• 1.

    Childs, M, DG Armstrong, and GW Edelson. :Is Charcot arthropathy a late sequela of osteoporosis in patients with diabetes mellitus? J Foot Ankle Surg 37::437. ,1998. .

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 2.

    van Baal, J, R Hubbard, F Game, et al. :Mortality associated with acute Charcot foot and neuropathic foot ulceration. .Diabetes Care 33::1086. ,2010. .

  • 3.

    Wild, S, G Roglic, A Green, et al. :Global prevalence of diabetes: estimates for the year 2000 and projections for 2030. .Diabetes Care 27::1047. ,2004. .

  • 4.

    Herbst, SA, KB Jones, and CL Saltzman. :Pattern of diabetic neuropathic arthropathy associated with the peripheral bone mineral density. .J Bone Joint Surg Br 86::378. ,2004. .

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 5.

    Eichenholtz, SN. :Charcot Joints. ,C.C. Thomas. ,Springfield, IL. ,1966. .

  • 6.

    Yoho, RM, J Frerichs, NB Dodson, et al. :A comparison of vitamin D levels in nondiabetic and diabetic patient populations. .JAPMA 99::35. ,2009. .

    • Search Google Scholar
    • Export Citation
  • 7.

    Frykberg, RG. :The High Risk Foot in Diabetes Mellitus. ,Churchill Livingstone. ,New York. ,1991. .

  • 8.

    Christensen, TM, J Bulow, L Simonsen, et al. :Bone mineral density in diabetes mellitus patients with and without a Charcot foot. .Clin Physiol Funct Imaging 30::130. ,2010. .

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9.

    Jirkovska, A, P Kasalicky, P Boucek, et al. :Calcaneal ultrasonometry in patients with Charcot osteoarthropathy and its relationship with densitometry in the lumbar spine and femoral neck and with markers of bone turnover. .Diabet Med 18::495. ,2001. .

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10.

    Petrova, NL and ME Edmonds. :A prospective study of calcaneal bone mineral density in acute Charcot osteoarthropathy. .Diabetes Care 33::2254. ,2010. .

  • 11.

    Petrova, NL, AV Foster, and ME Edmonds. :Calcaneal bone mineral density in patients with Charcot neuropathic osteoarthropathy: differences between type 1 and type 2 diabetes. .Diabet Med 22::756. ,2005. .

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12.

    Perez-Castrillon, JL. :Pixi bone density and screening of osteoporosis. .Maturitas 55::200. ,2006. .

  • 13.

    Harrison, EJ and JE Adams. :Application of a triage approach to peripheral bone densitometry reduces the requirement for central dxa but is not cost effective. .Calcif Tissue Int 79::199. ,2006. .

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 14.

    Hollis, BW and CL Wagner. :Normal serum vitamin d levels. .N Engl J Med 352::515. ,2005. .

  • 15.

    Riggs, BL, HW Wahner, E Seeman, et al. :Changes in bone mineral density of the proximal femur and spine with aging: differences between the postmenopausal and senile osteoporosis syndromes. .J Clin Invest 70::716. ,1982. .

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 16.

    Riggs, BL, HW Wahner, WL Dunn, et al. :Differential changes in bone mineral density of the appendicular and axial skeleton with aging: relationship to spinal osteoporosis. .J Clin Invest 67::328. ,1981. .

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 17.

    Li, W, GF Zhao, SW Xu, et al. :Role of dual energy x-ray absorptiometry in monitoring fracture healing in a rat femoral fracture model. .Chin J Traumatol 8::121. ,2005. .

    • Search Google Scholar
    • Export Citation
  • 18.

    Janes, GC, DM Collopy, R Price, et al. :Bone density after rigid plate fixation of tibial fractures: a dual-energy x-ray absorptiometry study. .J Bone Joint Surg Br 75::914. ,1993. .

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 19.

    Iida, Y, T Kuroda, T Kitano, et al. :Dexa-measured bone density changes over time after intertrochanteric hip fractures. .Kobe J Med Sci 46::1. ,2000. .

  • 20.

    Pitocco, D, G Zelano, G Gioffre, et al. :Association between osteoprotegerin g1181c and t245g polymorphisms and diabetic Charcot neuroarthropathy: a case-control study. .Diabetes Care 32::1694. ,2009. .

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 21.

    Guyton, AC and JE Hall. :Textbook of Medical Physiology. ,Elsevier Saunders. ,Philadelphia. ,2006. .

  • 22.

    Gaugris, S, RP Heaney, S Boonen, et al. :Vitamin D inadequacy among post-menopausal women: a systematic review. .QJM 98::667. ,2005. .

  • 23.

    Bevan, WP and MP Tomlinson. :Radiographic measures as a predictor of ulcer formation in diabetic Charcot mid-foot. .Foot Ankle Int 29::568. ,2008. .

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 24.

    Bevilacqua, NJ and LC Rogers. :Surgical management of Charcot midfoot deformities. .Clin Podiatr Med Surg 25::81. ,2008. .

  • 25.

    Jolly, GP, T Zgonis, and V Polyzois. :External fixation in the management of Charcot neuroarthropathy. .Clin Podiatr Med Surg 20::741. ,2003. .

  • 26.

    Marks, RM, BG Parks, and LC Schon. :Midfoot fusion technique for neuroarthropathic feet: biomechanical analysis and rationale. .Foot Ankle Int 19::507. ,1998. .

  • 27.

    Pinzur, MS and A Kelikian. :Charcot ankle fusion with a retrograde locked intramedullary nail. .Foot Ankle Int 18::699. ,1997. .

  • 28.

    Sayner, L and BI Rosenblum. :External fixation for Charcot foot reconstruction. .Curr Surg 62::618. ,2005. .

  • 29.

    Cummings, SR, F Cosman, and S Jamal. :Osteoporosis: An Evidence-Based Guide to Prevention and Management. ,American College of Physicians. ,Philadelphia. ,2002. .

    • Search Google Scholar
    • Export Citation
  • 30.

    Zarutsky, E, SM Rush, and JM Schuberth. :The use of circular wire external fixation in the treatment of salvage ankle arthrodesis. .J Foot Ankle Surg 44::22. ,2005. .

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 31.

    Greenhagen, RM, PD Highlander, and PR Burns. :Double row anchor fixation: a novel technique for a diabetic calanceal insufficiency avulsion fracture. .J Foot Ankle Surg 51::123. ,2012. .

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 32.

    Klos, K, B Gueorguiev, K Schwieger, et al. :Comparison of calcaneal fixation of a retrograde intramedullary nail with a fixed-angle spiral blade versus a fixed-angle screw. .Foot Ankle Int 30::1212. ,2009. .

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 33.

    Ito, K, R Hungerbuhler, D Wahl, et al. :Improved intramedullary nail interlocking in osteoporotic bone. .J Orthop Trauma 15::192. ,2001. .

  • 34.

    Miranda, MA. :Locking plate technology and its role in osteoporotic fractures. .Injury 38 ( suppl 3:):S35. ,2007. .

  • 35.

    Snow, M, G Thompson, and PG Turner. :A mechanical comparison of the locking compression plate (lcp) and the low contact-dynamic compression plate (dcp) in an osteoporotic bone model. .J Orthop Trauma 22::121. ,2008. .

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 36.

    Stoffel, K, G Booth, SM Rohrl, et al. :A comparison of conventional versus locking plates in intraarticular calcaneus fractures: a biomechanical study in human cadavers. .Clin Biomech (Bristol, Avon) 22::100. ,2007. .

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 37.

    Kim, T, UM Ayturk, A Haskell, et al. :Fixation of osteoporotic distal fibula fractures: a biomechanical comparison of locking versus conventional plates. .J Foot Ankle Surg 46::2. ,2007. .

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 38.

    Zehnder, S, JG Bledsoe, and A Puryear. :The effects of screw orientation in severely osteoporotic bone: a comparison with locked plating. .Clin Biomech (Bristol, Avon) 24::589. ,2009. .

    • Crossref
    • Search Google Scholar
    • Export Citation

Peripheral and Central Bone Mineral Density in Charcot’s Neuroarthropathy Compared in Diabetic and Nondiabetic Populations

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  • 1 Foot and Ankle Center of Nebraska, Omaha, NE.
  • | 2 Foot and Ankle Division, Department of Orthopedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA.
  • | 3 Podiatric Residency Program, The Western Pennsylvania Hospital, Pittsburgh, PA.
  • | 4 Physical Therapy/Academic, Des Moines University, Des Moines, IA.
  • | 5 College of Podiatric Medicine and Surgery, Des Moines University, Des Moines, IA.
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Background:

This prospective study was performed to compare calcaneal and lumbar bone mineral density (BMD) in individuals with and without diabetes mellitus. We compared bone density with the time from onset of Charcot’s neuroarthropathy (CN) in patients with unilateral, nonoperative, reconstructive-stage CN. The final purpose was to investigate the role that sex, age, and serum vitamin D level may have in osseous recovery.

Methods:

Thirty-three individuals were divided into three groups: controls and patients with diabetes mellitus with and without CN. Peripheral instantaneous x-ray imaging and dual-energy x-ray absorptiometry were performed.

Results:

The calcaneal BMD of patients with diabetes mellitus and CN was lower than that of the control group (P < .01) but was not significantly lower than that of patients with diabetes mellitus alone. There was no statistically significant difference in lumbar T-scores between groups. Women demonstrated lower BMD than did men (P = .02), but patients 60 years and older did not demonstrate significantly lower BMD than did patients younger than 60 years (P = .135). A negative linear relationship was demonstrated between time and BMD in patients with CN.

Conclusions:

The results of this study suggest that lumbar BMD does not reflect peripheral BMD in patients with diabetes mellitus and reconstructive-stage CN. This study has clinical implications when reconstructive osseous surgery is planned in patients with CN. (J Am Podiatr Med Assoc 102(3): 213–222, 2012)

Corresponding author: Robert M. Greenhagen, DPM, Foot and Ankle Center of Nebraska, 7337 Dodge St, Omaha, NE 68114. (E-mail: robert.m.greenhagen@gmail.com)