Effect of immobilization, off-loading and zoledronic acid on bone mineral density in patients with acute Charcot neuroarthropathy: A prospective randomized trial

Pakarinen, Toni-Karri; Laine, Heikki-Jussi; Mäenpää, Heikki; Kähönen, Mika; Mattila, Pentti; Lahtela, Jorma

doi:10.1016/j.fas.2012.12.007

Cited by 20 publications

(7 citation statements)

References 24 publications

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“…Neuropathic feet with low bone density continue to be at high risk for recurrent fragility fracture, progressive deformities, skin ulceration, infection and subsequent amputation [11, 41]. Our results continue to demonstrate neuropathic patients with CNA or NPU and low pedal BMD after immobilization may benefit from anti-resorptive or anabolic bone agents to help restore bone mass in conjunction with an effective reloading rehabilitation program [18, 22]. …”

Section: Discussionmentioning

confidence: 78%

“…There have been few reports of immobilization-induced pedal osteolysis in individuals with diabetic, neuropathic foot impairments [13, 19, 20–22] and no previous reports comparing the impact of pedal osteolysis or recovery in individuals with NPU to individuals with CNA. Therefore, we aimed to determine the magnitude of pedal osteolysis in both neuropathic impairments after immobilization and the time course of recovery.…”

Section: Introductionmentioning

confidence: 99%

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Immobilization-induced osteolysis and recovery in neuropathic foot impairments

Sinacore

Hastings

Bohnert

et al. 2017

Bone

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Background Neuropathic foot impairments treated with immobilization and off-loading result in osteolysis. In order to prescribe and optimize rehabilitation programs after immobilization we need to understand the magnitude of pedal osteolysis after immobilization and the time course for recovery. Objective To determine differences in a) foot skin temperature; b) calcaneal bone mineral density (BMD) after immobilization; c) calcaneal BMD after 33–53 weeks of recovery; and d) percent of feet classified as osteopenic or osteoporotic after recovery in participants with neuropathic plantar ulcers (NPU) compared to Charcot neuroarthropathy (CNA). Methods Fifty-five participants with peripheral neuropathy were studied. Twenty-eight participants had NPU and 27 participants had CNA. Bilateral foot skin temperature was assessed before immobilization and bilateral calcaneal BMD was assessed before immobilization, after immobilization and after recovery using quantitative ultrasonometry. Results Before immobilization, skin temperature differences in CNA between their index and contralateral foot were markedly higher than NPU feet (3.0 degree C versus 0.7 degree C, respectively, p < .01); BMD in NPU immobilized feet averaged 486 ± 136 mg/cm2, and CNA immobilized feet averaged 456 ± 138 mg/cm2, p >0.05). After immobilization, index NPU feet lost 27 mg/cm2; CNA feet lost 47 mg/cm2 of BMD, p < 0.05. After recovery, 61% of NPU index feet and 84% of CNA index feet were classified as osteopenic or osteoporotic. Conclusions There was a greater osteolysis after immobilization with an attenuated recovery in CNA feet compared to NPU feet. The attenuated recovery of pedal BMD in CNA feet resulted in a greater percentage of feet classified as osteoporotic and osteopenic.

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Section: Discussionmentioning

confidence: 78%

Section: Introductionmentioning

confidence: 99%

Immobilization-induced osteolysis and recovery in neuropathic foot impairments

Sinacore

Hastings

Bohnert

et al. 2017

Bone

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“…How immobilization and off-loading therapy affects BMD is still inconclusive. According to some authors, BMD falls over time in the affected foot as casting therapy is introduced [45], while other authors have shown no long-term effects of this therapy on further BMD loss [46,47]. At the beginning of the twenty-first century, inflammation was identified as a key component in the pathogenesis of Charcot neuroarthropathy.…”

Section: Pathogenesis Of Charcot Neuroarthropathymentioning

confidence: 99%

The role of genetic factors and monocyte-to-osteoclast differentiation in the pathogenesis of Charcot neuroarthropathy

Kłoska

Korzon-Burakowska

Malinowska

et al. 2020

Diabetes Research and Clinical Practice

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Charcot neuroarthropathy is a chronic, progressive condition of the skeletal system that affects some patients with diabetic neuropathy. It results in progressive destruction of bones of the foot and disorganisation of pedal joints and ligaments. Effective prevention and treatment for Charcot neuroarthropathy remain a challenge. Currently, there are no reliable repeatable markers to identify patients with diabetes who are at higher risk of developing Charcot neuroarthropathy. The pathogenesis underlying the development of Charcot neuroarthropathy also remains unclear. In this review, we provide an overview of the history, prevalence, symptoms, risk factors, diagnostics and treatment of Charcot neuroarthropathy. We also discuss the potential for OPG and RANKL gene variants to act as predictive markers for the development of Charcot neuroarthropathy. Finally, we summarise the latest research on the role of monocyte-to-osteoclast differentiation in the development of acute Charcot neuroarthropathy.

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“…Some studies reported the BMD may further loss during casting and no weight bearing [ 58 ]. However, Pakarinen et al [ 61 ] reported that immobilization and off-loading does not lead to marked disuse osteoporosis in patients with acute DNOAP after 6 months of treatment. BMD of DNOAP is also different according to the pattern of initial destruction.…”

Section: Relative Risk Factorsmentioning

confidence: 99%

Pathogenesis and potential relative risk factors of diabetic neuropathic osteoarthropathy

et al. 2017

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Diabetic neuropathic osteoarthropathy (DNOAP) is an uncommon, but with considerable morbidity and mortality rates, complication of diabetes. The real pathogenesis is still unclear. The two popular theories are the neuro-vascular theory and neuro-traumatic theory. Most theories and pathways focused on the uncontrolled inflammations that resulted in the final common pathway, receptor activator of nuclear factor κβ ligand (RANKL)/osteoprotegerin (OPG) axis, for the decreased bone density in DNOAP with an osteoclast and osteoblast imbalance. However, the RANKL/OPG pathway does not explain all the changes, other pathways and factors also play roles. A lot of DNOAP potential relative risk factors were evaluated and reported in the literature, including age, gender, weight, duration and type of diabetes, bone mineral density, peripheral neuropathy and arterial disease, trauma history, and some others. However, most of them are still in debates. Future studies focus on the pathogenesis of DNOAP are still needed, especially for the genetic factors. And, the relationship between DNOAP and those potential relative risk factors are still need to further clarify.

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Effect of immobilization, off-loading and zoledronic acid on bone mineral density in patients with acute Charcot neuroarthropathy: A prospective randomized trial

Cited by 20 publications

References 24 publications

Immobilization-induced osteolysis and recovery in neuropathic foot impairments

Immobilization-induced osteolysis and recovery in neuropathic foot impairments

The role of genetic factors and monocyte-to-osteoclast differentiation in the pathogenesis of Charcot neuroarthropathy

Pathogenesis and potential relative risk factors of diabetic neuropathic osteoarthropathy

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