Julie M. Paik

Calcium intake and risk of primary hyperparathyroidism in women: prospective cohort study.

Objective To examine the association between calcium intake and risk of primary hyperparathyroidism in women. Design Prospective cohort study. Setting Nurses’ Health Study I, which originally recruited participants from the 11 most populous states in the United States. Participants 58 354 female registered nurses enrolled in the Nurses’ Health Study I aged 39-66 years in 1986 and with no history of primary hyperparathyroidism. Calcium intake was assessed every four years using semiquantitative questionnaires on food frequency. Main outcome measure Incident primary hyperparathyroidism, confirmed by medical record review. Results During 22 years of follow-up, we recorded 277 incident cases of primary hyperparathyroidism. Women were divided into five equal groups, according to intake of dietary calcium. After adjusting for age, body mass index, race, and other factors, the relative risk of primary hyperparathyroidism for women in the group with the highest intake of dietary calcium was 0.56 (95% confidence interval 0.37 to 0.86, P=0.009 for trend), compared with the group with the lowest intake. The multivariable relative risk of primary hyperparathyroidism for women taking more than 500 mg/day of calcium supplements compared with no calcium supplements was 0.41 (95% confidence interval 0.29 to 0.60, P<0.001 for trend). Analyses restricted to participants with regular physical exams did not significantly change the association between calcium intake and risk of primary hyperparathyroidism. Conclusion Increased calcium intake is independently associated with a reduced risk of primary hyperparathyroidism in women.

Gout and the Risk of Non-vertebral Fracture.

Prior studies suggest an association between osteoporosis, systemic inflammation, and pro‐inflammatory cytokines such as interleukin (IL)‐1 and IL‐6. Conflicting findings exist on the association between hyperuricemia and osteoporosis. Furthermore, it remains unknown whether gout, a common inflammatory arthritis, affects fracture risk. Using data from a US commercial health plan (2004–2013), we evaluated the risk of non‐vertebral fracture (ie, forearm, wrist, hip, and pelvis) in patients with gout versus those without. Gout patients were identified with ≥2 diagnosis codes and ≥1 dispensing for a gout‐related drug. Non‐gout patients, identified with ≥2 visits coded for any diagnosis and ≥1 dispensing for any prescription drugs, were free of gout diagnosis and received no gout‐related drugs. Hip fracture was the secondary outcome. Fractures were identified with a combination of diagnosis and procedure codes. Cox proportional hazards models compared the risk of non‐vertebral fracture in gout patients versus non‐gout, adjusting for more than 40 risk factors for osteoporotic fracture. Among gout patients with baseline serum uric acid (sUA) measurements available, we assessed the risk of non‐vertebral fracture associated with sUA. We identified 73,202 gout and 219,606 non‐gout patients, matched on age, sex, and the date of study entry. The mean age was 60 years and 82% were men. Over the mean 2‐year follow‐up, the incidence rate of non‐vertebral fracture per 1,000 person‐years was 2.92 in gout and 2.66 in non‐gout. The adjusted hazard ratio (HR) was 0.98 (95% confidence interval [CI] 0.85–1.12) for non‐vertebral fracture and 0.83 (95% CI 0.65–1.07) for hip fracture in gout versus non‐gout. Subgroup analysis (n = 15,079) showed no association between baseline sUA and non‐vertebral fracture (HR = 1.03, 95% CI 0.93–1.15), adjusted for age, sex, comorbidity score, and number of any prescription drugs. Gout was not associated with a risk of non‐vertebral fracture. Among patients with gout, sUA was not associated with the risk of non‐vertebral fracture.

Gout and Risk of Fracture in Women: A Prospective Cohort Study

Uric acid may be linked to bone health through its antioxidant or prooxidant effects, thereby affecting bone resorption and formation, or through its dual inhibition of vitamin D activation and parathyroid hormone production. Results of prior studies on the relationship between uric acid and bone mineral density have been conflicting. This prospective study was undertaken to examine the relationship between gout, a disease characterized by hyperuricemia and inflammation, and risk of hip or wrist fracture in women.

Clinical problem solving: Itching for a diagnosis.

A 58-year-old woman presented with a 2-week history of generalized pruritus. She also reported having fatigue, dizziness, and decreased appetite. A week before the onset of symptoms, a mild upper respiratory tract infection had developed.