Peer Review History

Original SubmissionMay 22, 2023
Decision Letter - Ewa Tomaszewska, Editor

PONE-D-23-14590Serum High Sensitivity C-Reactive Protein Poorly Predicts Bone Mineral Density: A NHANES 2017-2020 AnalysisPLOS ONE

Dear Dr. Little,

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.

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We look forward to receiving your revised manuscript.

Kind regards,

Ewa Tomaszewska, DVM Ph.D

Academic Editor

PLOS ONE

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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 

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2. Thank you for stating the following in the Acknowledgments Section of your manuscript: 

"The author would like to thank Dr. Ayland Letsinger, Dr. Daniel Schmitt, and the Animal Locomotion Lab at Duke University for the much-appreciated conversations, feedback, and support. The authors salary is supported by Duke University School of Medicine." 

We note that you have provided funding information that is not currently declared in your Funding Statement. However, funding information should not appear in the Acknowledgments section or other areas of your manuscript. We will only publish funding information present in the Funding Statement section of the online submission form. 

Please remove any funding-related text from the manuscript and let us know how you would like to update your Funding Statement. Currently, your Funding Statement reads as follows: 

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5. We are unable to open your Supporting Information file [NHANESprojectfolder.zip]. Please kindly revise as necessary and re-upload.

6. 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 If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references.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.

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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: No

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2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

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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

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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

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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: I reviewed the manuscript titled “Serum High Sensitivity C-Reactive Protein Poorly Predicts Bone Mineral Density: A NHANES 2017-2020 Analysis” submitted for publication in PLOS One as a research article.

Disclaimers:

-please add keywords.

-it would be appropriate to briefly define the objectives of the analysis in a separate paragraph.

-summarizing the results of the discussion in the form of conclusions in a separate paragraph.

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Reviewer #1: Yes: Jakub Kosiński

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Revision 1

Rebuttal Letter: PONE-D-23-14590

Serum high sensitivity C-reactive protein poorly predicts bone mineral density: a NHANES 2017-2020 analysis

I thank the reviewer for their thoughtful review and suggested revisions. Please find below a point-by-point response. I hope you find all comments to be adequately addressed.

Reviewer Comment #1: please add keywords.

• The following keywords have been added to the manuscript on Page 1, Line 19: osteoporosis, fracture risk, diverse population

Reviewer Comment #2: it would be appropriate to briefly define the objectives of the analysis in a separate paragraph.

• The following sentence defining the objectives of the analysis have been added on Page 4, Lines 80-82:

“The specific objectives of this analysis were to determine if, and how, the sexual and racial diversity of the sample population impacts the correlative and predictive relationships between CRP and bone mineral density and fracture risk.”

Reviewer Comment #3: summarizing the results of the discussion in the form of conclusions in a separate paragraph.

• The following paragraph summarizing the results of the discussion in the form of conclusions has been added to Pages 14-15, Lines 322-332.

“In conclusion, serum levels of C-reactive protein statistically correlate with and predict femoral neck and spine BMD in a sexually and racially diverse population. However, as the magnitude is too low to be biologically meaningful, significant caution should be taken in interpreting the clinical significance and application of serum C-reactive protein as a biomarker for osteoporosis. Weight more robustly predicts femoral neck and spine BMD, compared to serum C-reactive protein. Given that overweight and obese individuals account for nearly half of all osteoporotic fractures, the predictive power of weight in identifying individuals at risk for osteoporosis is severely limited. Current research should continue efforts to identify a clinically available biomarker that robustly predicts low bone mineral density and fracture risk in a diverse population and across of range of body weights and compositions. Rates of both osteoporosis and obesity continue to increase, with osteoporosis remaining largely undetected prior to first fracture, lending significant credence to the need for a robust and predictive biomarker.”

Comments relating to Journal Requirements:

1. The manuscript has been revised to ensure it meets PLOS ONE’s style requirements, including those for file naming.

2. I request no changes to the Funding Statement. I request the Acknowledgements Section be revised as follows, which has been updated in the Manuscript:

“The author would like to thank Dr. Ayland Letsinger, Dr. Daniel Schmitt, and the Animal Locomotion Lab at Duke University for the much-appreciated conversations, feedback, and support.”

3. A full ethics statement has been included in the Methods section of the manuscript.

4. Captions for the Supporting Information materials have been included at the end of the manuscript according to PLOS ONE’s style guidelines.

5. The Supporting Information file has been revised and re-uploaded.

6. The reference list has been reviewed and is complete and correct.

Attachments
Attachment
Submitted filename: Response to Reviewers.docx
Decision Letter - Ewa Tomaszewska, Editor

Serum high sensitivity C-reactive protein poorly predicts bone mineral density: a NHANES 2017-2020 analysis

PONE-D-23-14590R1

Dear Dr. Sarah E Little-Letsinger,

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.

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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,

Ewa Tomaszewska, DVM 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

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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

**********

3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: 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

**********

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

**********

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 have re-reviewed the manuscript titled "Serum High Sensitivity C-Reactive Protein Poorly Predicts Bone Mineral Density: A NHANES 2017-2020 Analysis" submitted for publication in PLOS One as a research article.

The article has been supplemented in accordance with the suggestions from the first review.

I have no further objections.

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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: No

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Formally Accepted
Acceptance Letter - Ewa Tomaszewska, Editor

PONE-D-23-14590R1

Serum high sensitivity C-reactive protein poorly predicts bone mineral density: a NHANES 2017-2020 analysis

Dear Dr. Little-Letsinger:

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

Professor Ewa Tomaszewska

Academic Editor

PLOS ONE

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