Bone mineral density in diabetes mellitus patients with and without a Charcot foot

Abstract

Objective: To measure bone mineral density in patients with diabetes mellitus and the complication Charcot osteoarthropathy (CA).

Research design and methods: A total of 49 patients with diabetes were investigated. The population consisted of patients with an acute CA (n = 17) or chronic CA (n = 7). Control groups consisted of diabetes patients with (n = 9) and without neuropathy (n = 11) and who had an amputation of the first toe (n = 5). Values measured were bone mineral density (BMD) in lumbar spine, hip and calcaneus, using lunar DEXA scanner. The bone turnover markers CTX-1 and N-MID were measured.

Results: There were no differences in BMD measured in the spine and hip. There was an increase in the markers of bone turnover in the patients with acute CA. The BMD of the calcaneus was statistically lower in the affected foot in patients with chronic Charcot (P < 0.01), than in the unaffected foot, but there were no statistically significant differences between the BMD of the calcaneus in the feet in the other groups.

Conclusions: From this study, we can conclude that there were no differences in BMD values in the spine and hip between groups. There were no differences between BMD of the calcaneus between groups, except that patients with chronic Charcot had a significantly lower calcaneal BMD in the affected foot than in the healthy foot. Furthermore, there was an increased bone turnover in the group with acute CA, which was not found in the other patients groups. This suggests that the Charcot foot is a rather local phenomenon, with little effect on the skeleton in general.