{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T00:27:31Z","timestamp":1783643251789,"version":"3.55.0"},"reference-count":36,"publisher":"Oxford University Press (OUP)","issue":"6","license":[{"start":{"date-parts":[[2016,1,8]],"date-time":"2016-01-08T00:00:00Z","timestamp":1452211200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"DOI":"10.13039\/501100003653","name":"Korea National Institute of Health","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100003653","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2016,6,1]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n               <jats:sec>\n                  <jats:title>\u2003<\/jats:title>\n                  <jats:p>Thiazide diuretic (TZ) use is associated with higher bone mineral density, whereas loop diuretic (LD) use is associated with lower bone density and incident fracture. Dihydropyridine-sensitive calcium channels are expressed on parathyroid cells and may play a role in parathyroid hormone (PTH) regulation. The potential for diuretics and calcium-channel blockers (CCBs) to modulate PTH and calcium homeostasis may represent a mechanism by which they influence skeletal outcomes. We hypothesized that the use of LD and dihydropyridine CCBs is associated with higher PTH, and TZ use is associated with lower PTH. We conducted cross-sectional analyses of participants treated for hypertension in the Multi-Ethnic Study of Atherosclerosis who did not have primary hyperparathyroidism or chronic kidney disease (n\u2009=\u20091888). We used adjusted regression models to evaluate the independent association between TZ, LD, and CCB medication classes and PTH. TZ use was associated with lower PTH when compared with non-TZ use (44.4 versus 46.9\u2009pg\/mL, p\u2009=\u20090.02), whereas the use of LD and CCBs was associated with higher PTH when compared with non-users of each medication class (LD: 60.7 versus 45.5\u2009pg\/mL, p\u2009&amp;lt;\u20090.0001; CCB: 49.5 versus. 44.4\u2009pg\/mL, p\u2009&amp;lt;\u20090.0001). Adjusted regression models confirmed independent associations between TZ use and lower PTH (\u03b2\u2009=\u2009\u20133.2\u2009pg\/mL, p\u2009=\u20090.0007), and LD or CCB use and higher PTH (LD: \u03b2\u2009=\u2009+12.0\u2009pg\/mL, p\u2009&amp;lt;\u20090.0001; CCB: +3.7\u2009pg\/mL, p\u2009&amp;lt;\u20090.0001). Among CCB users, the use of dihydropyridines was independently associated with higher PTH (\u03b2\u2009=\u2009+5.0\u2009pg\/mL, p\u2009&amp;lt;\u20090.0001), whereas non-dihydropyridine use was not (\u03b2\u2009=\u2009+0.58\u2009pg\/mL, p\u2009=\u20090.68). We conclude that in a large community-based cohort with normal kidney function, TZ use is associated with lower PTH, whereas LD and dihydropyridine CCB use is associated with higher PTH. These associations may provide a mechanistic explanation linking use of these medications to the development of skeletal outcomes. \u00a9 2016 American Society for Bone and Mineral Research.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1002\/jbmr.2779","type":"journal-article","created":{"date-parts":[[2016,1,10]],"date-time":"2016-01-10T15:49:33Z","timestamp":1452440973000},"page":"1137-1145","source":"Crossref","is-referenced-by-count":28,"title":["Parathyroid Hormone and the Use of Diuretics and Calcium-Channel Blockers: The Multi-Ethnic Study of Atherosclerosis"],"prefix":"10.1093","volume":"31","author":[{"given":"Sarah","family":"Zaheer","sequence":"first","affiliation":[{"name":"Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women's HospitalHarvard Medical SchoolBostonMAUSA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ian","family":"de Boer","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Department of MedicineUniversity of WashingtonSeattleWAUSA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew","family":"Allison","sequence":"additional","affiliation":[{"name":"Division of Preventive MedicineUniversity of CaliforniaSan DiegoCAUSA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jenifer M","family":"Brown","sequence":"additional","affiliation":[{"name":"Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women's HospitalHarvard Medical SchoolBostonMAUSA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bruce M","family":"Psaty","sequence":"additional","affiliation":[{"name":"Cardiovascular Health Research Unit, Departments of Medicine, Epidemiology, and Health ServicesUniversity of WashingtonSeattleWAUSA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cassianne","family":"Robinson-Cohen","sequence":"additional","affiliation":[{"name":"Kidney Research InstituteUniversity of WashingtonSeattleWAUSA"},{"name":"Division of Nephrology, Department of MedicineUniversity of WashingtonSeattleWAUSA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joachim H","family":"Ix","sequence":"additional","affiliation":[{"name":"Division of Nephrology-HypertensionUniversity of CaliforniaSan DiegoCAUSA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bryan","family":"Kestenbaum","sequence":"additional","affiliation":[{"name":"Kidney Research InstituteUniversity of WashingtonSeattleWAUSA"},{"name":"Division of Nephrology, Department of MedicineUniversity of WashingtonSeattleWAUSA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Siscovick","sequence":"additional","affiliation":[{"name":"The New York Academy of MedicineNew YorkNYUSA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anand","family":"Vaidya","sequence":"additional","affiliation":[{"name":"Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women's HospitalHarvard Medical SchoolBostonMAUSA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2016,1,8]]},"reference":[{"key":"2024021014183104800_jbmr2779-bib-0001","doi-asserted-by":"crossref","first-page":"2396","DOI":"10.1210\/jc.2015-1619","article-title":"Hypertension, antihypertensive medications, and risk of incident primary hyperparathyroidism","author":"Vaidya","year":"2015","journal-title":"J Clin Endocrinol Metab"},{"key":"2024021014183104800_jbmr2779-bib-0002","doi-asserted-by":"crossref","first-page":"490","DOI":"10.1210\/jc.2014-3949","article-title":"Aldosterone, parathyroid hormone, and the use of renin-angiotensin-aldosterone system inhibitors: the multi-ethnic study of atherosclerosis","author":"Brown","year":"2015","journal-title":"J Clin Endocrinol Metab"},{"issue":"5","key":"2024021014183104800_jbmr2779-bib-0003","doi-asserted-by":"crossref","first-page":"515","DOI":"10.1161\/01.HYP.16.5.515","article-title":"Calcitropic hormones, platelet calcium, and blood pressure in essential hypertension","volume":"16","author":"Brickman","year":"1990","journal-title":"Hypertension"},{"key":"2024021014183104800_jbmr2779-bib-0004","doi-asserted-by":"crossref","first-page":"1214","DOI":"10.1016\/j.jacc.2014.01.012","article-title":"Association of 25-hydroxyvitamin D and parathyroid hormone with incident hypertension: MESA (Multi-Ethnic Study of Atherosclerosis)","author":"van Ballegooijen","year":"2014","journal-title":"J Am Coll Cardiol"},{"key":"2024021014183104800_jbmr2779-bib-0005","doi-asserted-by":"crossref","first-page":"855","DOI":"10.1111\/j.1532-5415.2009.02195.x","article-title":"Loop diuretic use and rates of hip bone loss and risk of falls and fractures in older women","author":"Lim","year":"2009","journal-title":"J Am Geriatr Soc"},{"key":"2024021014183104800_jbmr2779-bib-0006","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1359\/JBMR.051003","article-title":"Loop diuretics increase bone turnover and decrease BMD in osteopenic postmenopausal women: results from a randomized controlled study with bumetanide","author":"Rejnmark","year":"2006","journal-title":"J Bone Miner Res"},{"key":"2024021014183104800_jbmr2779-bib-0007","doi-asserted-by":"crossref","first-page":"132","DOI":"10.1001\/archinternmed.2008.526","article-title":"Loop diuretic use and fracture in postmenopausal women: findings from the Women's Health Initiative","author":"Carbone","year":"2009","journal-title":"Arch Int Med"},{"key":"2024021014183104800_jbmr2779-bib-0008","doi-asserted-by":"crossref","first-page":"362","DOI":"10.1016\/S0002-9343(00)00510-6","article-title":"Hydrochlorothiazide reduces loss of cortical bone in normal postmenopausal women: a randomized controlled trial","author":"Reid","year":"2000","journal-title":"Am J Med"},{"key":"2024021014183104800_jbmr2779-bib-0009","doi-asserted-by":"crossref","first-page":"1303","DOI":"10.1136\/bmj.301.6764.1303","article-title":"Effect of thiazide on rates of bone mineral loss: a longitudinal study","author":"Wasnich","year":"1990","journal-title":"BMJ"},{"key":"2024021014183104800_jbmr2779-bib-0010","doi-asserted-by":"crossref","first-page":"516","DOI":"10.7326\/0003-4819-133-7-200010030-00010","article-title":"Low-dose hydrochlorothiazide and preservation of bone mineral density in older adults. A randomized, double-blind, placebo-controlled trial","author":"LaCroix","year":"2000","journal-title":"Ann Intern Med"},{"issue":"1)","key":"2024021014183104800_jbmr2779-bib-0011","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1007\/BF01623465","article-title":"A prospective study of thiazide use and fractures in women","volume":"7","author":"Feskanich","year":"1997","journal-title":"Osteoporos Int"},{"key":"2024021014183104800_jbmr2779-bib-0012","first-page":"CD005185","article-title":"Thiazide diuretics and the risk of hip fracture","author":"Aung","year":"2011","journal-title":"Cochrane Database Syst Rev"},{"key":"2024021014183104800_jbmr2779-bib-0013","doi-asserted-by":"crossref","first-page":"227","DOI":"10.1016\/j.ejphar.2010.02.039","article-title":"Protective effect of amlodipine against osteoporosis in stroke-prone spontaneously hypertensive rats","author":"Ushijima","year":"2010","journal-title":"Eur J Pharmacol"},{"issue":"1)","key":"2024021014183104800_jbmr2779-bib-0014","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1016\/8756-3282(91)90053-L","article-title":"Chronic use of the calcium channel blocker nifedipine has no significant effect on bone metabolism in men","volume":"12","author":"Albers","year":"1991","journal-title":"Bone"},{"key":"2024021014183104800_jbmr2779-bib-0015","doi-asserted-by":"crossref","first-page":"581","DOI":"10.1097\/01.hjh.0000203845.26690.cb","article-title":"Treatment with beta-blockers, ACE inhibitors, and calcium-channel blockers is associated with a reduced fracture risk: a nationwide case-control study","author":"Rejnmark","year":"2006","journal-title":"J Hypertens"},{"key":"2024021014183104800_jbmr2779-bib-0016","doi-asserted-by":"crossref","first-page":"1258","DOI":"10.1093\/ndt\/gfr026","article-title":"Diuretics, calciuria and secondary hyperparathyroidism in the Chronic Renal Insufficiency Cohort","author":"Isakova","year":"2011","journal-title":"Nephrol Dial Transplant"},{"key":"2024021014183104800_jbmr2779-bib-0017","doi-asserted-by":"crossref","first-page":"E180","DOI":"10.1152\/ajpendo.2001.281.1.E180","article-title":"Parathyroid cells express dihydropyridine-sensitive cation currents and L-type calcium channel subunits","author":"Chang","year":"2001","journal-title":"Am J Physiol Endocrinol Metab"},{"key":"2024021014183104800_jbmr2779-bib-0018","doi-asserted-by":"crossref","first-page":"847","DOI":"10.1113\/expphysiol.2009.046813","article-title":"Dihydropyridine- and voltage-sensitive Ca2+ entry in human parathyroid cells","author":"Yokoyama","year":"2009","journal-title":"Exp Physiol"},{"key":"2024021014183104800_jbmr2779-bib-0019","doi-asserted-by":"crossref","first-page":"235","DOI":"10.1007\/s12576-013-0255-x","article-title":"Detection of dihydropyridine- and voltage-sensitive intracellular Ca(2+) signals in normal human parathyroid cells","author":"Iida","year":"2013","journal-title":"J Physiol Sci"},{"key":"2024021014183104800_jbmr2779-bib-0020","doi-asserted-by":"crossref","first-page":"1007","DOI":"10.1210\/jcem-68-6-1007","article-title":"The calcium channel blocker diltiazem lowers serum parathyroid hormone levels in vivo and in vitro","author":"Seely","year":"1989","journal-title":"J Clin Endocrinol Metab"},{"issue":"3)","key":"2024021014183104800_jbmr2779-bib-0021","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1097\/00000441-199009000-00001","article-title":"Effects of calcium channel blockade on calcium homeostasis in mild to moderate essential hypertension","volume":"300","author":"Townsend","year":"1990","journal-title":"Am J Med Sci"},{"issue":"1)","key":"2024021014183104800_jbmr2779-bib-0022","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1111\/j.1365-2265.1995.tb02592.x","article-title":"Nifedipine, but not verapamil, acutely elevates parathyroid hormone levels in premenopausal women","volume":"42","author":"Wynne","year":"1995","journal-title":"Clin Endocrinol"},{"issue":"4)","key":"2024021014183104800_jbmr2779-bib-0023","first-page":"890","article-title":"Diltiazem stimulates parathyroid hormone secretion in vivo whereas felodipine does not","volume":"76","author":"Villiger","year":"1993","journal-title":"J Clin Endocrinol Metab"},{"key":"2024021014183104800_jbmr2779-bib-0024","doi-asserted-by":"crossref","first-page":"871","DOI":"10.1093\/aje\/kwf113","article-title":"Multi-ethnic study of atherosclerosis: objectives and design","author":"Bild","year":"2002","journal-title":"Am J Epidemiol"},{"issue":"6)","key":"2024021014183104800_jbmr2779-bib-0025","doi-asserted-by":"crossref","first-page":"683","DOI":"10.1016\/0895-4356(92)90143-B","article-title":"Assessing the use of medications in the elderly: methods and initial experience in the Cardiovascular Health Study. The Cardiovascular Health Study Collaborative Research Group","volume":"45","author":"Psaty","year":"1992","journal-title":"J Clin Epidemiol"},{"key":"2024021014183104800_jbmr2779-bib-0026","doi-asserted-by":"crossref","first-page":"1950","DOI":"10.1093\/ndt\/gfr535","article-title":"Interpretation of serum PTH concentrations with different kits in dialysis patients according to the KDIGO guidelines: importance of the reference (normal) values","author":"Cavalier","year":"2012","journal-title":"Nephrol Dial Transplant"},{"key":"2024021014183104800_jbmr2779-bib-0027","doi-asserted-by":"crossref","first-page":"1243","DOI":"10.3945\/ajcn.112.054502","article-title":"Estimating mean annual 25-hydroxyvitamin D concentrations from single measurements: the Multi-Ethnic Study of Atherosclerosis","author":"Sachs","year":"2013","journal-title":"Am J Clin Nutr"},{"key":"2024021014183104800_jbmr2779-bib-0028","doi-asserted-by":"crossref","first-page":"604","DOI":"10.7326\/0003-4819-150-9-200905050-00006","article-title":"A new equation to estimate glomerular filtration rate","author":"Levey","year":"2009","journal-title":"Ann Int Med"},{"key":"2024021014183104800_jbmr2779-bib-0029","doi-asserted-by":"crossref","first-page":"4890","DOI":"10.1210\/jc.2013-2286","article-title":"Influence of estrogen therapy on calcium, phosphorus, and other regulatory hormones in postmenopausal women: the MESA study","author":"Bansal","year":"2013","journal-title":"J Clin Endocrinol Metab"},{"key":"2024021014183104800_jbmr2779-bib-0030","doi-asserted-by":"crossref","first-page":"e6390","DOI":"10.1136\/bmj.e6390","article-title":"Calcium intake and risk of primary hyperparathyroidism in women: prospective cohort study","volume":"345","author":"Paik","year":"2012","journal-title":"BMJ"},{"key":"2024021014183104800_jbmr2779-bib-0031","first-page":"20","article-title":"Furosemide stimulation of parathormone in humans: role of the calcium-sensing receptor and the renin-angiotensin system","author":"Muller","year":"2015","journal-title":"Pflugers Arch"},{"key":"2024021014183104800_jbmr2779-bib-0032","doi-asserted-by":"crossref","first-page":"137","DOI":"10.1001\/jamainternmed.2014.5857","article-title":"Association of loop diuretic use with higher parathyroid hormone levels in patients with normal renal function","author":"Corapi","year":"2015","journal-title":"JAMA Intern Med"},{"key":"2024021014183104800_jbmr2779-bib-0033","doi-asserted-by":"crossref","first-page":"1315","DOI":"10.1007\/s00198-008-0612-4","article-title":"Effects of three years of low-dose thiazides on mineral metabolism in healthy elderly persons","author":"Ott","year":"2008","journal-title":"Osteoporos Int"},{"issue":"11)","key":"2024021014183104800_jbmr2779-bib-0034","doi-asserted-by":"crossref","first-page":"1087","DOI":"10.1016\/0024-3205(95)02054-M","article-title":"The effect of nifedipine on serum parathyroid hormone and calcitonin in postmenopausal women","volume":"57","author":"Zofkova","year":"1995","journal-title":"Life Sci"},{"issue":"2)","key":"2024021014183104800_jbmr2779-bib-0035","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1002\/j.1552-4604.1990.tb03451.x","article-title":"The effects of nicardipine on sodium and calcium metabolism in hypertensive patients: a chronic study","volume":"30","author":"Soro","year":"1990","journal-title":"J Clin Pharmacol"},{"key":"2024021014183104800_jbmr2779-bib-0036","doi-asserted-by":"crossref","first-page":"273","DOI":"10.1161\/HYPERTENSIONAHA.113.01910","article-title":"Human interventions to characterize novel relationships between the renin-angiotensin-aldosterone system and parathyroid hormone","author":"Brown","year":"2014","journal-title":"Hypertension"}],"container-title":["Journal of Bone and Mineral Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1002%2Fjbmr.2779","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/academic.oup.com\/jbmr\/article-pdf\/31\/6\/1137\/56649180\/jbmr2779.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/jbmr\/article-pdf\/31\/6\/1137\/56649180\/jbmr2779.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,3,13]],"date-time":"2024-03-13T14:55:43Z","timestamp":1710341743000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/jbmr\/article\/31\/6\/1137-1145\/7605147"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2016,1,8]]},"references-count":36,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2016,1,8]]},"published-print":{"date-parts":[[2016,6,1]]}},"URL":"https:\/\/doi.org\/10.1002\/jbmr.2779","relation":{},"ISSN":["0884-0431","1523-4681"],"issn-type":[{"value":"0884-0431","type":"print"},{"value":"1523-4681","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2016,6,1]]},"published":{"date-parts":[[2016,1,8]]}}}