Charcot neuroarthropathy (CNA) is a disabling and devastating condition affecting patients with severe diabetic neuropathy. It can lead to foot deformity, recurrent foot ulceration and ultimately to amputation. The incidence is about 0.1±5 % in diabetic patients with peripheral neuropathy [1].The pathogenesis of CNA is not clear, one possible predisposing factor is reduced bone density [2,3], probably as a result of increases in bone turnover. Investigators measured carboxy-terminal telopeptide domain of type 1 collagen (1TCP) and carboxy-terminal propeptide of type 1 collagen (P1CP) as possible Diabetologia (2001) AbstractAims/hypothesis. The management of charcot neuroarthropathy, a severe disabling condition in diabetic patients with peripheral neuropathy, is currently inadequate with no specific pharmacological treatment available. We undertook a double-blind randomised controlled trial to study the effect of pamidronate, a bisphosphonate, in the management of acute diabetic Charcot neuroarthropathy. Methods. Altogether 39 diabetic patients with active Charcot neuroarthropathy from four centres in England were randomised in a double-blind placebo-controlled trial. Patients received a single infusion of 90 mg of pamidronate or placebo (saline). Foot temperatures, symptoms and markers of bone turnover (bone specific alkaline phosphatase and deoxypyridinoline crosslinks) were measured over the 12 months, in 10 visits. All patients also had standard treatment of the Charcot foot. Results. Mean age of the study group (59 % Type II (non-insulin-dependent) diabetes mellitus) was 56.3 10.2 years. The mean temperature difference between active and control groups was 3.6 1.7 C and 3.3 1.4 C, respectively. There was a fall in tem-

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