High degree of leisure-time physical activity, high occupational class, and high BMI protected against hip fracture. However, work-related physical activity was not protective. Smoking, tall stature, and interim stroke or dementia increased the risk.

No abstract

This nationwide study of patients with NFPA showed an overall excess mortality in women and in patients with a young age at diagnosis. Increased mortality was seen for cerebrovascular and infectious diseases.

ObjectiveThe general aim was to meet the need for empirical comparative studies of health-related quality of life (HRQoL) assessment instruments, by evaluating and comparing the psychometric properties and results of three different, widely used, generic HRQoL instruments in a population sample. The specific aims were to evaluate the subscales of the different instruments that measure the same domain and to assess the association between the HRQoL measures and a single-item self-rated health scale.DesignAn observational cross-sectional study.SettingA population-based sample from Gothenburg, Sweden, was studied in 2008 in the WHO MONItoring of trends and determinants for CArdiovascular disease.ParticipantsA total of 414 subjects were included, 77% women, age range 39–78 years.InterventionsThe Nottingham Health Profile (NHP), the Short Form-36 questionnaire (SF-36), the Psychological General Well-Being Index (PGWB) and a self-rated health scale were used.Outcome measuresScores were analysed for their psychometric properties, internal consistency (Cronbach’s α), construct validity (Spearman’s rank correlations and R2coefficients) and discriminative ability for the presence of self-rated ill-health.ResultsPGWB and SF-36 had higher Cronbach’s α scores than NHP. All correlations calculated between the subscales that were conceptually similar were significant (p<0.01). All subscales could differentiate the presence of self-rated ill-health according to the self-rated health scale (p<0.001). The self-rated health scale correlated strongly with all of the three HRQoL instruments used.ConclusionsThere was a high concordance between the instruments within each domain that was conceptually similar. All three HRQoL instruments (PGWB, SF-36 and NHP) could discriminate the presence of self-rated ill-health. The simple and quick self-rated health scale correlated strongly with the more time-consuming PGWB, SF-36 and NHP. The result supports the existence of a strong association between the self-rated health scale and HRQoL in the general population.

Objective: To study secular trends in sex hormones, anthropometry, bone measures and fractures. Design: A random population sample was studied twice and subjects of similar age group were compared 13 years apart. Methods: X-ray-verified fractures were retrieved from a random population sample of 2400 men and women (participants 1616Z67%) aged 25-64 years from the WHO, MONICA Project in Gothenburg, Sweden, in 1995 and. Fasting serum hormones and calcaneal ultrasound were measured in every fourth subject. In fertile women, measurements were performed on cycle day interval 7-9. Results: In 2008, men had lower serum free testosterone than men of similar age in 1995 (P!0.001). Body composition, physical activity and fracture incidence were similar. In women, hormone replacement therapy (HRT) was lower in 2008, 7 vs 28% (P!0.0001), as was serum oestradiol, although use of tranquilisers and leisure time physical activity were higher. In 2008, the fracture incidence was higher in postmenopausal women, 29 vs 17% (P!0.001), and vertebral crush had increased from 8 to 19% of all fractures (PZ0.031). Serum cholesterol and triglycerides were lower in all subjects in 2008 compared with that in 1995. Conclusions: Secular trends were observed with lower serum testosterone in men in 2008, but no effect was seen on the fracture incidence of these fairly young men. In postmenopausal women in 2008, there was a higher fracture incidence along with more vertebral compressions. Lower HRT use, lower serum oestradiol and higher fall risk exposure due with more tranquilisers and leisure time physical activity in 2008 may explain the results.

SummaryObjectiveThere is limited knowledge about the natural history of normocalcaemic, vitamin D‐sufficient hyperparathyroidism (nHPT). The aim was to study the prevalence of nHPT and its relation to morbidity.DesignCross‐sectional and retrospective study at the Sahlgrenska University Hospital, Gothenburg, Sweden.SubjectsA random population of 608 men and women, age 25–64 years, was studied in 1995 as part of the WHO MONICA study and reinvestigated in 2008 (n = 410, of whom 277 were vitamin D sufficient).MeasurementsA serum intact parathyroid hormone (S‐PTH) ≥60 ng/l was considered as HPT, S‐calcium 2·15–2·49 mmol/l as normocalcaemia and S‐25(OH)D ≥ 50 nmol/l as vitamin D sufficiency. Data on fractures, stroke and myocardial infarction were retrieved until 2013, that is a 17‐year follow‐up.ResultsThe prevalence of nHPT was 2·0% in 1995 (age 25–64) and 11·0% in 2008 (age 38–79). S‐PTH was positively correlated with age and BMI. After adjustment for these variables, a high S‐PTH level (≥60 ng/l) at follow‐up was associated with previously low S‐25(OH)D, high osteocalcin, S‐PTH and both past and presently treated hypertension. No relation was seen with creatinine, cystatin C, malabsorption markers, thyroid function, glucose, insulin, lipids, calcaneal quantitative ultrasound, fractures, myocardial infarction, stroke or death at follow‐up.ConclusionsThis small random population study showed that nHPT was common, 11% at follow‐up. Only one individual developed mild hypercalcaemia in 13 years. Previous S‐PTH was predictive of nHPT and hypertension was prevalent, but no increase in hard end‐points was seen over a 17‐year period.

STUDY QUESTION What are the predictive factors for later development of type 2 diabetes (T2DM) in women with polycystic ovary syndrome (PCOS)? SUMMARY ANSWER Obesity and abdominal fat distribution in women with PCOS in the mid-fertile years were the major risk factors for T2DM development 24 years later when lifestyle factors were similar to controls. WHAT IS KNOWN ALREADY Women with PCOS have an increased prevalence of T2DM. STUDY DESIGN, SIZE, DURATION A longitudinal and cross-sectional study was performed. Women with PCOS were examined in 1992 and in 2016. Randomly selected, age-matched women from the general population served as controls. PARTICIPANTS/MATERIALS, SETTING, METHODS Women with PCOS (n = 27), attending an outpatient clinical at a tertiary care centre for infertility or hirsutism were diagnosed in 1992 (mean age 30 years) and re-examined in 2016 (mean age 52 years). Women from the World Health Organization MONItoring of trends and determinants for CArdiovascular disease (WHO MONICA-GOT) 2008, aged 38–68 years, served as controls (n = 94), and they were previously examined in 1995. At both at baseline and at follow-up, women had blood samples taken, underwent a clinical examination and completed structured questionnaires, and the women with PCOS also underwent a glucose clamp test at baseline. MAIN RESULTS AND THE ROLE OF CHANCE None of women with PCOS had T2DM at baseline. At the 24-year follow-up, 19% of women with PCOS had T2DM versus 1% of controls (P &lt; 0.01). All women with PCOS who developed T2DM were obese and had waist-hip ratio (WHR) &gt;0.85 at baseline. No difference was seen between women with PCOS and controls regarding use of high-fat diet, Mediterranean diet or amount of physical activity at follow-up at peri/postmenopausal age. However, women with PCOS had a lower usage of a high-sugar diet as compared to controls (P = 0.01). The mean increases in BMI and WHR per year were similar in women with PCOS and controls during the follow-up period. LIMITATIONS, REASONS FOR CAUTION The small sample size of women with PCOS and the fact that they were recruited due to infertility or hirsutism make generalization to women with milder forms of PCOS uncertain. WIDER IMPLICATIONS OF THE FINDINGS Obesity and abdominal fat distribution, but not hyperandrogenism per se, in women with PCOS in the mid-fertile years were the major risk factors for T2DM development 24 years later when peri/postmenopausal. Lifestyle factors were similar to controls at that time. STUDY FUNDING/COMPETING INTEREST(S) The study was financed by grants from the Swedish state under the agreement between the Swedish government and the country councils, the ALF-agreement (ALFGBG-718611), the Gothenburg Medical Association GLS 694291 and 780821, the Swedish Heart Lung Foundation and Hjalmar Svensson Foundation. The authors have no conflict of interest.

Introduction Epidemiological studies on the incidence of Cushing's syndrome (CS) are few and most often includes only patients with the most common form, that is Cushing's disease (CD). Objective To analyse the incidence of endogenous CS in an unselected cohort of patients from western Sweden between 2002 and 2017. Methods Medical records from patients who had received a diagnostic code for CS and adrenocortical carcinoma in the Västra Götaland County between 2002 and 2017 were reviewed. Eighty‐two patients had been diagnosed with endogenous CS in the region during the study period and were included in this analysis. Results Thirty‐nine patients (48%) had CD, 21 (26%) had ectopic ACTH‐producing tumour, 17 (21%) had a benign adrenal CS, and 5 (6%) had cortisol‐producing adrenocortical carcinoma. Nine of 21 (43%) patients with ectopic CS had an ACTH‐producing lung tumour, 4 had a neuroendocrine pancreas tumour, and 5 had an occult tumour. The annual incidence of endogenous CS was 3.2 cases per million/y; 1.5 for CD, 0.8 for ectopic CS, 0.7 for benign adrenal CS and 0.2 for adrenocortical carcinoma. Conclusions Approximately three new cases of endogenous CS, per one million inhabitants, were diagnosed annually between 2002 and 2017. Compared with previous reports, proportionally more patients had ectopic CS. The reason for this is unclear although increased awareness of hypercortisolism in patients with malignant tumours in the modern era is a possible explanation.