Alterations to bone mineral composition as an early indication of osteomyelitis in the diabetic foot.
OBJECTIVE
Osteomyelitis in the diabetic foot is a major risk factor for amputation, but there is a limited understanding of early-stage infection, impeding limb-preserving diagnoses. We hypothesized that bone composition measurements provide insight into the early pathophysiology of diabetic osteomyelitis.


METHODS
Compositional analysis by Raman spectroscopy was performed on bone specimens from patients with a clinical diagnosis of osteomyelitis in the foot requiring surgical intervention as either a biopsy (n = 6) or an amputation (n = 11).


RESULTS
An unexpected result was the discovery of pathological calcium phosphate minerals in addition to normal bone mineral. Dicalcium phosphate dihydrate, also called brushite, and uncarbonated apatite were found to be exclusively associated with infected bone.


CONCLUSIONS
Compositional measurements provided a unique insight into the pathophysiology of osteomyelitis in diabetic foot ulcers. At-patient identification of pathological minerals by Raman spectroscopy may serve as an early-stage diagnostic approach.
Corresponding author: Blake J. Roessler, roessler@umich.edu.
Karen A
KA
Esmonde-White
Francis W L
FW
Esmonde-White
Crystal M
CM
Holmes
Michael D
MD
Morris
Blake J
BJ
Roessler
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical; D015519:Bone Density; D017719:Diabetic Foot / Q000150:complications* / Q000473:pathology / Q000601:surgery*; D042241:Early Diagnosis; D005260:Female; D005528:Foot / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D010019:Osteomyelitis / Q000175:diagnosis* / Q000209:etiology / Q000473:pathology; D013059:Spectrum Analysis, Raman