewer #2: Yes Reviewer #4: Yes ****** 4. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #1: (No Response) Reviewer #2: Yes Reviewer #4: Yes ****** 5. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: (No Response) Reviewer #2: Yes Reviewer #4: Yes ****** 6. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: The paper has not been modified in line with suggestions. For example, discussion section. Conclusion is lengthy. Kindly shorten it. I think the word 'Demographic' has special meaning. It can be replaced with 'baseline information'. Captions of tables need to be well described in detail. For example, for table number 1. Reviewer #2: This study found that Adult Pakistani women have a fair understanding of osteoporosis, but the OPAAT tool clarifies some common misconceptions. There is a need to develop educational strategies to increase the knowledge of osteoporosis among Pakistani adults and to promote a bone-healthy lifestyle. This is an interesting and meaningful study, and I recommend accept. Reviewer #4: Thank you for letting me review your article. For the most part, It is much more coherent now that it has been revised according to the reviewer's advice. Again, data management is very important in a social media study like this study. Please describe what you took care this time in the METHODOLOGY to manage the data so that future research using social media will not neglect data management in the same way. ****** 7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy. Reviewer #1: Yes: Dr Satish Prasad Barnawal Reviewer #2: No Reviewer #4: No ******** [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.] While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step.<quillbot-extension-portal></quillbot-extension-portal> https://doi.org/10.1371/journal.pone.0288057.r003
Revision 2
6 Jun 2023 Author Response Authors’ Responses to Reviewer Comments Comments to the Author 1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation. Reviewer #1: (No Response) Reviewer #2: All comments have been addressed Reviewer #4: All comments have been addressed Authors’ Response: N/A 2. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: (No Response) Reviewer #2: Yes Reviewer #4: Yes Authors’ Response: N/A 3. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: (No Response) Reviewer #2: Yes Reviewer #4: Yes Authors’ Response: N/A 4. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #1: (No Response) Reviewer #2: Yes Reviewer #4: Yes Authors’ Response: N/A 5. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: (No Response) Reviewer #2: Yes Reviewer #4: Yes Authors’ Response: N/A 6. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: The paper has not been modified in line with suggestions. For example, discussion section. Conclusion is lengthy. Kindly shorten it. I think the word 'Demographic' has special meaning. It can be replaced with 'baseline information'. Captions of tables need to be well described in detail. For example, for table number 1. Reviewer #2: This study found that Adult Pakistani women have a fair understanding of osteoporosis, but the OPAAT tool clarifies some common misconceptions. There is a need to develop educational strategies to increase the knowledge of osteoporosis among Pakistani adults and to promote a bone-healthy lifestyle. This is an interesting and meaningful study, and I recommend accept. Reviewer #4: Thank you for letting me review your article. For the most part, It is much more coherent now that it has been revised according to the reviewer's advice. Again, data management is very important in a social media study like this study. Please describe what you took care this time in the METHODOLOGY to manage the data so that future research using social media will not neglect data management in the same way. Authors’ Response: To Reviewer 1: Thank you for your comments. The discussion has been modified in line with comments. Conclusion has been shortened and captions of tables have been described in detail. To Reviewer 2: Thank you for your comments! We appreciate the recommendation to accept. To Reviewer 4: Data management has been described in a separate section in the Methods. https://doi.org/10.1371/journal.pone.0288057.r004
19 Jun 2023 Decision Letter - Tauqeer Hussain Mallhi, Editor Assessing the Knowledge, Attitude and Practice of Osteoporosis among Pakistani Women: A National Social-Media Based Survey PONE-D-22-34888R2 Dear Dr. Ahmed, We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements. Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication. An invoice for payment will follow shortly after the formal acceptance. To ensure an efficient process, please log into Editorial Manager at http://www.editorialmanager.com/pone/, click the 'Update My Information' link at the top of the page, and double check that your user information is up-to-date. If you have any billing related questions, please contact our Author Billing department directly at authorbilling@plos.org. If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org. Kind regards, Tauqeer Hussain Mallhi, Ph.D Academic Editor PLOS ONE Additional Editor Comments (optional): Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation. Reviewer #1: All comments have been addressed Reviewer #4: All comments have been addressed ******** 2. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: Yes Reviewer #4: Yes ****** 3. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes Reviewer #4: Yes ****** 4. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #1: Yes Reviewer #4: Yes ****** 5. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: Yes Reviewer #4: Yes ****** 6. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: I would like to congratulate the authors for wonderful work. It can be accepted for publication provided that all the technical and editorial procedures are over. Reviewer #4: It has been corrected appropriately and is much better. This is an interesting and meaningful study, and I recommend accept. ****** 7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy. Reviewer #1: Yes: Dr Satish Prasad Barnawal Reviewer #4: No ******** <quillbot-extension-portal></quillbot-extension-portal> https://doi.org/10.1371/journal.pone.0288057.r005
Formally Accepted
4 Jul 2023 Acceptance Letter - Tauqeer Hussain Mallhi, Editor PONE-D-22-34888R2 Assessing the Knowledge, Attitude and Practice of Osteoporosis among Pakistani Women: A National Social-Media Based Survey Dear Dr. Ahmed: I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now with our production department. If your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information please contact onepress@plos.org. If we can help with anything else, please email us at plosone@plos.org. Thank you for submitting your work to PLOS ONE and supporting open access. Kind regards, PLOS ONE Editorial Office Staff on behalf of Dr. Tauqeer Hussain Mallhi Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0288057.r006

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