Unexpected geographic variation in rates of hospitalization for patients who have fracture of the hip. Medicare enrollees in the United States.

With the use of data from hospitals for fiscal year 1985, we calculated the rates of hospitalization for fracture of the hip, by state of residence, for all enrollees in Medicare who were sixty-five years old or older; we adjusted for age and race. The rate of fracture of the hip was highest in the South and lowest in the Northeast, especially in women. The cause of this difference is not known.

Sex steroids and bone density in premenopausal and perimenopausal women.

Bone density begins to decline in women before menopause, and the degree of bone loss is variable. We performed a cross-sectional analysis on the entry data of a 5-yr prospective study of risk factors for osteoporosis to determine the correlation of bone density with serum sex steroid concentrations and body weight. We studied 292 healthy white women, aged 35-50 yr, who were menstruating regularly or had had menses in the past 12 months. Blood samples were drawn in the early follicular phase for estradiol (E2), testosterone (T), dehydroepiandrosterone sulfate, and sex hormone-binding globulin (SHBG). Free levels of E2 (FE2) and T (FT) were calculated based on total T and E2, SHBG, and albumin levels. Women were classified as premenopausal (FSH, less than 12 U/L) and perimenopausal (FSH greater than or equal to 12 U/L; n = 46; 16%). Bone density was measured by dual photon absorptiometry of the lumbar spine (L2-L4) and hip and by single photon absorptiometry of the wrist. Perimenopausal women were older than premenopausal women (45.5 +/- 3.5 and 41.0 +/- 3.9 yr, respectively), but did not differ in height or weight. While bone density did not correlate with age in each group, perimenopausal women had significantly lower bone density at the L2-L4 and femoral neck (L2-L4, 1.18 +/- 0.14 in perimenopausal and 1.24 +/- 0.12 g/cm2 in premenopausal women; femur, 0.84 +/- 0.11 in perimenopausal and 0.90 +/- 0.11 g/cm2 in premenopausal women; P less than 0.005). Body weight showed the strongest positive correlation with bone density. Log FT, percent FT, and FE2 percent correlated positively with bone density, even after controlling for weight. Log SHBG was negatively correlated with bone density in premenopausal women at the hip and wrist after controlling for weight. FSH was inversely correlated with bone density, and E2 and T were lower in perimenopausal than premenopausal women. These data suggest that women who are still menstruating may have relative deficiencies in both E2 and T, with reduced bone densities as a consequence.

Connective tissue disease in southeastern Georgia: a case-control study of etiologic factors.

The authors conducted a population-based case-control study of connective tissue disease in a four-county area in southeastern Georgia. Interviews with 44 cases and 88 controls were conducted in September and October of 1986. The association with a family history of these disorders was reconfirmed, and a positive association with the use of hair dyes was found. A negative association was found with a family history of diabetes mellitus.

Premature thelarche in Puerto Rico. A search for environmental factors.

Pediatric endocrinologists in Puerto Rico reported a threefold increase in the number of patients with premature thelarche seen between 1978 and 1981. A matched-pairs case-control study was conducted to evaluate associations with potential environmental exposures to substances with estrogenic activity, as well as with familial factors. Analysis was performed on 120 pairs, the case subjects of which were selected from those diagnosed between 1978 and 1982. In subjects 2 years of age or older at the onset of thelarche, no significant associations were found. In subjects with onset before 2 years of age, significant positive associations were found with a maternal history of ovarian cysts, consumption of soy-based formula, and consumption of various meat products. A statistically significant negative association was found with consumption of corn products. These statistical associations are probably not sufficient to explain the reported increase because in over 50% of the case subjects there was no exposure to any of the risk factors for which statistical associations were found. Exposure to other substances with possible estrogenic effect, such as waste products from pharmaceutical factories and pesticides, was also excluded as a possible cause. These findings suggest that better diagnosis and reporting, or conceivably the presence of entirely new, unsuspected factors, could account for the reported increase.

Effects of polychlorinated biphenyls and lipemia on serum analytes.

Twelve serum analytes [triglycerides, cholesterol, total and conjugated bilirubin, high-density-lipoprotein cholesterol (HDL-C), alkaline phosphatase (AP), gammaglutamyl transferase (GGT), aspartate aminotransferase (AST), alanine aminotransferase (ALT), beta-glucuronidase (beta-glu), alanine aminopeptidase (AAP), and 5'-nucleotidase (5'nuc)] were measured to investigate their correlation with exposure to polychlorinated biphenyls (PCBs) and 1,1,1-trichloro-2,2-bis(p-chlorophenyl)ethane (DDT). The relationship between serum lipids, lipophilic toxicants, and the analytes was also evaluated. The beta-glu, 5'nuc, triglycerides, cholesterol, and total bilirubin correlated positively and significantly with log concentrations of serum total PCBs and 1,1-dichloro-2,2-bis(p-chlorophenyl)ethylene (DDE), a metabolite of DDT. The more highly chlorinated PCBs (Aroclor 1260) had significant, positive correlations with several serum analytes, but the less chlorinated PCBs (Aroclor 1242) correlated significantly and negatively only with HDL-cholesterol. Triglyceride- and cholesterol-rich lipoproteins were added to serum to determine the effects of lipids on these assays. Several were spuriously elevated. AP and beta-glu were not affected by lipoprotein addition with the methods used in this study. AAP was increased significantly only at triglyceride concentrations exceeding 400 mg/dl. Lipoproteins may be elevated because of deranged lipid metabolism in response to PCBs, or PCBs may be elevated because elevated lipoproteins are present, as in familial triglyceridemia, a relatively common dyslipoproteinemia. Because this relationship is not well understood with respect to cause and effect, we propose the further use in epidemiological investigations of assay methods that are little affected by blood lipids yet are correlated with PCB concentrations. Congener-specific quantification of PCBs would help elucidate the effects of PCBs on assays used to monitor health effects.

Cancer incidence in the Netherlands Antilles: a survey covering the period 1968--1979.

In 1977 a retrospective study was started into the cancer incidence in the Netherlands Antilles, simultaneously with the onset of a cancer registry. This paper presents the results of this study and of the running registry, together covering a period of 12 years. In total, 1496 cancer cases were registered in males, and 1480 in females. The resulting age-standardized cancer rate (World Standard Population) was 215 cases per 100,000 males and 164 cases per 100,000 females. The most frequently involved primary sites in males were, in order of frequency, lung, stomach, prostate, skin, and esophagus. Cancer in females was most frequently found in breast, uterine cervix, skin, stomach and esophagus. A comparison is made with countries inside and outside the Caribbean region, and a short comment is made on possibly etiologic factors.

Microhematuria found by mass screening of apparently healthy males.

Preparation of urinary sediments was adapted for mass screening purposes. The procedure, characterized by most careful collection and transfer of the sediment and by a rigidly controlled work scheme, was tested in a limited population screening program with 446 healthy male participants. A capacity of 100 samples per 12 manhours was achieved. The procedure was found effective in collecting the cellular content, but there was serious cytolysis due to a 11 hours delay between micturition and processing. An unexpected finding was the presence of erythrocytes in all the samples. In 8.8 per cent of the smears more than ten RBC/hpf were present. The significance of this feature is still in study, but it might prove to be a useful prescreening criterion in the cytologic assessment of bladder cancer in large populations.