{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T22:45:32Z","timestamp":1785797132083,"version":"3.56.0"},"reference-count":55,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,5,25]],"date-time":"2026-05-25T00:00:00Z","timestamp":1779667200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"},{"start":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T00:00:00Z","timestamp":1785715200000},"content-version":"vor","delay-in-days":70,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Sci Rep"],"DOI":"10.1038\/s41598-026-54960-9","type":"journal-article","created":{"date-parts":[[2026,5,25]],"date-time":"2026-05-25T07:35:04Z","timestamp":1779694504000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Prevalence and determinants of secondary hyperparathyroidism: IMOS-2021"],"prefix":"10.1038","volume":"16","author":[{"given":"Hedieh","family":"Koochaki","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2184-7043","authenticated-orcid":false,"given":"Nekoo","family":"Panahi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fatemeh","family":"Mashaknejadian Behbahani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Faezeh","family":"Sehatpour","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kazem","family":"Khalagi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hamid Reza","family":"Aghaei Meybodi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maryam","family":"Panahi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mahnaz","family":"Sanjari","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nazila","family":"Rezaei","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Farideh","family":"Razi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bagher","family":"Larijani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Afshin","family":"Ostovar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Noushin","family":"Fahimfar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,5,25]]},"reference":[{"key":"54960_CR1","doi-asserted-by":"crossref","unstructured":"Lombardi, G. et al. Physical activity-dependent regulation of parathyroid hormone and calcium-phosphorous metabolism. Int. J. Mol. Sci., 21(15) (2020).","DOI":"10.3390\/ijms21155388"},{"issue":"2","key":"54960_CR2","doi-asserted-by":"publisher","first-page":"115","DOI":"10.1038\/nrendo.2017.104","volume":"14","author":"MD Walker","year":"2018","unstructured":"Walker, M. D. & Silverberg, S. J. Primary hyperparathyroidism. Nat. Rev. Endocrinol. 14 (2), 115\u2013125 (2018).","journal-title":"Nat. Rev. Endocrinol."},{"key":"54960_CR3","doi-asserted-by":"crossref","unstructured":"Dandurand, K., Ali, D. S. & Khan, A. A. Primary hyperparathyroidism: A narrative review of diagnosis and medical management. J. Clin. Med., 10(8) (2021).","DOI":"10.3390\/jcm10081604"},{"key":"54960_CR4","doi-asserted-by":"publisher","first-page":"16033","DOI":"10.1038\/nrdp.2016.33","volume":"2","author":"JP Bilezikian","year":"2016","unstructured":"Bilezikian, J. P. et al. Primary hyperparathyroidism. Nat. Rev. Dis. Primers. 2, 16033 (2016).","journal-title":"Nat. Rev. Dis. Primers"},{"issue":"4","key":"54960_CR5","doi-asserted-by":"publisher","first-page":"913","DOI":"10.2215\/CJN.06040710","volume":"6","author":"J Cunningham","year":"2011","unstructured":"Cunningham, J., Locatelli, F. & Rodriguez, M. Secondary hyperparathyroidism: Pathogenesis, disease progression, and therapeutic options. Clin. J. Am. Soc. Nephrol. 6 (4), 913\u2013921 (2011).","journal-title":"Clin. J. Am. Soc. Nephrol."},{"issue":"10","key":"54960_CR6","doi-asserted-by":"publisher","first-page":"e1117","DOI":"10.1210\/clinem\/dgad201","volume":"108","author":"E Soto-Pedre","year":"2023","unstructured":"Soto-Pedre, E., Newey, P. J. & Leese, G. P. Stable incidence and increasing prevalence of primary hyperparathyroidism in a population-based study in Scotland. J. Clin. Endocrinol. Metabolism. 108 (10), e1117\u2013e1124 (2023).","journal-title":"J. Clin. Endocrinol. Metabolism"},{"issue":"11","key":"54960_CR7","doi-asserted-by":"publisher","first-page":"3993","DOI":"10.1210\/jc.2018-01225","volume":"103","author":"JP Bilezikian","year":"2018","unstructured":"Bilezikian, J. P. Primary hyperparathyroidism. J. Clin. Endocrinol. Metab. 103 (11), 3993\u20134004 (2018).","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"54960_CR8","doi-asserted-by":"publisher","first-page":"1400891","DOI":"10.3389\/fendo.2024.1400891","volume":"15","author":"Y Wang","year":"2024","unstructured":"Wang, Y. et al. Estimating the global prevalence of secondary hyperparathyroidism in patients with chronic kidney disease. Front. Endocrinol. (Lausanne). 15, 1400891 (2024).","journal-title":"Front. Endocrinol. (Lausanne)"},{"key":"54960_CR9","doi-asserted-by":"publisher","first-page":"117108","DOI":"10.1016\/j.bone.2024.117108","volume":"184","author":"D Fitzpatrick","year":"2024","unstructured":"Fitzpatrick, D. et al. Secondary hyperparathyroidism: Predictors and relationship with vitamin D status, bone turnover markers and bone mineral density. Bone 184, 117108 (2024).","journal-title":"Bone"},{"key":"54960_CR10","doi-asserted-by":"publisher","first-page":"1070808","DOI":"10.3389\/fnut.2023.1070808","volume":"10","author":"A Cui","year":"2023","unstructured":"Cui, A. et al. Global and regional prevalence of vitamin D deficiency in population-based studies from 2000 to 2022: A pooled analysis of 7.9 million participants. Front. Nutr. 10, 1070808 (2023).","journal-title":"Front. Nutr."},{"issue":"1","key":"54960_CR11","doi-asserted-by":"publisher","first-page":"818","DOI":"10.1186\/s12877-022-03532-3","volume":"22","author":"K Khalagi","year":"2022","unstructured":"Khalagi, K. et al. Iranian Multi-center Osteoporosis Study (IMOS), 2021\u20132022: The study protocol. BMC Geriatr. 22 (1), 818 (2022).","journal-title":"BMC Geriatr."},{"issue":"10","key":"54960_CR12","doi-asserted-by":"publisher","first-page":"e0310135","DOI":"10.1371\/journal.pone.0310135","volume":"19","author":"A Ghazbani","year":"2024","unstructured":"Ghazbani, A. et al. Dietary calcium intake among Iranian adults: Iranian Multicenter Osteoporosis Study (IMOS-2021). PLoS ONE. 19 (10), e0310135 (2024).","journal-title":"PLoS ONE"},{"issue":"11","key":"54960_CR13","doi-asserted-by":"publisher","first-page":"1917","DOI":"10.1007\/s00198-023-06867-8","volume":"34","author":"D Fitzpatrick","year":"2023","unstructured":"Fitzpatrick, D. et al. The association between proton pump inhibitors and hyperparathyroidism: A potential mechanism for increased fracture\u2014Results of a large observational cohort study. Osteoporos. Int. 34 (11), 1917\u20131926 (2023).","journal-title":"Osteoporos. Int."},{"issue":"2","key":"54960_CR14","doi-asserted-by":"publisher","first-page":"235","DOI":"10.1007\/s12020-021-02845-4","volume":"74","author":"JL de Mu\u00f1oz","year":"2021","unstructured":"de Mu\u00f1oz, J. L. et al. A practical approach to normocalcemic primary hyperparathyroidism. Endocrine 74 (2), 235\u2013244 (2021).","journal-title":"Endocrine"},{"issue":"2","key":"54960_CR15","doi-asserted-by":"publisher","first-page":"1206","DOI":"10.3892\/etm.2016.3438","volume":"12","author":"Y Wei","year":"2016","unstructured":"Wei, Y. et al. Risk factors associated with secondary hyperparathyroidism in patients with chronic kidney disease. Exp. Ther. Med. 12 (2), 1206\u20131212 (2016).","journal-title":"Exp. Ther. Med."},{"issue":"5","key":"54960_CR16","first-page":"1522","volume":"82","author":"S Khosla","year":"1997","unstructured":"Khosla, S. et al. Effects of age and estrogen status on serum parathyroid hormone levels and biochemical markers of bone turnover in women: A population-based study. J. Clin. Endocrinol. Metab. 82 (5), 1522\u20131527 (1997).","journal-title":"J. Clin. Endocrinol. Metab."},{"issue":"5","key":"54960_CR17","doi-asserted-by":"publisher","first-page":"2131","DOI":"10.1210\/jc.2014-4370","volume":"100","author":"SJ Carrivick","year":"2015","unstructured":"Carrivick, S. J. et al. Brief report: Does PTH increase with age, independent of 25-hydroxyvitamin D, phosphate, renal function, and ionized calcium? J. Clin. Endocrinol. Metab. 100 (5), 2131\u20132134 (2015).","journal-title":"J. Clin. Endocrinol. Metab."},{"issue":"11","key":"54960_CR18","doi-asserted-by":"publisher","first-page":"3989","DOI":"10.1210\/jc.2012-2276","volume":"97","author":"A Valcour","year":"2012","unstructured":"Valcour, A. et al. Effects of age and serum 25-OH-vitamin D on serum parathyroid hormone levels. J. Clin. Endocrinol. Metab. 97 (11), 3989\u20133995 (2012).","journal-title":"J. Clin. Endocrinol. Metab."},{"issue":"3","key":"54960_CR19","doi-asserted-by":"publisher","first-page":"329","DOI":"10.1046\/j.1365-2265.2000.00912.x","volume":"52","author":"ST Haden","year":"2000","unstructured":"Haden, S. T. et al. The effects of age and gender on parathyroid hormone dynamics. Clin. Endocrinol. (Oxf.). 52 (3), 329\u2013338 (2000).","journal-title":"Clin. Endocrinol. (Oxf.)"},{"issue":"5","key":"54960_CR20","doi-asserted-by":"publisher","first-page":"523","DOI":"10.1111\/j.1365-2265.2006.02502.x","volume":"64","author":"LB Yanoff","year":"2006","unstructured":"Yanoff, L. B. et al. The prevalence of hypovitaminosis D and secondary hyperparathyroidism in obese Black Americans. Clin. Endocrinol. (Oxf.). 64 (5), 523\u2013529 (2006).","journal-title":"Clin. Endocrinol. (Oxf.)"},{"key":"54960_CR21","doi-asserted-by":"crossref","unstructured":"Vrani\u0107, L., Mikola\u0161evi\u0107, I. & Mili\u0107, S. Vitamin D deficiency: Consequence or cause of obesity?. Medicina (Kaunas), 55(9) (2019).","DOI":"10.3390\/medicina55090541"},{"issue":"3","key":"54960_CR22","doi-asserted-by":"publisher","first-page":"690","DOI":"10.1093\/ajcn\/72.3.690","volume":"72","author":"J Wortsman","year":"2000","unstructured":"Wortsman, J. et al. Decreased bioavailability of vitamin D in obesity. Am. J. Clin. Nutr. 72 (3), 690\u2013693 (2000).","journal-title":"Am. J. Clin. Nutr."},{"issue":"1","key":"54960_CR23","doi-asserted-by":"publisher","first-page":"90","DOI":"10.1007\/s12020-008-9051-4","volume":"33","author":"M Blum","year":"2008","unstructured":"Blum, M. et al. Vitamin D3 in fat tissue. Endocrine 33 (1), 90\u201394 (2008).","journal-title":"Endocrine"},{"issue":"5","key":"54960_CR24","doi-asserted-by":"publisher","first-page":"425","DOI":"10.1016\/0026-0495(88)90041-8","volume":"37","author":"T Andersen","year":"1988","unstructured":"Andersen, T. et al. Secondary hyperparathyroidism of morbid obesity regresses during weight reduction. Metab. Clin. Exp. 37 (5), 425\u2013428 (1988).","journal-title":"Metab. lin. Exp."},{"key":"54960_CR25","doi-asserted-by":"crossref","unstructured":"Hamroun, A. et al. Ionized calcium: Analytical challenges and clinical relevance. J. Lab. Precision Med. 5 (2020).","DOI":"10.21037\/jlpm-20-60"},{"issue":"11","key":"54960_CR26","doi-asserted-by":"publisher","first-page":"4917","DOI":"10.1210\/jc.2010-0666","volume":"95","author":"MA Adam","year":"2010","unstructured":"Adam, M. A. et al. Severe obesity is associated with symptomatic presentation, higher parathyroid hormone levels, and increased gland weight in primary hyperparathyroidism. J. Clin. Endocrinol. Metabolism. 95 (11), 4917\u20134924 (2010).","journal-title":"J. Clin. Endocrinol. Metabolism"},{"issue":"4","key":"54960_CR27","doi-asserted-by":"publisher","first-page":"143","DOI":"10.1159\/000520660","volume":"27","author":"MK Jumaahm","year":"2021","unstructured":"Jumaahm, M. K., Alhamza, A. H. A. & Mansour, A. A. The study of the association of serum parathyroid hormone level with obesity in patients admitted to a Tertiary Care Center in Basrah. Dubai Diabetes Endocrinol. J. 27 (4), 143\u2013149 (2021).","journal-title":"Dubai Diabetes Endocrinol. J."},{"key":"54960_CR28","doi-asserted-by":"publisher","first-page":"447","DOI":"10.1007\/s40618-015-0400-x","volume":"39","author":"J George","year":"2016","unstructured":"George, J. et al. Visceral adiposity is a predictor of parathyroid hormone levels in healthy adults. J. Endocrinol. Investig. 39, 447\u2013453 (2016).","journal-title":"J. Endocrinol. Investig."},{"issue":"12","key":"54960_CR29","doi-asserted-by":"publisher","first-page":"1165","DOI":"10.1016\/j.amjmed.2011.07.009","volume":"124","author":"W Saliba","year":"2011","unstructured":"Saliba, W. et al. The relationship between serum 25(OH)D and parathyroid hormone levels. Am. J. Med. 124 (12), 1165\u20131170 (2011).","journal-title":"Am. J. Med."},{"issue":"3","key":"54960_CR30","doi-asserted-by":"publisher","first-page":"620","DOI":"10.1016\/j.jsbmb.2006.12.076","volume":"103","author":"P Lips","year":"2007","unstructured":"Lips, P. Vitamin D status and nutrition in Europe and Asia. J. Steroid Biochem. Mol. Biol. 103 (3), 620\u2013625 (2007).","journal-title":"J. Steroid Biochem. Mol. Biol."},{"issue":"12","key":"54960_CR31","doi-asserted-by":"publisher","first-page":"e10585","DOI":"10.1002\/jbm4.10585","volume":"5","author":"P Lips","year":"2021","unstructured":"Lips, P., de Jongh, R. T. & van Schoor, N. M. Trends in vitamin D status around the world. JBMR Plus. 5 (12), e10585 (2021).","journal-title":"JBMR Plus"},{"key":"54960_CR32","unstructured":"Karimi- Hasanabad, S., Rafraf, M. & Asghari-Jafarabadi, M. Prevalence of vitamin D deficiency and its relationship with body mass index and waist circumference in female adolescents 17\u2009\u2013\u200914 years,  Boukan. Iran. J. Diabetes Lipid Disord. 14(1), 55\u201362 (2015)."},{"key":"54960_CR33","doi-asserted-by":"publisher","first-page":"241","DOI":"10.1016\/j.fct.2018.01.052","volume":"113","author":"E Hoseinzadeh","year":"2018","unstructured":"Hoseinzadeh, E. et al. The impact of air pollutants, UV exposure and geographic location on vitamin D deficiency. Food Chem. Toxicol. 113, 241\u2013254 (2018).","journal-title":"Food Chem. Toxicol."},{"issue":"4","key":"54960_CR34","first-page":"137","volume":"21","author":"H Pouraram","year":"2018","unstructured":"Pouraram, H. et al. Second national integrated micronutrient survey in Iran: Study design and preliminary findings. Arch. Iran. Med. 21 (4), 137\u2013144 (2018).","journal-title":"Arch. Iran. Med."},{"issue":"1","key":"54960_CR35","doi-asserted-by":"publisher","first-page":"13","DOI":"10.1530\/EC-12-0008","volume":"1","author":"RR Rao","year":"2012","unstructured":"Rao, R. R. et al. Prolonged treatment with vitamin D in postmenopausal women with primary hyperparathyroidism. Endocr. Connect. 1 (1), 13\u201321 (2012).","journal-title":"Endocr. Connect."},{"issue":"9","key":"54960_CR36","doi-asserted-by":"publisher","first-page":"667","DOI":"10.1093\/qjmed\/hci096","volume":"98","author":"S Gaugris","year":"2005","unstructured":"Gaugris, S. et al. Vitamin D inadequacy among post-menopausal women: A systematic review. Qjm 98 (9), 667\u2013676 (2005).","journal-title":"Qjm"},{"issue":"11","key":"54960_CR37","doi-asserted-by":"publisher","first-page":"1770","DOI":"10.1359\/jbmr.060721","volume":"21","author":"JR Walters","year":"2009","unstructured":"Walters, J. R. et al. Calcium channel TRPV6 expression in human duodenum: Different relationships to the vitamin D system and aging in men and women*. J. Bone Miner. Res. 21 (11), 1770\u20131777 (2009).","journal-title":"J. Bone Miner. Res."},{"issue":"6","key":"54960_CR38","doi-asserted-by":"publisher","first-page":"F1005","DOI":"10.1152\/ajprenal.00013.2004","volume":"286","author":"RA Chen","year":"2004","unstructured":"Chen, R. A. & Goodman, W. G. Role of the calcium-sensing receptor in parathyroid gland physiology. Am. J. Physiol. Renal Physiol. 286 (6), F1005\u2013F1011 (2004).","journal-title":"Am. J. Physiol. Renal Physiol."},{"issue":"7","key":"54960_CR39","first-page":"2255","volume":"83","author":"T Carling","year":"1998","unstructured":"Carling, T. et al. Vitamin D receptor (VDR) and parathyroid hormone messenger ribonucleic acid levels correspond to polymorphic VDR Alleles in human parathyroid tumors1. J. Clin. Endocrinol. Metab. 83 (7), 2255\u20132259 (1998).","journal-title":"J. Clin. Endocrinol. Metab."},{"issue":"3","key":"54960_CR40","doi-asserted-by":"publisher","first-page":"492","DOI":"10.1172\/JCI106517","volume":"50","author":"E Slatopolsky","year":"1971","unstructured":"Slatopolsky, E. et al. On the pathogenesis of hyperparathyroidism in chronic experimental renal insufficiency in the dog. J. Clin. Invest. 50 (3), 492\u2013499 (1971).","journal-title":"J. Clin. Invest."},{"issue":"6","key":"54960_CR41","doi-asserted-by":"publisher","first-page":"693","DOI":"10.1007\/s11914-018-0486-0","volume":"16","author":"RM Elias","year":"2018","unstructured":"Elias, R. M. et al. CKD-MBD: From the pathogenesis to the identification and development of potential novel therapeutic targets. Curr. Osteoporos. Rep. 16 (6), 693\u2013702 (2018).","journal-title":"Curr. Osteoporos. Rep."},{"issue":"1","key":"54960_CR42","doi-asserted-by":"publisher","first-page":"31","DOI":"10.1038\/sj.ki.5002009","volume":"71","author":"A Levin","year":"2007","unstructured":"Levin, A. et al. Prevalence of abnormal serum vitamin D, PTH, calcium, and phosphorus in patients with chronic kidney disease: Results of the study to evaluate early kidney disease. Kidney Int. 71 (1), 31\u201338 (2007).","journal-title":"Kidney Int."},{"key":"54960_CR43","doi-asserted-by":"crossref","unstructured":"Silver, J. & Levi, R. Regulation of PTH synthesis and secretion relevant to the management of secondary hyperparathyroidism in chronic kidney disease. Kidney Int. Suppl. (95), S8\u201312 (2005).","DOI":"10.1111\/j.1523-1755.2005.09501.x"},{"issue":"6","key":"54960_CR44","doi-asserted-by":"publisher","first-page":"2140","DOI":"10.1046\/j.1523-1755.1998.00221.x","volume":"54","author":"AL de Francisco","year":"1998","unstructured":"de Francisco, A. L. et al. Effect of serum phosphate on parathyroid hormone secretion during hemodialysis. Kidney Int. 54 (6), 2140\u20132145 (1998).","journal-title":"Kidney Int."},{"key":"54960_CR45","doi-asserted-by":"publisher","first-page":"37","DOI":"10.1007\/978-3-030-91623-7_5","volume":"1362","author":"NS Akimbekov","year":"2022","unstructured":"Akimbekov, N. S. et al. Vitamin D and phosphate interactions in health and disease. Adv. Exp. Med. Biol. 1362, 37\u201346 (2022).","journal-title":"Adv. Exp. Med. Biol."},{"issue":"5","key":"54960_CR46","doi-asserted-by":"publisher","first-page":"715","DOI":"10.1359\/jbmr.1997.12.5.715","volume":"12","author":"O Kifor","year":"1997","unstructured":"Kifor, O. et al. The Ca2+-sensing receptor (CaR) activates phospholipases C, A2, and D in bovine parathyroid and CaR-transfected, human embryonic kidney (HEK293) cells. J. Bone Min. Res. 12 (5), 715\u2013725 (1997).","journal-title":"J. Bone Min. Res."},{"issue":"3","key":"54960_CR47","doi-asserted-by":"publisher","first-page":"266","DOI":"10.1056\/NEJMra070553","volume":"357","author":"MF Holick","year":"2007","unstructured":"Holick, M. F. Vitamin D deficiency. N. Engl. J. Med. 357 (3), 266\u2013281 (2007).","journal-title":"N. Engl. J. Med."},{"issue":"5","key":"54960_CR48","doi-asserted-by":"publisher","first-page":"666","DOI":"10.20945\/2359-3997000000556","volume":"66","author":"NE Cusano","year":"2022","unstructured":"Cusano, N. E. & Cetani, F. Normocalcemic primary hyperparathyroidism. Arch. Endocrinol. Metab. 66 (5), 666\u2013677 (2022).","journal-title":"Arch. Endocrinol. Metab."},{"issue":"8","key":"54960_CR49","doi-asserted-by":"publisher","first-page":"e10391","DOI":"10.1002\/jbm4.10391","volume":"4","author":"G Zavatta","year":"2020","unstructured":"Zavatta, G. & Clarke, B. L. Normocalcemic hyperparathyroidism: A heterogeneous disorder often misdiagnosed? JBMR Plus. 4 (8), e10391 (2020).","journal-title":"JBMR Plus"},{"issue":"2","key":"54960_CR50","doi-asserted-by":"publisher","first-page":"168","DOI":"10.1359\/jbmr.1998.13.2.168","volume":"13","author":"BL Riggs","year":"1998","unstructured":"Riggs, B. L. et al. Long-term effects of calcium supplementation on serum parathyroid hormone level, bone turnover, and bone loss in elderly women. J. Bone Min. Res. 13 (2), 168\u2013174 (1998).","journal-title":"J. Bone Min. Res."},{"issue":"18","key":"54960_CR51","doi-asserted-by":"publisher","first-page":"2336","DOI":"10.1001\/jama.294.18.2336","volume":"294","author":"L Steingrimsdottir","year":"2005","unstructured":"Steingrimsdottir, L. et al. Relationship between serum parathyroid hormone levels, vitamin D sufficiency, and calcium intake. Jama 294 (18), 2336\u20132341 (2005).","journal-title":"Jama"},{"issue":"5","key":"54960_CR52","doi-asserted-by":"publisher","first-page":"1236","DOI":"10.3390\/nu15051236","volume":"15","author":"M Wang","year":"2023","unstructured":"Wang, M. et al. Focusing on phosphorus loads: From healthy people to chronic kidney disease. Nutrients 15 (5), 1236 (2023).","journal-title":"Nutrients"},{"issue":"1","key":"54960_CR53","doi-asserted-by":"publisher","first-page":"15781","DOI":"10.1038\/s41598-024-66937-7","volume":"14","author":"L Hu","year":"2024","unstructured":"Hu, L. et al. Association between tobacco smoke exposure and serum parathyroid hormone levels among US adults (NHANES 2003\u20132006). Sci. Rep. 14 (1), 15781 (2024).","journal-title":"Sci. Rep."},{"issue":"1","key":"54960_CR54","doi-asserted-by":"publisher","first-page":"75","DOI":"10.5301\/JN.2011.7740","volume":"25","author":"G Tripepi","year":"2012","unstructured":"Tripepi, G. et al. Smoking and hyperparathyroidism in patients with end-stage renal disease (ESRD). J. Nephrol. 25 (1), 75\u201383 (2012).","journal-title":"J. Nephrol."},{"issue":"3","key":"54960_CR55","first-page":"367","volume":"5","author":"A Bouassida","year":"2006","unstructured":"Bouassida, A. et al. Parathyroid hormone and physical exercise: A brief review. J. Sports Sci. Med. 5 (3), 367\u2013374 (2006).","journal-title":"J. Sports Sci. Med."}],"container-title":["Scientific Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.nature.com\/articles\/s41598-026-54960-9","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41598-026-54960-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41598-026-54960-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T22:02:27Z","timestamp":1785794547000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.nature.com\/articles\/s41598-026-54960-9"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,25]]},"references-count":55,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["54960"],"URL":"https:\/\/doi.org\/10.1038\/s41598-026-54960-9","relation":{},"ISSN":["2045-2322"],"issn-type":[{"value":"2045-2322","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,25]]},"assertion":[{"value":"4 December 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"21 May 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"25 May 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The study adhered to the ethical principles outlined in the Declaration of Helsinki. Both parts of the original study were approved by the ethic committees. The STEPs survey was approved by the ethic committee of the National Institute of Health Research of the Islamic Republic of Iran (ethic code: IR.TUMS.NIHR.REC.1398.006) and the IMOS study was approved by the Iranian National Institute for Medical Research Development (NIMAD) ethics committee (ethic code: IR.NIMAD.1398.056). Written informed consents were separately obtained from the participants in each of the two parts of the study. The ethical code of the current study is IR.TUMS.SHARIATI.REC.1403.010.","order":1,"name":"Ethics","label":"Ethics approval and consent to participate","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":2,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"23815"}}