Evidence map›Paper›PMID 40269910›Full record

ArticleJournal of orthopaedic surgery and research2025

Serum alkaline phosphatase/creatinine ratio serving as a screening tool for low lumbar bone mineral density in patients with degenerative lumbar scoliosis.

Zhenning Cai, Xing Sun, Bo Shi, Zhenhua Feng, Sen Li, Zezhang Zhu, Yong Qiu, Benlong Shi

Abstract read
In one paragraph

Article in Journal of orthopaedic surgery and research, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors.

Zhenning CaiDivision of Spine Surgery, Department of Orthopaedic Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China.
Xing SunDivision of Spine Surgery, Department of Orthopaedic Surgery, Nanjing Drum Tower Hospital, The Clinical College of Nanjing Medical University, Nanjing, China.
Bo ShiDivision of Spine Surgery, Department of Orthopaedic Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China.
Zhenhua FengDivision of Spine Surgery, Department of Orthopaedic Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China.
Sen LiDivision of Spine Surgery, Department of Orthopaedic Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China.
Zezhang ZhuDivision of Spine Surgery, Department of Orthopaedic Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China.
Yong QiuDivision of Spine Surgery, Department of Orthopaedic Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China.
Benlong ShiDivision of Spine Surgery, Department of Orthopaedic Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China. shi-benlong@163.com.

Funding

Jiangsu Funding Program for Excellent Post-doctoral Talent No. 2022ZB692National Natural Science Foundation of China No. 82202711National Natural Science Foundation of China No. 82302685
6 · The paper itself

Abstract

purpose(1) To figure out a simple and effective indicator that could assist in the assessment of bone mineral density (BMD) based on big data and (2) to verify its predictive value for low BMD among patients with degenerative lumbar scoliosis (DLS).

methodsA total of 6,167 participants from the National Health and Nutrition Examination Survey (NHANES) database (2009-2010, 2013-2014, 2017-2018) and 166 patients who were diagnosed with DLS and hospitalized in our center between June 2019 and April 2023 were enrolled in the study. Cases were divided into two groups based on whether the T-score was below - 1. The Osteopenia Index (OI) was defined as the ratio of alkaline phosphatase (ALP) (IU/L) to creatinine (mg/dL). Multivariable logistic regression was performed to identify risk factors, while restricted cubic spline (RCS) analysis was applied to explore the potential non-linear relationship. Patients with DLS from our center were used to validate the diagnostic value of OI through receiver operating characteristic curve (ROC) analysis.

resultsParticipants from NHANES were divided into three subgroups according to the tertiles of OI: subgroup 1 (OI < 68), subgroup 2 (68 ≤ OI < 93), and subgroup 3 (OI ≥ 93). A multivariable logistic regression model adjusted for age, gender, and race revealed that elevated OI was a significant risk factor for osteopenia (subgroup 2 vs. subgroup 1: odds ratio [OR] = 1.473, 95% confidence interval [CI] = 1.173-1.849; subgroup 3 vs. subgroup 1: OR = 2.092, 95% CI = 1.566-2.796). Moreover, the RCS plot showed that the risk of osteopenia gradually increased with the elevation of OI. In patients with DLS, OI showed a significant correlation with lumbar T-score (ρ = - 0.392) and HU value (ρ = - 0.373) (both P < 0.001). ROC analysis revealed that the area under the curve of OI was 0.757, and the cut-off value was set at 124.73 according to the Youden index. A nomogram based on a logistic regression model adjusted for age, gender, and blood urea nitrogen was plotted, with a McFadden R² of 0.212.

conclusionOI correlated significantly with lumbar BMD and HU value. Logistic regression and RCS analysis demonstrated that OI could serve as a simple, economical, and effective screening tool for low lumbar BMD in DLS patients, with its predictive ability further enhanced when adjusted for age and gender.

Indexed as

Alkaline PhosphataseBone DensityCreatinineLumbar VertebraeScoliosisAgedBiomarkersBone Diseases, MetabolicFemaleHumansMaleMass ScreeningMiddle AgedNutrition SurveysAlkaline PhosphataseBiomarkersCreatinineAlkaline phosphataseBone mineral densityCreatinineDegenerative lumbar scoliosisNHANESOsteopenia

Identifiers

PMID40269910
PMCPMC12016479

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.