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Pattern of Diabetic Neuropathic Arthropathy Associated with the Peripheral Bone Mineral Density
Pattern of Diabetic Neuropathic Arthropathy Associated with the Peripheral Bone Mineral Density -- Posted by Gumbo on 03-06-05 06:51
Pattern of Diabetic Neuropathic Arthropathy Associated with the Peripheral
Bone Mineral Density
Lower limb
S. A. Herbst, K. B. Jones, C. L. Saltzman
From the University of Iowa Hospitals and Clinics, Iowa City, USA
J Bone Joint Surg [Br] 2004;86-B:378-83.
The relationship between the bone mineral density (BMD) and Charcot
arthropathy is unclear. Prospectively, 55 consecutive diabetic patients
presenting with a Charcot arthropathy of the foot or ankle were classified
as having a fracture, dislocation, or a combination fracture-dislocation
pattern of initial destruction. In these groups we used dual-energy x-ray
absorptiometry to compare the peripheral bone of the affected and unaffected
limbs. The clinical data relating to diabetes and related major
comorbidities and the site of the arthropathy (ankle, hindfoot, midfoot,
forefoot) were also compared. There were 23 patients with a fracture
pattern, 23 with a dislocation pattern, and nine with a combination.
The age-adjusted odds ratio for developing a Charcot joint with a fracture
pattern as opposed to a dislocation pattern in patients with osteopenia was
9.5 (95% confidence interval 2.4 to 37.4; p = 0.0014). Groups also differed
as to the site of the arthropathy. Fracture patterns predominated at the
ankle and forefoot whereas dislocations did so in the midfoot. Diabetic
Charcot arthropathy of the foot and ankle differs according to the pattern
of the initial destruction. The fracture pattern is associated with
peripheral deficiency of BMD. The dislocation pattern is associated with a
normal BMD.
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