Osteoporosis Medications: Not All They’re Cracked Up to Be 骨粗鬆症薬の効果はどれほど確かか：試験結果の「ひっくり返りやすさ」を点検する 研究者は、主要誌に掲載された骨粗鬆症薬の無作為化試験27件を見直し、骨折予防効果が「どれほど簡単に崩れるか」を検証した。 手法は、治療群で追加の骨折が何件起きるかと統計的な有意差が消えるかを数えるもの。 その結果、有効性はごく少数の変化で逆転し得ることが示された。 骨折アウトカム1件を防ぐのに必要な治療人数の中央値は約86人で、治療群に平均9件の骨折が増えるだけで有意差がなくなる（試験規模は平均約2000人）。 薬剤別の中央値は、ビスホスホネート8件、副甲状腺ホルモン類似薬6件、デノスマブ4件で、絶対的な利益は控えめで、低リスク患者では不確かさが大きい可能性がある。 Across 27 randomized trials of osteoporosis medications, reported fracture benefits looked statistically fragile. A handful of extra fractures in the treatment arms—about nine on average—would erase significance, despite trials enrolling around 2,000 people. Fragility was greatest for denosumab and modest for bisphosphonates and parathyroid hormone analogs, showing modest absolute reductions. clinician.nejm.org/osteoporo… #骨粗鬆症 #骨折予防 #エビデンスの脆さ #osteoporosis #fractureprevention #fragilityindex Fragility of Evidence for the Efficacy of Anti-Fracture Medications academic.oup.com/jcem/articl…

How strong isthe evidence for QT grafts in ACL reconstruction? Most RCTs are statistically fragile — just 1 patient could flip the results. Caution needed in interpretation. #ACL #Orthopaedics #SportsMedicine #FragilityIndex Reach here: doi.org/10.1002/ksa.12535

📢 Launching a New Study for Lasting Impact! 🌍 Today, @IOMSouthSudan & @DukeU will present significant #Fragilityindex findings in 🇸🇸 Through the study, we aim to shift from crisis response to sustainable recovery. With thanks to @EUinSouthSudan for making this possible.

A paper published last week reminded me of the #FragilityIndex concept to assess the stability of the results of clinical trials 1/7 #MethodologyMonday #86

How fragile are results from trials comparing neuraxial anaesthesia and general anaesthesia for hip fracture surgery? New correspondence by Restrepo et al #statistics #fragilityindex #hipfracture bjanaesthesia.org/article/S0…

What is the quality of evidence of randomized trials in hernia? Maybe not as good as we think. #FragilityIndex #RCTs @THeniford @plasticfish83 @GregoryTScarola @AlexisHollandMD @CMC_GSResidents @AmericanHernia @eurohernias jamanetwork.com/journals/jam…

Statistical fragility of reporting hemidiaphragmatic paralysis after brachial plexus blocks in randomized controlled trials: a systematic review. A #FragilityIndex #anesthesiology link.springer.com/article/10…

Sloppy methodology with a low powered study where only a few poorly completed death certificates (ie cardiac arrest is not a cause of death) could completely change the statistical significance of the findings by anonymous authors = dubious conclusions. #fragilityindex

This is the #fragilityindex (which is a measure of how many events the statistical significance of a result depends on) applied to critically ill mRCTs reporting a statistically significant effect on mortality @IntensiveBot pubmed.ncbi.nlm.nih.gov/2696…

This is the fragility index applied to perioperative trials with statistically significant effect on survivial. The Fragility Index may complement frequentist analysis and provide quantitative assessment of robustness. #fragilityindex @IntensiveBot pubmed.ncbi.nlm.nih.gov/3102…

A review of the fragility index, a metric which may be used to assess the robustness of a study's statistical significance. #statistics #pvalue #fragilityindex @QueensuPHS link.springer.com/article/10…

How interesting. I wonder what would happen if @scotgov analysed the #FragilityIndex for Scotland alone.

Our recent #hiparthroscopy systematic survey on RCTs published in @ArthroscopyJ resulted in a low #Fragilityindex, indicating that the findings tended to be fragile. Link below pubmed.ncbi.nlm.nih.gov/3353…

📣 Journal Club Tool #FragilityIndex: Measures trial robustness Calculates # of pts required to lose statistical significance i.e. Would 1 more pt w/the outcome change statistical significance? Would 10 more change it? Learned from @GermHunterMD at #IDWeek2020 #toppaperstxid

Now on @JAMAInternalMed .The basis of a good trial design is the delicate balance between the number of patients whose treatment is based on randomization and the solidity of the results.The #fragilityindex is an important first step in this direction. ja.ma/2ZVX6lx

Not only was I ratio-ed by #MedTwitter, I was also reprimanded by @RogueRad on the pod. As a (former) bike racer, current AF ablation doc, and co-author of a #FragilityIndex paper, I have b/c accustomed to tension, frustration and criticism/abuse. So bring it on!

Researching the question (vulnerability of findings/conclusions to minor perturbations) is a good idea. Relying on the #fragilityindex as sole arbiter not ideal.

The question (how vulnerable are these findings/conclusions to minor perturbations) and idea (using a number to express this) are good. But it’s naive to expect ultimate truth from a number without context. #fragilityindex

Look 👀! Our latest paper is out.Thanks for all your help and hard work team! #BladderBowelDysfuntion #Altmetrics #FragilityIndex @jpurology @DanKeefe12 @JHannickMD @laudakris @karenmilford @JoanaRosaP @nirajm @KoyleMarty @ArmandoJLorenzo

#Botswana is the only stable country in #Africa on this #fragilityindex #FragilityStatesIndex