Skip to main content
  • Letter to the Editor
  • Open access
  • Published:

In reply to the letter to the editor regarding “The Relationship Between Serum Vitamin D and Fracture Risk in the Elderly: A Meta-Analysis”

Dear Editor,

We wish to thank all of the reviewers for their thought-provoking and insightful comments about our recent meta-analysis published in the journal [1]. Our answers to the questions raised are as follows:

First, at present, there is no conclusion about the database to be searched. The two databases we searched (PubMed and Embase) can find most of the literature. Many meta-analysis also searched only two or three databases [2,3,4,5,6,7,8,9,10,11,12].

Second, registration is not a necessary condition for meta-analysis. On the contrary, most meta-analyses are not registered in PROSPERO. Compared with the significance of the research itself, whether it is registered in the Cochrane Library or PROSPERO is not a matter of special concern. We strictly followed the steps of PRISMA during the research process. According to the relevant requirements of JOSR, the author is required to provide registration information about the system review, including the registration number (if any), and we have clearly indicated our registration status in our Abstract.

Third, participants from Swanon et al. and Cauley et al. are indeed from the same research cohort, but the number of people included in each study is different. More importantly, adjustment factors for the final results are quite different, and the final results remain unchanged even when we exclude one of the studies.

Fourth, compared with previous meta-analyses conducted on this topic, our research sets standards based on bone turnover rate and stricter age limits, which was why we conducted a subgroup analysis of gender. We did feel it was necessary to conduct analysis on BMI as a previous meta-analysis already studied BMI and showed that low BMI under any conditions is one of the risk factors for elderly fractures [13, 14].

Finally, thanks again for the comments you made on this article, and we hope that our reply helps answer your questions.

Availability of data and materials

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.


  1. Wang N, Chen Y, Ji J, Chang J, Yu S, Yu B. The relationship between serum vitamin D and fracture risk in the elderly: a meta-analysis. J Orthop Surg Res. 2020;15(1):81. Published 2020 Feb 27.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Olesen TB, Sand FL, Rasmussen CL, et al. Prevalence of human papillomavirus DNA and p16INK4a in penile cancer and penile intraepithelial neoplasia: a systematic review and meta-analysis. Lancet Oncol. 2019;20(1):145–58.

    Article  CAS  PubMed  Google Scholar 

  3. Gay F, Jackson G, Rosiñol L, et al. Maintenance treatment and survival in patients with myeloma: a systematic review and network meta-analysis. JAMA Oncol. 2018;4(10):1389–97.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Dhakal B, Szabo A, Chhabra S, et al. Autologous transplantation for newly diagnosed multiple myeloma in the era of novel agent induction: a systematic review and meta-analysis. JAMA Oncol. 2018;4(3):343–50.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Boulos MI, Jairam T, Kendzerska T, Im J, Mekhael A, Murray BJ. Normal polysomnography parameters in healthy adults: a systematic review and meta-analysis. Lancet Respir Med. 2019;7(6):533–43.

    Article  PubMed  Google Scholar 

  6. van Geffen WH, Slebos DJ, Herth FJ, Kemp SV, Weder W, Shah PL. Surgical and endoscopic interventions that reduce lung volume for emphysema: a systemic review and meta-analysis. Lancet Respir Med. 2019;7(4):313–24.

    Article  PubMed  Google Scholar 

  7. Bolland MJ, Grey A, Avenell A. Effects of vitamin D supplementation on musculoskeletal health: a systematic review, meta-analysis, and trial sequential analysis. Lancet Diabetes Endocrinol. 2018;6(11):847–58.

    Article  CAS  PubMed  Google Scholar 

  8. Bethel MA, Patel RA, Merrill P, et al. Cardiovascular outcomes with glucagon-like peptide-1 receptor agonists in patients with type 2 diabetes: a meta-analysis. Lancet Diabetes Endocrinol. 2018;6(2):105–13.

    Article  PubMed  Google Scholar 

  9. Al-Shahi Salman R, Frantzias J, Lee RJ, et al. Absolute risk and predictors of the growth of acute spontaneous intracerebral haemorrhage: a systematic review and meta-analysis of individual patient data [published correction appears in Lancet Neurol. 2018 Sep 19]. Lancet Neurol. 2018;17(10):885–94.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Román LS, Menon BK, Blasco J, et al. Imaging features and safety and efficacy of endovascular stroke treatment: a meta-analysis of individual patient-level data [published correction appears in Lancet Neurol. 2018 Dec;17(12):e2-e3]. Lancet Neurol. 2018;17(10):895–904.

    Article  PubMed  Google Scholar 

  11. Chan XHS, Win YN, Mawer LJ, Tan JY, Brugada J, White NJ. Risk of sudden unexplained death after use of dihydroartemisinin-piperaquine for malaria: a systematic review and Bayesian meta-analysis [published correction appears in Lancet Infect Dis. 2018 Jun 26]. Lancet Infect Dis. 2018;18(8):913–23.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Clarke MA, Long BJ, Del Mar MA, Arbyn M, Bakkum-Gamez JN, Wentzensen N. Association of endometrial cancer risk with postmenopausal bleeding in women: a systematic review and meta-analysis. JAMA Intern Med. 2018;178(9):1210–22.

    Article  PubMed  PubMed Central  Google Scholar 

  13. De Laet C, Kanis JA, Odén A, et al. Body mass index as a predictor of fracture risk: a meta-analysis. Osteoporos Int. 2005;16(11):1330–8.

    Article  PubMed  Google Scholar 

  14. Feng Y, Cheng G, Wang H, Chen B. The associations between serum 25-hydroxyvitamin D level and the risk of total fracture and hip fracture. Osteoporos Int. 2017;28(5):1641–52.

    Article  CAS  PubMed  Google Scholar 

Download references



Author information

Authors and Affiliations



NW and JDJ wrote this manuscript. YGC and JLC reviewed the included literature in the article, and SWY checked and evaluated the criteria for included literature. BY revised the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Bo Yu.

Ethics declarations

Ethics approval and consent to participate


Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Wang, N., Ji, J., Yu, S. et al. In reply to the letter to the editor regarding “The Relationship Between Serum Vitamin D and Fracture Risk in the Elderly: A Meta-Analysis”. J Orthop Surg Res 15, 324 (2020).

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: