title: The effect of diabetic neuropathy on foot bones: a systematic review and meta-analysis.
abstract: OBJECTIVE
  It is proposed that diabetic neuropathy may affect peripheral bone. Direct innervation of bone as well as neural control over its vascular supply and muscular influences may be affected by diabetes-induced peripheral neuropathies. Associated changes to bone may contribute to the occurrence of foot bone pathology in this population. This systematic review aims to examine the literature related to the effect of diabetic neuropathy on foot bones.
  
  
  METHODS
  Studies examining relationships between neuropathy and indicators of bone health (e.g. bone mineral density) in populations with diabetes were sought. Relevant publications were obtained from searches in MEDLINE, CINAHL and Embase in the period up to March 2013. Meta-analysis was performed using a random effects model in the statistical package Stata version 12.1.
  
  
  RESULTS
  Ten studies met the inclusion criteria and were included in the narrative synthesis. All studies were cross-sectional or case-control in design. Four of the 10 included studies found results indicating poorer bone health in those with diabetes and neuropathy compared with those with diabetes without neuropathy. Seven of the 10 studies were able to be included in a meta-analysis. The mean pooled effect was -0.36 (95% CI -0.76 to 0.04; P = 0.08), indicating a non-significant trend towards poorer bone health in those with diabetic neuropathy.
  
  
  CONCLUSIONS
  We did not find a significant relationship between presence of neuropathy in those with diabetes and poorer peripheral bone health. However, methodological limitations of the included studies mean further research is required to investigate this theoretical relationship.
authors.affiliation: School of Health Sciences, Faculty of Health.
authors.forename: A L
authors.initials: AL
authors.lastname: Barwick
authors.forename: X A K Janse
authors.initials: XA
authors.lastname: de Jonge
authors.forename: J W
authors.initials: JW
authors.lastname: Tessier
authors.forename: A
authors.initials: A
authors.lastname: Ho
authors.forename: V H
authors.initials: VH
authors.lastname: Chuter
mesh_terms: D015519:Bone Density; D001851:Bone Diseases, Metabolic / Q000453:epidemiology / Q000209:etiology / Q000473:pathology; D003430:Cross-Sectional Studies; D003929:Diabetic Neuropathies / Q000150:complications / Q000453:epidemiology / Q000473:pathology*; D005529:Foot Bones / Q000473:pathology*; D006801:Humans