Physical Activity and the Risk of Primary Hyperparathyroidism

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


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

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

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

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

Outcomes: 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.

Results: 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).

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

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Exercise / physiology*
  • Female
  • Humans
  • Hyperparathyroidism, Primary / epidemiology*
  • Hyperparathyroidism, Primary / etiology
  • Hyperparathyroidism, Primary / prevention & control*
  • Incidence
  • Maine / epidemiology
  • Middle Aged
  • Prospective Studies
  • Risk Factors