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Calcaneal bone mineral density in patients with Charcot neuropathic osteoarthropathy: differences between Type 1 and Type 2 diabetes
Author(s) -
Petrova N. L.,
Foster A. V. M.,
Edmonds M. E.
Publication year - 2005
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/j.1464-5491.2005.01510.x
Subject(s) - medicine , spinal osteoarthropathy , bone mineral , type 2 diabetes , diabetes mellitus , dermatology , surgery , osteoporosis , endocrinology
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.