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The effect of diabetic neuropathy on foot bones: a systematic review and meta‐analysis
Author(s) -
Barwick A. L.,
Jonge X. A. K. Janse,
Tessier J. W.,
Ho A.,
Chuter V. H.
Publication year - 2014
Publication title -
diabetic medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.474
H-Index - 145
eISSN - 1464-5491
pISSN - 0742-3071
DOI - 10.1111/dme.12347
Subject(s) - medicine , diabetes mellitus , peripheral neuropathy , meta analysis , cinahl , diabetic neuropathy , diabetic foot , bone mineral , population , surgery , physical therapy , endocrinology , osteoporosis , environmental health , psychiatry , psychological intervention
Aims 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.