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Causes of secondary hyperparathyroidism in a healthy population: the Tromsø study

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Abstract

Secondary hyperparathyroidism (SHPT) develops as a compensatory mechanism when the body is in calcium deficit. SHPT may be harmful and has been associated with elevated blood pressure. The cause of SHPT could be low calcium intake, reduced intestinal calcium absorption, or increased excretion. However, the relative importance of these factors for the development of SHPT is not known. During the 5th Tromsø study, serum PTH and calcium were measured in 7954 subjects. Then 96 subjects with SHPT (defined as serum PTH above 6.4 pmol/l together with serum calcium below 2.40 mmol/l) and 106 control subjects were examined at follow-up with a food frequency questionnaire, calcium absorption test, measurement of 24-h urinary calcium excretion, and serum vitamin D status. The statistical analyses showed several interactions necessitating subgroup analysis. It was found that the calcium intake was significantly lower in the SHPT group, but only in nonsmoking males; the calcium absorption was nonsignificantly higher in the SHPT group; the serum 25-hydroxyvitamin D levels were significantly lower in the SHPT group but only in nonsmokers; and the 24-h urinary calcium excretion was significantly lower in the SHPT group but only in those not on blood pressure medication. The most frequent cause of SHPT appeared to be low calcium intake (18%) and a low serum 25-hydroxyvitamin D level (18%). However, in most subjects with SHPT all tests were within the normal range, and the cause is therefore probably a combination of several factors.

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References

  1. R Bouillon G Carmeliet S Boonen (1997) ArticleTitleAgeing and calcium metabolism Ballieres Clin Endocrinol Metab 11 341–365 Occurrence Handle1:STN:280:DyaK1c%2Fms1ygsg%3D%3D

    CAS  Google Scholar 

  2. R Jorde KH Bønaa J Sundsfjord (1999) ArticleTitlePopulation based study on serum ionised calcium, serum parathyroid hormone, and blood pressure: the Tromsø study Eur J Endocrinol 141 350–357 Occurrence Handle10526247 Occurrence Handle10.1530/eje.0.1410350 Occurrence Handle1:CAS:528:DyaK1MXntlOrs7s%3D

    Article  PubMed  CAS  Google Scholar 

  3. E Kamycheva J Sundsfjord R Jorde (2004) ArticleTitleSerum parathyroid hormone level is associated with body mass index: the 5th Tromsø study Eur J Endocrinol 151 167–172 Occurrence Handle15296470 Occurrence Handle10.1530/eje.0.1510167 Occurrence Handle1:CAS:528:DC%2BD2cXntlClsL4%3D

    Article  PubMed  CAS  Google Scholar 

  4. FN Saleh H Schirmer J Sundsfjord R Jorde (2003) ArticleTitleParathyroid hormone and left ventricular hypertrophy Eur Heart J 24 2054–2060 Occurrence Handle14613742 Occurrence Handle10.1016/j.ehj.2003.09.010 Occurrence Handle1:CAS:528:DC%2BD3sXovVehsbs%3D

    Article  PubMed  CAS  Google Scholar 

  5. KH Bønaa E Arnesen (1992) ArticleTitleAssociation between heart rate and atherogenic blood lipid fractions in a population: the Tromsø study Circulation 86 394–405 Occurrence Handle1638708

    PubMed  Google Scholar 

  6. R Jorde KH Bønaa J Sundsfjord (1999) ArticleTitlePopulation based study on serum ionised calcium, serum parathyroid hormone, and blood pressure: the Tromsø study Eur J Endocinol 141 350–357 Occurrence Handle1:CAS:528:DyaK1MXntlOrs7s%3D

    CAS  Google Scholar 

  7. R Jorde KH Bønaa (2000) ArticleTitleCalcium from dairy products, vitamin D intake, and blood pressure: the Tromsø study Am J Clin Nutr 71 1530–1535 Occurrence Handle10837295 Occurrence Handle1:CAS:528:DC%2BD3cXjvFGns70%3D

    PubMed  CAS  Google Scholar 

  8. BE Nordin HA Morris JM Wishart F Scopacasa M Horowitz AG Need PM Clifton (1998) ArticleTitleModification and validation of a single-isotope radiocalcium absorption test J Nucl Med 39 108–113 Occurrence Handle9443747 Occurrence Handle1:CAS:528:DyaK1cXnsFCksQ%3D%3D

    PubMed  CAS  Google Scholar 

  9. R Jorde J Sundsfjord E Haug KH Bønaa (2000) ArticleTitleRelation between low calcium intake, parathyroid hormone, and blood pressure Hypertension 35 1154–1159 Occurrence Handle10818080 Occurrence Handle1:CAS:528:DC%2BD3cXjvV2qt78%3D

    PubMed  CAS  Google Scholar 

  10. K Landin-Wilhelmsen L Wilhelmsen G Lappas T Rosén G Lindstedt PA Lundberg J Wilske BÅ Bengtsson (1995) ArticleTitleSerum intact parathyroid hormone in a random population sample of men and women: relationship to anthropometry, life-style factors, blood pressure, and vitamin D Calcif Tissue Int 56 104–108 Occurrence Handle7736316 Occurrence Handle10.1007/BF00296339 Occurrence Handle1:CAS:528:DyaK2MXkvVylu7w%3D

    Article  PubMed  CAS  Google Scholar 

  11. R Marcus P Madvig G Young (1984) ArticleTitleAge-related changes in parathyroid hormone and parathyroid hormone action in normal humans J Clin Endocrinol Metab 58 223–230 Occurrence Handle6319444 Occurrence Handle1:CAS:528:DyaL2cXpslWmtQ%3D%3D Occurrence Handle10.1210/jcem-58-2-223

    Article  PubMed  CAS  Google Scholar 

  12. J Buchanan C Myers R Greer (1988) ArticleTitleEffect of declining renal function on bone density in aging women Calcif Tissue Int 43 1–6 Occurrence Handle3145115 Occurrence Handle1:CAS:528:DyaL1cXkvFSksLs%3D

    PubMed  CAS  Google Scholar 

  13. J Silver R Levi (2005) ArticleTitleCellular and molecular mechanisms of secondary hyperparathyroidism Clin Nephrol 63 119–126 Occurrence Handle15730054 Occurrence Handle1:CAS:528:DC%2BD2MXhslynsro%3D

    PubMed  CAS  Google Scholar 

  14. JC Souberbielle C Cormier C Kindermans P Gao T Cantor F Forette EE Baulieu (2001) ArticleTitleVitamin D status and redefining serum parathyroid hormone reference range in the elderly J Clin Endocrinol Metab 86 3086–3090 Occurrence Handle11443171 Occurrence Handle10.1210/jc.86.7.3086 Occurrence Handle1:CAS:528:DC%2BD3MXlt1Gjsbc%3D

    Article  PubMed  CAS  Google Scholar 

  15. AG Need A Kemp N Giles HA Morris M Horowitz BEC Nordin (2002) ArticleTitleRelationships between intestinal calcium absorption, serum vitamin D metabolites and smoking in postmenopausal women Osteoporos Int 13 83–88 Occurrence Handle11883410 Occurrence Handle10.1007/s198-002-8342-9 Occurrence Handle1:STN:280:DC%2BD387ltFSqtw%3D%3D

    Article  PubMed  CAS  Google Scholar 

  16. AG Need PD O'Loughlin HA Morris M Horowitz BEC Nordin (2004) ArticleTitleThe effects of age and other variables on serum parathyroid hormone in postmenopausal women attending an osteoporosis center J Clin Endocrinol Metab 89 1646–1649 Occurrence Handle15070925 Occurrence Handle10.1210/jc.2003-031539 Occurrence Handle1:CAS:528:DC%2BD2cXjt1elsLc%3D

    Article  PubMed  CAS  Google Scholar 

  17. AJ Brown A Dusso E Slatopolsky (1999) ArticleTitleVitamin D Am J Physiol Renal Physiol 277 F157–F175 Occurrence Handle1:CAS:528:DyaK1MXls1amsLY%3D

    CAS  Google Scholar 

  18. P Lips T Duong A Oleksik D Black S Cummings D Cox T Nickelsen (2001) ArticleTitleA global study of vitamin D status and parathyroid function in postmenopausal women with osteoporosis: baseline data from the multiple outcomes of Raloxifene Evaluation Clinical Trial J Clin Endocrinol Metab 86 1212–1221 Occurrence Handle11238511 Occurrence Handle10.1210/jc.86.3.1212 Occurrence Handle1:CAS:528:DC%2BD3MXitFWnt7s%3D

    Article  PubMed  CAS  Google Scholar 

  19. PB Rapuri JC Gallagher KE Balhorn KL Ryschon (2000) ArticleTitleSmoking and bone metabolism in elderly women Bone 27 429–436 Occurrence Handle10962356 Occurrence Handle10.1016/S8756-3282(00)00341-0 Occurrence Handle1:CAS:528:DC%2BD3cXmtVGjtr8%3D

    Article  PubMed  CAS  Google Scholar 

  20. P Szulc P Garnero B Claustrat F Marchand F Duboeuf PD Delmas (2002) ArticleTitleIncreased bone resorption in moderate smokers with low body weight: the Minos study J Clin Endocrinol Metab 87 666–674 Occurrence Handle11836302 Occurrence Handle10.1210/jc.87.2.666 Occurrence Handle1:CAS:528:DC%2BD38XhsVSisr8%3D

    Article  PubMed  CAS  Google Scholar 

  21. L Lind A Hänni A Hvarfner T Pollare S Ljunghall H Lithell (1994) ArticleTitleInfluences of different antihypertensive treatments on indices of systemic mineral metabolism Am J Hypertens 7 302–307 Occurrence Handle7913330 Occurrence Handle1:STN:280:DyaK2czgsVGruw%3D%3D

    PubMed  CAS  Google Scholar 

  22. L Rejnmark P Vestergaard L Heickendorff F Andreasen L Mosekilde (2001) ArticleTitleEffects of thiazide- and loop-diuretics, alone or in combination, on calcitropic hormones and biochemical bone markers: a randomized controlled study J Intern Med 250 144–153 Occurrence Handle11489064 Occurrence Handle10.1046/j.1365-2796.2001.00868.x Occurrence Handle1:CAS:528:DC%2BD3MXmsVOltrc%3D

    Article  PubMed  CAS  Google Scholar 

  23. Y Almaden A Hernandez V Torregrosa A Canalejo L Sabate L Fernandez Cruz JM Campistol A Torres M Rodrigues (1998) ArticleTitleHigh phosphate level directly stimulates parathyroid hormone secretion and synthesis by human parathyroid tissue in vitro J Am Soc Nephrol 9 1845–1852 Occurrence Handle9773785 Occurrence Handle1:CAS:528:DyaK1cXmslCju7w%3D

    PubMed  CAS  Google Scholar 

  24. JC Estepa E Aguilera-Tejero I Lopez Y Almaden M Rodriguez AJ Felsenfeld (1999) ArticleTitleEffect of phosphate on parathyroid hormone secretion in vivo J Bone Miner Res 14 1848–1854 Occurrence Handle10571684 Occurrence Handle1:CAS:528:DyaK1MXnsFektr0%3D

    PubMed  CAS  Google Scholar 

  25. SS Harris E Soteriades B Dawson-Hughes (2001) ArticleTitleSecondary hyperparatyroidism and bone turnover in elderly blacks and whites J Clin Endocrinol Metab 86 3801–3804 Occurrence Handle11502814 Occurrence Handle1:CAS:528:DC%2BD3MXlvFekurw%3D

    PubMed  CAS  Google Scholar 

  26. E Lundgren P Ridefelt G Åkerström S Ljunghall J Rastad (1996) ArticleTitleParathyroid tissue in normocalcemic and hypercalcemic primary hyperparathyroidism recruited by health screening World J Surg 20 727–735 Occurrence Handle8678973 Occurrence Handle10.1007/s002689900111 Occurrence Handle1:STN:280:DyaK28vislaitw%3D%3D

    Article  PubMed  CAS  Google Scholar 

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Correspondence to Farahnaz Saleh.

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Saleh, F., Jorde, R., Sundsfjord, J. et al. Causes of secondary hyperparathyroidism in a healthy population: the Tromsø study. J Bone Miner Metab 24, 58–64 (2006). https://doi.org/10.1007/s00774-005-0647-y

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  • DOI: https://doi.org/10.1007/s00774-005-0647-y

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