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1.  Population based case-control study of sick leave in postmenopausal women before diagnosis of hyperparathyroidism 
BMJ : British Medical Journal  1998;317(7162):848-851.
Objective: To analyse sick leave in women at risk of primary hyperparathyroidism before its diagnosis.
Design: Case-control study nested within a screened cohort of postmenopausal women. Cases were women with hyperparathyroidism without prior knowledge of their disease and no traditional symptoms or complications. Controls were women from the screened population without hyperparathyroidism.
Setting: Population based screening within a Swedish community.
Subject: 48 case-control pairs of women aged 55-70 years.
Main outcome measure: Sick leave during the 5 years before diagnosis.
Results: Total duration of sickness benefits was longer in the cases than controls, and this discrepancy included sick leave on full time or half time and for periods of longer than a week. Cases had an increased risk of sick leave more than half of the investigated time compared with controls (odds ratio 12). Doctors’ certificates showed that the overrepresented sick leave in the cases related mainly to cardiovascular diseases.
Conclusion: Asymptomatic mild primary hyperparathyroidism in postmenopausal women is accompanied by a previously unrecognised morbidity, which has consequences for clinical management of the disorder and its impact on the health economy.
Key messages Primary hyperparathyroidism mainly affects postmenopausal women, many of whom lack classic symptoms and complications of the disorder and are currently considered suitable for conservative follow up Postmenopausal women with asymptomatic primary hyperparathyroidism drew more sickness benefit than matched controls during the 5 years before the diagnosis Cardiovascular diseases were the main cause of sick leave The duration of sick leave was not correlated with age or serum calcium concentration Mild undiagnosed hyperparathyroidism in postmenopausal women is linked with previously unrecognised ill health of importance to the clinical and economic impact of the disorder
PMCID: PMC31094  PMID: 9748176
2.  Hormone replacement therapy and risk of hip fracture: population based case-control study 
BMJ : British Medical Journal  1998;316(7148):1858-1863.
Objective: To determine the relative risk of hip fracture associated with postmenopausal hormone replacement therapy including the effect of duration and recency of treatment, the addition of progestins, route of administration, and dose.
Design: Population based case-control study.
Setting: Six counties in Sweden.
Subjects: 1327 women aged 50-81 years with hip fracture and 3262 randomly selected controls.
Main outcome measure: Use of hormone replacement therapy.
Results: Compared with women who had never used hormone replacement therapy, current users had an odds ratio of 0.35 (95 % confidence interval 0.24 to 0.53) for hip fracture and former users had an odds ratio of 0.76 (0.57 to 1.01). For every year of therapy, the overall risk decreased by 6% (3% to 9%): 4% (1% to 8%) for regimens without progestin and 11% (6% to 16%) for those with progestin. Last use between one and five years previously, with a duration of use more than five years, was associated with an odds ratio of 0.27 (0.08 to 0.94). After five years without hormone replacement therapy the protective effect was substantially diminished (−7% to 48%). With current use, an initiation of therapy nine or more years after the menopause gave equally strong reduction in risk for hip fracture as an earlier start. Oestrogen treatment with skin patches gave similar risk estimates as oral regimens.
Conclusions: Recent use of hormone replacement therapy is required for optimum fracture protection, but therapy can be started several years after the menopause. The protective effect increases with duration of use, and an oestrogen-sparing effect is achieved when progestins are included in the regimen.
Key messages Hormone replacement therapy should be continued for long periods for optimal protection of hip fracture No overall substantial hip fracture protection remains after five years without hormone replacement therapy Therapy can be initiated several years after menopause without loss of fracture protection Oral or transdermal therapy are equally effective in reducing the risk of hip fracture The addition of progestins permits lower doses of oestrogens
PMCID: PMC28583  PMID: 9632404

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