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Naz A, Kumar S, Khatri M. Contribution of peripheral neuropathy to poor bone health in the feet of people with type 2 diabetes mellitus. Acta Diabetol 2023; 60:711-712. [PMID: 36740652 DOI: 10.1007/s00592-023-02039-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 01/19/2023] [Indexed: 02/07/2023]
Affiliation(s)
| | - Satesh Kumar
- Shaheed Mohtarma Benazir Bhutto Medical College Liyari, Karachi, Pakistan
| | - Mahima Khatri
- Dow University of Health Sciences, Karachi, Pakistan
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Lasschuit JWJ, Greenfield JR, Tonks KTT. Contribution of peripheral neuropathy to poor bone health in the feet of people with type 2 diabetes mellitus. Acta Diabetol 2022; 59:217-224. [PMID: 34568958 PMCID: PMC8475816 DOI: 10.1007/s00592-021-01803-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 09/13/2021] [Indexed: 02/07/2023]
Abstract
AIMS To evaluate the impact of peripheral neuropathy on bone health in people with type 2 diabetes mellitus (T2DM). METHODS Participants with T2DM were grouped according to the presence of peripheral neuropathy as assessed by vibration perception threshold (VPT). Recruitment ensured groups were balanced for age, sex and body mass index (BMI). Bone health was measured by calcaneal quantitative ultrasound (QUS) and compared between groups. Calcaneal QUS parameters were correlated across the cohort with VPT and other prespecified variables. RESULTS Thirty-four participants (17 per group) were included with mean age 68 ± 12 years, 47% male, with median BMI 29.9 (IQR 26.9-32.7) kg/m2. The peripheral neuropathy group had significantly lower mean Stiffness Index (87 ± 12 versus 101 ± 16, p = 0.01), Speed of Sound (1542 ± 28 versus 1574 ± 34 m/s, p < 0.01), and a trend towards lower Broadband Ultrasound Attenuation (113 ± 10 versus 120 ± 12 dB/MHz, p = 0.07). Pedal bone health asymmetry was not a significant feature in those with peripheral neuropathy. All calcaneal QUS parameters correlated negatively with VPT, although significance of the relationship with Broadband Ultrasound Attenuation was nullified if controlled for diabetes duration or time on insulin. Broadband Ultrasound Attenuation showed independent negative correlation with diabetes duration. CONCLUSIONS People with T2DM and peripheral neuropathy have poorer bone health as measured by calcaneal QUS than those without peripheral neuropathy, independent of age, sex and BMI.
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Affiliation(s)
- Joel Willem Johan Lasschuit
- Department of Endocrinology and Diabetes, St Vincent's Hospital, Sydney, NSW, Australia.
- Healthy Ageing, Garvan Institute of Medical Research, Sydney, NSW, Australia.
- Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia.
| | - Jerry Richard Greenfield
- Department of Endocrinology and Diabetes, St Vincent's Hospital, Sydney, NSW, Australia
- Healthy Ageing, Garvan Institute of Medical Research, Sydney, NSW, Australia
- Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Katherine Thuy Trang Tonks
- Department of Endocrinology and Diabetes, St Vincent's Hospital, Sydney, NSW, Australia
- Healthy Ageing, Garvan Institute of Medical Research, Sydney, NSW, Australia
- Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
- School of Medicine, University of Notre Dame, Sydney, NSW, Australia
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Mohseni M, Hosseinzadeh P, Civitelli R, Eisen S. Effect of peripheral neuropathy on bone mineral density in adults with diabetes: A systematic review of the literature and meta-analysis. Bone 2021; 147:115932. [PMID: 33757900 PMCID: PMC8224476 DOI: 10.1016/j.bone.2021.115932] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 03/12/2021] [Accepted: 03/16/2021] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Peripheral neuropathy occurs in two thirds of patients with diabetes mellitus (DM). It can lead to severe pathological changes in the feet, and it increases the risk of fracture more than any other diabetic complication. The objective of this review is to analyze available literature on the effect of peripheral neuropathy on BMD of the foot, spine, or hip. We hypothesize that the presence of diabetic neuropathy leads to lower BMD in adults with diabetes. METHODS Original studies investigating the effects of diabetic neuropathy on bone density were searched for inclusion in this systematic review. Studies were eligible if they met the following criteria: 1) participants included adults with either Type 1 DM or Type 2 DM; 2) Method used for the diagnosis of neuropathy described in the manuscript 3) DXA scan, ultrasound, or CT scan was used to measure proximal femur, spine, or foot bone mineral density were reported, and 4) bone parameters were analyzed based on the presence and absence of neuropathy. RESULTS Among the 5 studies that met eligibility criteria, 4 did not find a significant effect of neuropathy on BMD. One study showed a significant negative impact of neuropathy on calcaneal BMD in patients with type 1 diabetes. The meta-analysis did not show a significant effect of peripheral neuropathy on BMDs of proximal femur, spine, and calcaneus in diabetic adults. CONCLUSION Our study shows no evidence that peripheral neuropathy affects bone density or bone turnover in DM. However, this conclusion should be taken with caution since only a very limited number of studies were available for inclusion in the analysis and included both type 1 and type 2 DM patients. Improved measures of peripheral neuropathy and more advanced imaging technologies are needed to better assess the effect of diabetes on bone health.
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Affiliation(s)
- Mahshid Mohseni
- Division of Bone and Mineral Diseases, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA.
| | - Pooya Hosseinzadeh
- Department of Orthopedic Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Roberto Civitelli
- Division of Bone and Mineral Diseases, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Seth Eisen
- Division of Rheumatology, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
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Liu C, Lv H, Niu P, Tan J, Ma Y. Association between diabetic neuropathy and osteoporosis in patients: a systematic review and meta-analysis. Arch Osteoporos 2020; 15:125. [PMID: 32779030 DOI: 10.1007/s11657-020-00804-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 07/31/2020] [Indexed: 02/03/2023]
Abstract
OBJECTIVES Many studies have explored the association between neuropathy and osteoporosis in patients with diabetes mellitus. However, the results still remain inconsistent and controversial. We aimed to estimate the association between diabetic neuropathy and osteoporosis. METHODS Databases, including PubMed, Embase, Web of Science, the Cochrane library, Chinese Biomedical Literature Database (CBM), and Wanfang, were screened from inception to 30 March 2020. Studies were selected and data were extracted by two independent reviewers. Study characteristics and quality sections were reviewed independently. Pooled ORs and 95% CIs were calculated using random effects model when evidence of heterogeneity was present; otherwise, fixed effects model was used. Meta-regression and subgroup analyses were performed to explore the source of heterogeneity. Sensitivity analysis and publication bias were also tested. RESULTS A total of 11 studies with 27,585 participants were included in this analysis which indicated that there was an increased odd between diabetic neuropathy and osteoporosis (overall OR 2.20, 95% CI 1.71-2.83). In the subgroup analyses and meta-regression, diabetic neuropathy has no significant difference in osteoporosis or fracture (p = 0.532). And osteoporosis also has no significant difference in type 1 or type 2 diabetic neuropathy (p = 0.668). CONCLUSIONS This meta-analysis suggests that patients with diabetic neuropathy have a significantly increased chance of developing osteoporosis, even fragility fracture. The clinicians should pay more attention to the patients with diabetic neuropathy. Further studies were still needed to explore the confounding factors among studies and to elucidate the underlying biological mechanisms.
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Affiliation(s)
- Chunhua Liu
- Department of Endocrinology, The First Hospital of Lanzhou University, 1 Donggang West Road, Lanzhou, Gansu, 730000, People's Republic of China
| | - Haihong Lv
- Department of Endocrinology, The First Hospital of Lanzhou University, 1 Donggang West Road, Lanzhou, Gansu, 730000, People's Republic of China.
| | - Peng Niu
- Department of Orthopaedics, Tongchuan Mining Central Hospital, The affiliated Shaanxi University of Chinese Medicine, 15 Chuankou Road, Tongchuan, Shaanxi, 727000, People's Republic of China
| | - Jiaojiao Tan
- Department of Endocrinology, The First Hospital of Lanzhou University, 1 Donggang West Road, Lanzhou, Gansu, 730000, People's Republic of China
| | - Yuping Ma
- Department of Endocrinology, The First Hospital of Lanzhou University, 1 Donggang West Road, Lanzhou, Gansu, 730000, People's Republic of China
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Charcot Neuroarthropathy Advances: Understanding Pathogenesis and Medical and Surgical Management. Clin Podiatr Med Surg 2019; 36:663-684. [PMID: 31466574 DOI: 10.1016/j.cpm.2019.07.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Understanding new theories of the epidemiology of Charcot neuroarthropathy is practice changing. Treatment of Charcot neuroarthropathy is evolving from a passive approach to one that sees the urgency of proactive, early recognition, thereby avoiding the cascading events that lead to the complex, limb-threatening deformities. Preventive medicine is the most efficient at avoiding severe deformity, with prolonged offloading and immobilization as the current mainstay of treatment. However, with recent advancements in medical and surgical modalities, this may become the treatment of the past as clinicians begin to favor medical management and early surgical intervention.
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Jansen RB, Svendsen OL. A review of bone metabolism and developments in medical treatment of the diabetic Charcot foot. J Diabetes Complications 2018; 32:708-712. [PMID: 29857955 DOI: 10.1016/j.jdiacomp.2018.04.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2018] [Revised: 04/20/2018] [Accepted: 04/23/2018] [Indexed: 02/07/2023]
Abstract
Charcot foot is a rare but severe, and possibly limb-threatening, complication to neuropathy and diabetes mellitus. The current treatment consists of long-term off-loading, and has a large negative impact on the patient's life. Much research has gone into understanding the condition and its biochemical mechanisms, however, the underlying pathogenesis of a Charcot foot is not yet fully understood. In the recent decades several key advances in our understanding of the Charcot foot have been made, both in regards to the changes in bone metabolism and structure an acute Charcot foot can cause, and to the molecular pathways involved in this. This review summerizes the available research into the bone metabolism around a Charcot foot, with an emphasis on the biochemical profile. The existing data regarding attempts at medical treatment is also reviewed, including novel trials targetting specific inflammatory pathways upregulated in the acute diabetic Charcot foot.
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Affiliation(s)
- Rasmus Bo Jansen
- Department of Endocrinology, Bispebjerg Hospital, University of Copenhagen, DK-2400 Copenhagen, NV, Denmark.
| | - Ole Lander Svendsen
- Department of Endocrinology, Bispebjerg Hospital, University of Copenhagen, DK-2400 Copenhagen, NV, Denmark; Copenhagen Diabetes Foot Center (CODIF), Bispebjerg Hospital, University of Copenhagen, DK-2400 Copenhagen, NV, Denmark
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Shanbhogue VV, Hansen S, Frost M, Brixen K, Hermann AP. Bone disease in diabetes: another manifestation of microvascular disease? Lancet Diabetes Endocrinol 2017; 5:827-838. [PMID: 28546096 DOI: 10.1016/s2213-8587(17)30134-1] [Citation(s) in RCA: 83] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Revised: 02/27/2017] [Accepted: 03/28/2017] [Indexed: 12/24/2022]
Abstract
Type 1 and type 2 diabetes are generally accepted to be associated with increased bone fracture risk. However, the pathophysiological mechanisms of diabetic bone disease are poorly understood, and whether the associated increased skeletal fragility is a comorbidity or a complication of diabetes remains under debate. Although there is some indication of a direct deleterious effect of microangiopathy on bone, the evidence is open to question, and whether diabetic osteopathy can be classified as a chronic, microvascular complication of diabetes remains uncertain. Here, we review the current knowledge of potential contributory factors to diabetic bone disease, particularly the association between diabetic microangiopathy and bone mineral density, bone structure, and bone turnover. Additionally, we discuss and propose a pathophysiological model of the effects of diabetic microvascular disease on bone, and examine the progression of bone disease alongside the evolution of diabetes.
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Affiliation(s)
| | - Stinus Hansen
- Department of Endocrinology, Odense University Hospital, Odense, Denmark
| | - Morten Frost
- Department of Endocrinology, Odense University Hospital, Odense, Denmark
| | - Kim Brixen
- Department of Endocrinology, Odense University Hospital, Odense, Denmark
| | - Anne P Hermann
- Department of Endocrinology, Odense University Hospital, Odense, Denmark
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Barwick AL, Tessier JW, Janse de Jonge X, Chuter VH. Foot bone density in diabetes may be unaffected by the presence of neuropathy. J Diabetes Complications 2016; 30:1087-92. [PMID: 27156167 DOI: 10.1016/j.jdiacomp.2016.04.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Revised: 03/15/2016] [Accepted: 04/18/2016] [Indexed: 11/29/2022]
Abstract
AIMS Neuropathies are common complications of diabetes and are proposed to influence peripheral bone, principally via an altered vascular supply. This study aimed to determine the relationship between subtypes of neuropathy and vascular reactivity on foot bone density in people with diabetes. METHODS A case-control observational design was utilised with two groups: those with diabetic peripheral large fibre neuropathy (n=23) and a control group with diabetes but without neuropathy (n=23). Bone density in 12 foot bones was determined with computed tomography scanning. Additionally, post-occlusive reactive hyperemia, presence of small fibre neuropathy and heart rate variability were determined. T-tests and hierarchical regression were used to examine the relationships among the variables. RESULTS No difference in foot bone density was found between those with and those without large fibre neuropathy. Furthermore, no association between heart rate variability or reactive hyperemia and bone density was found. Small fibre neuropathy was associated with increased cuboid trabecular bone density (p=0.006) with its presence predictive of 14% of the variance. CONCLUSIONS This study found no clear association between presence of diabetic neuropathies and foot bone density. Furthermore, vascular reactivity appears to have no impact on bone density.
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Affiliation(s)
- Alex L Barwick
- Faculty of Health and Medicine, University of Newcastle, 10 Chittaway Rd, Ourimbah, Australia.
| | - John W Tessier
- Faculty of Health and Medicine, University of Newcastle, 10 Chittaway Rd, Ourimbah, Australia
| | - Xanne Janse de Jonge
- Faculty of Science and Information Technology, University of Newcastle, 10 Chittaway Rd, Ourimbah, Australia
| | - Vivienne H Chuter
- Faculty of Health and Medicine, University of Newcastle, 10 Chittaway Rd, Ourimbah, Australia
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