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March 29, 2016; 86 (13) Article

Reduced bone resorption and increased bone mineral density in women with restless legs syndrome

Mehmet Ali Cikrikcioglu, Yahya Sekin, Gulistan Halac, Elif Kilic, Siddika Kesgin, Senay Aydin, Nihal Ozaras, Onur Akan, Kenan Celik, Jamshid Hamdard, Mehmet Zorlu, Cumali Karatoprak, Mustafa Cakirca, Muharrem Kiskac
First published February 26, 2016, DOI: https://doi.org/10.1212/WNL.0000000000002521
Mehmet Ali Cikrikcioglu
From the Departments of Internal Medicine (M.A.C., Y.S., K.C., J.H., M.Z., C.K., M.C., M.K.), Neurology (G.H.), Biochemistry (E.K., S.K.), and Physical Medicine and Rehabilitation (N.O.), Bezmialem Vakif University Medical Faculty, Fatih; Department of Neurology (S.A.), Yedikule Chest Diseases and Chest Surgery Training and Research Hospital, Zeytinburnu; and Department of Neurology (O.A.), Okmeydani Training and Research Hospital, Sisli, Istanbul, Turkey.
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Yahya Sekin
From the Departments of Internal Medicine (M.A.C., Y.S., K.C., J.H., M.Z., C.K., M.C., M.K.), Neurology (G.H.), Biochemistry (E.K., S.K.), and Physical Medicine and Rehabilitation (N.O.), Bezmialem Vakif University Medical Faculty, Fatih; Department of Neurology (S.A.), Yedikule Chest Diseases and Chest Surgery Training and Research Hospital, Zeytinburnu; and Department of Neurology (O.A.), Okmeydani Training and Research Hospital, Sisli, Istanbul, Turkey.
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Gulistan Halac
From the Departments of Internal Medicine (M.A.C., Y.S., K.C., J.H., M.Z., C.K., M.C., M.K.), Neurology (G.H.), Biochemistry (E.K., S.K.), and Physical Medicine and Rehabilitation (N.O.), Bezmialem Vakif University Medical Faculty, Fatih; Department of Neurology (S.A.), Yedikule Chest Diseases and Chest Surgery Training and Research Hospital, Zeytinburnu; and Department of Neurology (O.A.), Okmeydani Training and Research Hospital, Sisli, Istanbul, Turkey.
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Elif Kilic
From the Departments of Internal Medicine (M.A.C., Y.S., K.C., J.H., M.Z., C.K., M.C., M.K.), Neurology (G.H.), Biochemistry (E.K., S.K.), and Physical Medicine and Rehabilitation (N.O.), Bezmialem Vakif University Medical Faculty, Fatih; Department of Neurology (S.A.), Yedikule Chest Diseases and Chest Surgery Training and Research Hospital, Zeytinburnu; and Department of Neurology (O.A.), Okmeydani Training and Research Hospital, Sisli, Istanbul, Turkey.
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Siddika Kesgin
From the Departments of Internal Medicine (M.A.C., Y.S., K.C., J.H., M.Z., C.K., M.C., M.K.), Neurology (G.H.), Biochemistry (E.K., S.K.), and Physical Medicine and Rehabilitation (N.O.), Bezmialem Vakif University Medical Faculty, Fatih; Department of Neurology (S.A.), Yedikule Chest Diseases and Chest Surgery Training and Research Hospital, Zeytinburnu; and Department of Neurology (O.A.), Okmeydani Training and Research Hospital, Sisli, Istanbul, Turkey.
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Senay Aydin
From the Departments of Internal Medicine (M.A.C., Y.S., K.C., J.H., M.Z., C.K., M.C., M.K.), Neurology (G.H.), Biochemistry (E.K., S.K.), and Physical Medicine and Rehabilitation (N.O.), Bezmialem Vakif University Medical Faculty, Fatih; Department of Neurology (S.A.), Yedikule Chest Diseases and Chest Surgery Training and Research Hospital, Zeytinburnu; and Department of Neurology (O.A.), Okmeydani Training and Research Hospital, Sisli, Istanbul, Turkey.
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Nihal Ozaras
From the Departments of Internal Medicine (M.A.C., Y.S., K.C., J.H., M.Z., C.K., M.C., M.K.), Neurology (G.H.), Biochemistry (E.K., S.K.), and Physical Medicine and Rehabilitation (N.O.), Bezmialem Vakif University Medical Faculty, Fatih; Department of Neurology (S.A.), Yedikule Chest Diseases and Chest Surgery Training and Research Hospital, Zeytinburnu; and Department of Neurology (O.A.), Okmeydani Training and Research Hospital, Sisli, Istanbul, Turkey.
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Onur Akan
From the Departments of Internal Medicine (M.A.C., Y.S., K.C., J.H., M.Z., C.K., M.C., M.K.), Neurology (G.H.), Biochemistry (E.K., S.K.), and Physical Medicine and Rehabilitation (N.O.), Bezmialem Vakif University Medical Faculty, Fatih; Department of Neurology (S.A.), Yedikule Chest Diseases and Chest Surgery Training and Research Hospital, Zeytinburnu; and Department of Neurology (O.A.), Okmeydani Training and Research Hospital, Sisli, Istanbul, Turkey.
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Kenan Celik
From the Departments of Internal Medicine (M.A.C., Y.S., K.C., J.H., M.Z., C.K., M.C., M.K.), Neurology (G.H.), Biochemistry (E.K., S.K.), and Physical Medicine and Rehabilitation (N.O.), Bezmialem Vakif University Medical Faculty, Fatih; Department of Neurology (S.A.), Yedikule Chest Diseases and Chest Surgery Training and Research Hospital, Zeytinburnu; and Department of Neurology (O.A.), Okmeydani Training and Research Hospital, Sisli, Istanbul, Turkey.
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Jamshid Hamdard
From the Departments of Internal Medicine (M.A.C., Y.S., K.C., J.H., M.Z., C.K., M.C., M.K.), Neurology (G.H.), Biochemistry (E.K., S.K.), and Physical Medicine and Rehabilitation (N.O.), Bezmialem Vakif University Medical Faculty, Fatih; Department of Neurology (S.A.), Yedikule Chest Diseases and Chest Surgery Training and Research Hospital, Zeytinburnu; and Department of Neurology (O.A.), Okmeydani Training and Research Hospital, Sisli, Istanbul, Turkey.
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Mehmet Zorlu
From the Departments of Internal Medicine (M.A.C., Y.S., K.C., J.H., M.Z., C.K., M.C., M.K.), Neurology (G.H.), Biochemistry (E.K., S.K.), and Physical Medicine and Rehabilitation (N.O.), Bezmialem Vakif University Medical Faculty, Fatih; Department of Neurology (S.A.), Yedikule Chest Diseases and Chest Surgery Training and Research Hospital, Zeytinburnu; and Department of Neurology (O.A.), Okmeydani Training and Research Hospital, Sisli, Istanbul, Turkey.
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Cumali Karatoprak
From the Departments of Internal Medicine (M.A.C., Y.S., K.C., J.H., M.Z., C.K., M.C., M.K.), Neurology (G.H.), Biochemistry (E.K., S.K.), and Physical Medicine and Rehabilitation (N.O.), Bezmialem Vakif University Medical Faculty, Fatih; Department of Neurology (S.A.), Yedikule Chest Diseases and Chest Surgery Training and Research Hospital, Zeytinburnu; and Department of Neurology (O.A.), Okmeydani Training and Research Hospital, Sisli, Istanbul, Turkey.
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Mustafa Cakirca
From the Departments of Internal Medicine (M.A.C., Y.S., K.C., J.H., M.Z., C.K., M.C., M.K.), Neurology (G.H.), Biochemistry (E.K., S.K.), and Physical Medicine and Rehabilitation (N.O.), Bezmialem Vakif University Medical Faculty, Fatih; Department of Neurology (S.A.), Yedikule Chest Diseases and Chest Surgery Training and Research Hospital, Zeytinburnu; and Department of Neurology (O.A.), Okmeydani Training and Research Hospital, Sisli, Istanbul, Turkey.
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Muharrem Kiskac
From the Departments of Internal Medicine (M.A.C., Y.S., K.C., J.H., M.Z., C.K., M.C., M.K.), Neurology (G.H.), Biochemistry (E.K., S.K.), and Physical Medicine and Rehabilitation (N.O.), Bezmialem Vakif University Medical Faculty, Fatih; Department of Neurology (S.A.), Yedikule Chest Diseases and Chest Surgery Training and Research Hospital, Zeytinburnu; and Department of Neurology (O.A.), Okmeydani Training and Research Hospital, Sisli, Istanbul, Turkey.
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Citation
Reduced bone resorption and increased bone mineral density in women with restless legs syndrome
Mehmet Ali Cikrikcioglu, Yahya Sekin, Gulistan Halac, Elif Kilic, Siddika Kesgin, Senay Aydin, Nihal Ozaras, Onur Akan, Kenan Celik, Jamshid Hamdard, Mehmet Zorlu, Cumali Karatoprak, Mustafa Cakirca, Muharrem Kiskac
Neurology Mar 2016, 86 (13) 1235-1241; DOI: 10.1212/WNL.0000000000002521

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Abstract

Objective: To investigate bone resorption and formation markers as well as bone mineral density in women with restless legs syndrome (RLS).

Methods: This was a prospective cross-sectional case-control study involving drug-naive women with RLS and age- and body mass index (BMI)–matched female controls. Routine blood analyses, markers of bone formation, procollagen 1 n-terminal peptide, bone resorption, c-telopeptide of type 1 collagen (CTX), sclerostin, and bone mineral density (BMD) were compared between the 2 groups. Pregnant or breastfeeding women and individuals with comorbidities other than iron deficiency, type 2 diabetes mellitus, or hypertension were excluded.

Results: A significant increase in lumbar BMD was found among 78 women with RLS as compared to 78 age- and BMI-matched controls (p = 0.001). The proportion of patients with osteopenia as defined by a lumbar T score was significantly lower among patients with RLS (p = 0.040). CTX and sclerostin were significantly lower in patients with RLS (p = 0.006 and p = 0.011, respectively), as were the levels of 25-hydroxy vitamin D3, calcemia, and free T3 (p = 0.017, p = 0.017, and p = 0.002, respectively).

Conclusions: Despite lower 25-hydroxy vitamin D3, patients with RLS had lower bone resorption markers, higher lumbar BMD, and lower frequency of lumbar osteopenia. As patients with RLS make movements night and day to decrease the severity of their symptoms, they unconsciously perform exercise, which may potentially explain the better bone profile among patients with RLS than in controls.

GLOSSARY

BMD=
bone mineral density;
BMI=
body mass index;
CBC=
complete blood count;
CTX=
C-telopeptide of type 1 collagen;
IRLSSG=
International Restless Legs Syndrome Study Group;
PINP=
procollagen 1 N-terminal peptide;
RLS=
restless legs syndrome

Footnotes

  • Go to Neurology.org for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.

  • Editorial, page 1179

  • Received July 20, 2015.
  • Accepted in final form November 25, 2015.
  • © 2016 American Academy of Neurology
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Disputes & Debates: Rapid online correspondence

  • Author Response to Liguori et al.
    • Mehmet Ali Cikrikcioglu, Associate Professor, Istanbulmalicikrikcioglu@yahoo.com
    • Gulistan Halac, Elif Kilic, Kenan Celik, Senay Aydin, Nihal Ozaras, Onur Akan
    Submitted April 06, 2016
  • Increased bone mineral density after Restless legs syndrome dopaminergic-treatment
    • Claudio Liguori, MD, University of Rome "Tor Vergata", Rome, Italydott.claudioliguori@yahoo.it
    • Fabio Placidi, Rome, Italy; Umberto Tarantino, Rome, Italy; Nicola B Mercuri, Rome, Italy; Francesca Izzi, Rome, Italy
    Submitted March 29, 2016
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