title: A comparative study of zoledronic acid and once weekly Alendronate in the management of acute Charcot arthropathy of foot in patients with diabetes mellitus.
abstract: OBJECTIVE
  The aim of this study was to assess and compare the response to two forms of treatment-immobilization with zoledronic acid injection and immobilization with oral weekly Alendronate, in patients with diabetes mellitus and acute Charcot arthropathy (CA) of foot in terms of clinical and radiological parameters.
  
  
  METHODS
  Patients attending the endocrinology and podiatry clinic with history of diabetes mellitus and Acute CA were taken for study. The patients were randomized into two treatment groups. Group Z-zoledronic acid injection along with total contact cast (TCC). Group A-Tab. Alendronate 70 mg. once a week till the complete clinical resolution of acute CA along with TCC. Forty-five patients were randomized and 40 of them completed the study. The primary end point was complete clinical resolution of acute CA-defined as temperature difference between normal and affected foot <1°F.
  
  
  RESULTS
  Among the 40 patients, 30 (75%) had complete clinical resolution. The mean number of days taken for complete clinical resolution since the initiation of treatment (either Zoledronic acid or Alendronate) was approximately 122 days. There was no significant difference in a number of days required for complete clinical resolution, between the two forms of therapy. There was more than 50% reduction in the visual score between the baseline and the final scan. The target to non-target ratio in the skeletal phase also showed an average of 40% reduction from the baseline to the final skeletal scintigraphy.
  
  
  CONCLUSIONS
  Both Intravenous Zoledronic acid and oral alendronate had comparable efficacy with respect to the time taken for attaining complete clinical resolution of acute CA of foot. However, Alendronate therapy was cost effective among the two. (99m)Tc MDP bone scan can be used as an adjuvant to the clinical parameters in assessing the response to therapy.
authors.affiliation: Department of Endocrinology, Chettinad Super Speciality Hospital, Kelambakkam, Kancheepuram District, Tamil Nadu, India.
authors.forename: R
authors.initials: R
authors.lastname: Bharath
authors.forename: Arun
authors.initials: A
authors.lastname: Bal
authors.forename: Shanmuga
authors.initials: S
authors.lastname: Sundaram
authors.forename: A G
authors.initials: AG
authors.lastname: Unnikrishnan
authors.forename: V P
authors.initials: VP
authors.lastname: Praveen
authors.forename: Nisha
authors.initials: N
authors.lastname: Bhavani
authors.forename: Vasantha
authors.initials: V
authors.lastname: Nair
authors.forename: R V
authors.initials: RV
authors.lastname: Jayakumar
authors.forename: Harish
authors.initials: H
authors.lastname: Kumar
keywords: Arthropathy; Charcot; alendronate; resolution; zoledronic acid