Restless legs syndrome in patients with high serum ferritin and normal iron levels

Trabajo presentado como póster en el 18.º Congreso de la European Sleep Research Society, celebrado en Innsbruck (Austria) en 2006Objetivo. Documentar la asociación entre síndrome de piernas inquietas (SPI) y concentraciones de ferritina elevadas en cinco pacientes. Pacientes y métodos. Estudiamos a cinco varones con una edad media de 59 años (rango: 36-73 años). Todos los pacientes fueron remitidos por SPI (dos de ellos donantes de sangre), en dos casos asociado a síndrome de apnea obstructiva del sueño. Se efectuaron registros videopolisomnográficos y se realizó una analítica para determinar los niveles de ferritina y hierro en plasma. Resultados. Los cinco pacientes presentaban criterios clínicos de SPI: parestesias en las pantorrillas asociadas a una necesidad imperiosa de mover las piernas, inquietud motora, agravamiento de los síntomas por la tarde y por la noche, mejoría con el movimiento, dificultad de conciliación del sueño y despertares nocturnos frecuentes. La exploración neurológica, el electroencefalograma, el electromiograma y la resonancia magnética cerebral fueron normales. Los registros videopolisomnográficos mostraron sueño nocturno fragmentado, reducción del tiempo total de sueño, escasa eficiencia, índice de apnea-hipopnea > 10/h en dos casos, y en los cinco casos, índice de movimientos periódicos de las piernas por hora de sueño > 5/h. En todos los casos los niveles de hierro sérico estaban dentro de los límites normales y la concentración de ferritina era elevada. Conclusiones. La asociación entre SPI con movimientos periódicos de las piernas durante el sueño, hierro sérico normal y ferritina elevada no se ha descrito previamente. El hallazgo de la disminución de concentración de ferritina en uno de los pacientes –meses más tarde del tratamiento con fármacos dopaminérgicos– apoya la implicación de un mecanismo dopaminérgico en la fisiopatología del SPIAim. To document the association between restless legs syndrome (RLS) and high ferritin levels in five patients. Patients and methods. The five patients were male, mean age: 59 years (range: 36-73 years). The patients were referred for RLS (two of them blood donors), in two cases associated with obstructive sleep apnea. Patients underwent a video-PSG recording. Serum iron and serum ferritin were determined. Results. All patients fulfilled the clinical criteria for RLS: leg paresthesias associated with an urge to move, motor restlessness, worsening of symptoms during the evening and night, and partial relief with activity, difficulty falling asleep, and presence of nocturnal awakenings due to RLS. Neurological examination, EEGs, EMGs and MRIs were normal. Video-PSGs recordings showed a disturbed and fragmented sleep with a reduction in total sleep time, low sleep efficiency, respiratory abnormalities with an apnea-hipopnea index > 10/h in two cases, and in all of them a periodic leg movements index > 5/h. The serum iron levels were within the normal range in all cases, whereas those in serum ferritin levels were high. Conclusions. To our knowledge the association of normal serum iron with high serum ferritin levels in patients diagnosed clinically and polygraphically as having RLS with periodic leg movements has not been described before. The notion of an involvement of a dopaminergic mechanism in the pathophysiology of RLS is supported by the decrease in the values of serum ferritin concentration observed in one patient during follow-up while being treated with dopaminergic agent

Impact of hip fracture on health-related quality of life and activities of daily living: the SPARE-HIP prospective cohort study

There is a scarcity of prospectively collected data on functional and patient-reported outcomes following hip fracture. We therefore aimed to measure health-related quality of life (HRQoL) and activities of daily living activities (ADL) before, during index admission for a hip/proximal femur fracture, and at 1 and 4 months later

Bone mineral density and body composition among athletes: Lightweight versus heavyweight sports

Objectives: Energy restriction and weight loss techniques are associated with adverse effects on bone mineral density (BMD) whilst participation in sports is known to be beneficial for skeletal health. However, it is not entirely clear the skeletal health status in lightweight sports where participants often use weight management techniques to attain relatively low mass. Therefore, the aim of this study is to evaluate the differences in BMD and body composition among athletes engaged in weight restricted and non-weight restricted sports.Published versio

Half hip fracture patients are reportedly ‘worse’ than dead as based on health-related quality of life at the time of admission, with partial recovery at 1 and 4-months follow-up: the spare-hip prospective cohort

Objective: To estimate the impact of hip fracture on health-related quality of life (HRQoL) up to 4 months post-fracture

In-hospital care, complications, and 4-month mortality following a hip or proximal femur fracture: the Spanish registry of osteoporotic femur fractures prospective cohort study

Summary We have characterised 997 hip fracture patients from a representative 45 Spanish hospitals, and followed them up prospectively for up to 4 months. Despite suboptimal surgical delays (average 59.1 hours), in-hospital mortality was lower than in Northern European cohorts. The secondary fracture prevention gap is unacceptably high at 85%. Purpose To characterise inpatient care, complications, and 4-month mortality following a hip or proximal femur fracture in Spain. Methods Design: prospective cohort study. Consecutive sample of patients ≥ 50 years old admitted in a representative 45 hospitals for a hip or proximal femur fragility fracture, from June 2014 to June 2016 and followed up for 4 months post-fracture. Patient characteristics, site of fracture, in-patient care (including secondary fracture prevention) and complications, and 4-month mortality are described. Results A total of 997 subjects (765 women) of mean (standard deviation) age 83.6 (8.4) years were included. Previous history of fracture/s (36.9%) and falls (43%) were common, and 10-year FRAX-estimated major and hip fracture risks were 15.2% (9.0%) and 8.5% (7.6%) respectively. Inter-trochanteric (44.6%) and displaced intra-capsular (28.0%) were the most common fracture sites, and fixation with short intramedullary nail (38.6%) with spinal anaesthesia (75.5%) the most common procedures. Surgery and rehabilitation were initiated within a mean 59.1 (56.7) and 61.9 (55.1) hours respectively, and average length of stay was 11.5 (9.3) days. Antithrombotic and antibiotic prophylaxis were given to 99.8% and 98.2% respectively, whilst only 12.4% received secondary fracture prevention at discharge. Common complications included delirium (36.1 %) and kidney failure (14.1%), with in-hospital and 4-month mortality of 2.1% and 11% respectively. Conclusions Despite suboptimal surgical delay, post-hip fracture mortality is low in Spanish hospitals. The secondary fracture prevention gap is unacceptably high at > 85%, in spite of virtually universal anti-thrombotic and antibiotic prophylaxis