Calcaneal bone mineral density in patients with Charcot neuropathic osteoarthropathy: differences between Type 1 and Type 2 diabetes

• Published in: Diabetic medicine Vol. 22; no. 6; pp. 756 - 761
• Main Authors: Petrova, N. L., Foster, A. V. M., Edmonds, M. E.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Science Ltd 01.06.2005; Blackwell
• Subjects: Adult; Arthropathy, Neurogenic - physiopathology; Biological and medical sciences; Bone Density - physiology; bone mineral density; Calcaneus - physiopathology; Charcot neuropathic osteoarthropathy; Diabetes Mellitus, Type 1 - physiopathology; Diabetes Mellitus, Type 2 - physiopathology; Diabetes. Impaired glucose tolerance; Diabetic Neuropathies - complications; Diabetic Neuropathies - physiopathology; Diseases of the osteoarticular system; Endocrine pancreas. Apud cells (diseases); Endocrinopathies; Female; Humans; Male; Medical sciences; Middle Aged; Miscellaneous. Osteoarticular involvement in other diseases; neuropathy; Type 1 diabetes; Type 2 diabetes; Endocrinopathy; Type 2 diabetes; Human; Immunopathology; Nervous system diseases; Diseases of the osteoarticular system; Metabolic diseases; Patient; Autoimmune disease; Neuropathy; Calcaneum; Type 1 diabetes; Arthropathy; Bone mineral density; Charcot neuropathic osteoarthropathy
• ISSN: 0742-3071; 1464-5491
• DOI: 10.1111/j.1464-5491.2005.01510.x

Aims  To measure bone density and neuropathy in both feet in Type 1 and Type 2 patients with unilateral Charcot osteoarthropathy and controls. Methods  Calcaneal bone density, temperature and vibration thresholds were compared between 17 Type 1 diabetic patients with osteoarthropathy and 47 Type 1 controls and between 18 Type 2 diabetic patients and 48 Type 2 controls. As well as the Charcot foot, the non‐Charcot foot was studied to assess osteopenia at onset of osteoarthropathy. Results  In Type 1 diabetes, bone density was reduced in the non‐Charcot foot compared with controls [Z‐score: −1.7 ({−1.9}–{−1.4}) vs. −0.2 ({−1.1}–{0.5}), P < 0.0001, median (interquartile range)]; but not in Type 2 diabetes [Z‐score: 0.15 ({−0.45}–{0.85}) vs. 0.3 ({−0.5}–{0.9}), P = 0.675]. Bone density in the Charcot foot was lower compared with the non‐Charcot foot in both Type 1 [Z‐score: −2.0 ({−2.8}–{−1.4}) vs. −1.7 ({−1.9}–{−1.4}), P = 0.018] and Type 2 diabetes [Z‐score: −0.2 ({−1.4}–{0.1}) vs. 0.3 ({−0.5}–{0.9}), P = 0.001]. In Type 1 diabetes, bone density of the non‐Charcot foot was reduced compared with that in Type 2 (P < 0.0001). Body mass index was lower in Type 1 than in Type 2 Charcot patients (P = 0.007). Type 2 patients had high temperature (P = 0.001) and vibration thresholds (P < 0.0001) in the non‐Charcot foot compared with Type 2 controls whereas Type 1 patients had a high temperature threshold (P = 0.01) but not vibration threshold compared with Type 1 controls (P = 0.077). Conclusion  Bone density was reduced in the non‐Charcot foot in Type 1 but not in Type 2 diabetes. Type 2 patients had high temperature and vibration thresholds in contrast to Type 1 patients who had a high temperature threshold only.