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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

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