title: Effect of immobilization, off-loading and zoledronic acid on bone mineral density in patients with acute Charcot neuroarthropathy: a prospective randomized trial.
abstract: BACKGROUND
  Bisphosphonates are commonly used as an adjuvant in the management of acute Charcot neuroarthropathy (CNA), although the clinical efficacy of the treatment is controversial. The aim of the present study is to investigate the effect of immobilization and zoledronic acid on bone mineral density (BMD) changes during the treatment of acute CNA.
  
  
  METHODS
  Thirty-five patients with acute midfoot CNA were randomly assigned to treatment with either zolendronic acid or placebo. BMD of the lumbar spine and both hips was measured at baseline and after six months of treatment.
  
  
  RESULTS
  Comparison between BMD at presentation and at 6 months demonstrated a significant fall in BMD in the placebo group at the CNA-affected femoral neck (-3.2%, p=0.016) and in the CNA-free hip (-1.2%, p=0.026). Conversely, a significant rise in BMD was observed in the zolendronic acid group at all measured areas of the CNA-free hip.
  
  
  CONCLUSIONS
  Immobilization and off-loading does not lead to marked disuse osteoporosis in patients with acute CNA after 6 months of treatment. Treatment with zoledronic acid led to a statistically significant increase in hip BMD compared to placebo.
authors.affiliation: Department of Orthopaedics and Traumatology, Tampere University Hospital, Finland. tkpakarinen@me.com
authors.forename: Toni-Karri
authors.initials: TK
authors.lastname: Pakarinen
authors.forename: Heikki-Jussi
authors.initials: HJ
authors.lastname: Laine
authors.forename: Heikki
authors.initials: H
authors.lastname: Mäenpää
authors.forename: Mika
authors.initials: M
authors.lastname: Kähönen
authors.forename: Pentti
authors.initials: P
authors.lastname: Mattila
authors.forename: Jorma
authors.initials: J
authors.lastname: Lahtela
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D001177:Arthropathy, Neurogenic / Q000188:drug therapy* / Q000209:etiology; D015519:Bone Density; D050071:Bone Density Conservation Agents / Q000627:therapeutic use*; D002370:Casts, Surgical; D004164:Diphosphonates / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007093:Imidazoles / Q000627:therapeutic use*; D007103:Immobilization; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000517:prevention & control*; D011446:Prospective Studies; D016474:Weight-Bearing; D000077211:Zoledronic Acid
chemical_list: D050071:Bone Density Conservation Agents; D004164:Diphosphonates; D007093:Imidazoles; D000077211:Zoledronic Acid