title: Inflammatory osteolysis in diabetic neuropathic (charcot) arthropathies of the foot.
abstract: OBJECTIVE
  Osteolysis and low bone mineral density (BMD) are underappreciated consequences of several chronic diseases that may elevate the risk for fracture. The purpose of this study was to assess tarsal BMD associated with acute inflammation (ie, inflammatory osteolysis) in individuals with chronic diabetes mellitus (DM), peripheral neuropathy (PN), and recent-onset neuropathic (Charcot) arthropathy (NCA) of the foot.
  
  
  METHODS
  This was a case-control study of 32 people (11 men, 21 women) with DM, PN, and NCA of the foot or ankle. The subjects with DM, PN, and NCA were compared with 64 age-, sex-, and race-matched control subjects (24 men, 40 women) without DM, PN or NCA. Within the first 3 weeks of cast immobilization, BMD was estimated in both calcanei using quantitative ultrasonometry. Acute inflammation was confirmed by comparing skin temperature differences between the feet of the subjects with DM, PN, and NCA and the feet of the control subjects.
  
  
  RESULTS
  Skin temperature differences averaged 6.7 degrees F (SD=4.0 degrees F) (involved foot minus noninvolved foot) in the feet of the subjects with DM, PN, and NCA compared with 0.0 degrees F (SD=1.3 degrees F) in the feet of the control subjects. Calcaneal BMD averaged 384 mg/cm(2) (SD=110) in the involved feet and 467 mg/cm(2) (SD=123) in the noninvolved feet of the subjects with DM, PN, and NCA and 545 mg/cm(2) (SD=121) in combined right and left feet of the control subjects.
  
  
  CONCLUSIONS
  Inflammation in individuals with DM, PN, and NCA may contribute to or exacerbate a rapid loss of BMD. Inflammatory osteolysis may be a prominent factor responsible for both the spontaneous onset of neuropathic fracture and the insidious and progressive foot deformity that is the hallmark of the chronic Charcot foot.
authors.affiliation: Department of Medicine and Program in Physical Therapy, Washington University School of Medicine, 4444 Forest Park Blvd, St. Louis, MO 63108, USA. sinacored@wustl.edu
authors.forename: David R
authors.initials: DR
authors.lastname: Sinacore
authors.forename: Mary K
authors.initials: MK
authors.lastname: Hastings
authors.forename: Kathryn L
authors.initials: KL
authors.lastname: Bohnert
authors.forename: Faye A
authors.initials: FA
authors.lastname: Fielder
authors.forename: Dennis T
authors.initials: DT
authors.lastname: Villareal
authors.forename: Vilray P
authors.initials: VP
authors.lastname: Blair
authors.forename: Jeffrey E
authors.initials: JE
authors.lastname: Johnson
mesh_terms: D001177:Arthropathy, Neurogenic / Q000150:complications* / Q000209:etiology; D015519:Bone Density; D016022:Case-Control Studies; D017719:Diabetic Foot / Q000150:complications*; D003929:Diabetic Neuropathies / Q000150:complications*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010000:Osteitis / Q000145:classification / Q000150:complications*; D010014:Osteolysis / Q000150:complications* / Q000209:etiology*; D012720:Severity of Illness Index; D012881:Skin Temperature / Q000502:physiology; D016474:Weight-Bearing
references.citation: J Orthop Sports Phys Ther. 1999 Dec;29(12):736-46
references.pmid: 10612071
references.citation: J Digit Imaging. 2009 Oct;22(5):492-502
references.pmid: 18478296
references.citation: Arthritis Rheum. 2001 Jun;44(6):1254-60
references.pmid: 11407683
references.citation: Diabetologia. 2001 Nov;44(11):2032-7
references.pmid: 11719835
references.citation: Arthritis Rheum. 2001 Dec;44(12):2790-6
references.pmid: 11762939
references.citation: Diabetes Res Clin Pract. 2002 Oct;58(1):1-9
references.pmid: 12161051
references.citation: Clin Biomech (Bristol, Avon). 2003 Aug;18(7):567-75
references.pmid: 12880704
references.citation: J Bone Joint Surg Br. 2004 Apr;86(3):378-83
references.pmid: 15125125
references.citation: J Foot Ankle Surg. 2004 Sep-Oct;43(5):285-9
references.pmid: 15480402
references.citation: Clin Sci (Lond). 1982 Mar;62(3):329-36
references.pmid: 6977427
references.citation: J Nucl Med. 1986 Oct;27(10):1540-9
references.pmid: 3760978
references.citation: J Bone Miner Res. 1988 Oct;3(5):573-82
references.pmid: 3195368
references.citation: Phys Ther. 1989 Oct;69(10):797-802
references.pmid: 2780806
references.citation: Diabetes Care. 1990 May;13(5):513-21
references.pmid: 2351029
references.citation: J Bone Joint Surg Am. 1993 Dec;75(12):1765-73
references.pmid: 8258546
references.citation: Ann Rheum Dis. 1994 Mar;53(3):163-6
references.pmid: 8154932
references.citation: Osteoporos Int. 1994 Nov;4(6):368-81
references.pmid: 7696835
references.citation: Diabetes Care. 1995 Jan;18(1):34-8
references.pmid: 7698045
references.citation: J Rehabil Res Dev. 1997 Jul;34(3):317-21
references.pmid: 9239625
references.citation: J Bone Miner Res. 1997 Aug;12(8):1303-13
references.pmid: 9258762
references.citation: Phys Ther. 1998 Jan;78(1):74-80
references.pmid: 9442198
references.citation: J Diabetes Complications. 1998 Sep-Oct;12(5):287-93
references.pmid: 9747646
references.citation: J Rheumatol. 1999 Aug;26(8):1843-5
references.pmid: 10451089
references.citation: Phys Ther. 2005 Mar;85(3):249-56
references.pmid: 15733049
references.citation: Osteoporos Int. 2005 Nov;16(11):1330-8
references.pmid: 15928804
references.citation: Bone. 2006 Mar;38(3):387-93
references.pmid: 16203196
references.citation: Curr Opin Pharmacol. 2006 Jun;6(3):313-8
references.pmid: 16650802
references.citation: Nutr Rev. 2007 Dec;65(12 Pt 2):S147-51
references.pmid: 18240539
references.citation: Clin Biomech (Bristol, Avon). 2008 Jun;23(5):653-61
references.pmid: 17602806
references.citation: Phys Ther. 2008 Nov;88(11):1425-35
references.pmid: 18801856
references.citation: Phys Ther. 2008 Nov;88(11):1385-98
references.pmid: 18801859
references.citation: Phys Ther. 2008 Nov;88(11):1375-84
references.pmid: 18801862
references.citation: Arthritis Res. 2000;2(1):33-7
references.pmid: 11094416