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J Clin Endocrinol Metab. 2016 Apr;101(4):1590-7. doi: 10.1210/jc.2015-3836. Epub 2016 Jan 26.

Physical Activity and the Risk of Primary Hyperparathyroidism.

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Division of Endocrinology, Diabetes, and Hypertension (A.V.), Division of Renal Medicine (G.C.C., J.M.P.), Channing Division of Network Medicine (G.C.C., J.M.P., E.N.T.), Brigham and Women's Hospital (A.V., G.C.C., J.M.P., E.N.T.), Boston, Massachusetts; Harvard Medical School (A.V., J.M.P.), Boston, Massachusetts; Department of Epidemiology (G.C.C. J.M.P., M.W.), Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Division of Nephrology and Transplantation (E.N.T.), Maine Medical Center, Portland, Maine 02115.



Primary hyperparathyroidism (P-HPTH) is relatively common and predominantly affects women. Prior studies have shown that physical activity (PA) can lower PTH levels.


Our objective was to evaluate the hypothesis that lower PA is a risk factor for developing P-HPTH.


This prospective cohort study included 69 621 female participants in the Nurses' Health Study I followed for 22 years.


PA and other dietary and demographic exposures were quantified via detailed, and validated, biennial questionnaires.


Incident P-HPTH was confirmed by medical record review after initial assessment by questionnaire. Adjusted Cox proportional hazards models were used to evaluate whether PA was an independent risk factor for developing P-HPTH. We also evaluated the risk of developing P-HPTH when combining low PA (<16 metabolic equivalent hours/week) with a previously identified independent risk factor for developing P-HPTH: low calcium intake (<800 mg/day). The relation between PA and PTH levels was evaluated in 625 participants.


We confirmed 302 incident cases of P-HPTH during 1 474 993 person-years of follow-up. Participants in the highest quintile (Q) of PA had a 50% lower risk of developing P-HPTH: age-adjusted relative risks and 95% confidence intervals for incident P-HPTH by lowest to highest of PA were Q1 = 1.0 (reference); Q2 = 0.83 (0.60–1.15); Q3 = 0.84 (0.61–1.15); Q4 = 0.50 (0.34–0.74); Q5 = 0.50 (0.35–0.73); P for trend <.001. Extensive multivariable adjustments did not materially change these findings. The adjusted relative risk for developing P-HPTH among participants with the combination lower PA and lower calcium intake was 2.37-fold (1.60–3.51) higher than in participants with higher PA and higher calcium intake. PA was inversely correlated with serum PTH (ρ = −0.09, P = .03); the mean adjusted serum PTH in Q 2–5 of PA was lower than in Q 1 (36.3 vs 39.1 pg/mL, P = .02).


Low physical activity may be a modifiable risk factor for developing P-HPTH in women.

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