Trabecular Quality and Cellular Characteristics of Normal, Diabetic, and Charcot Bone

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Charcot neuroarthropathy (CN) is a disabling and devastating condition that affects many neuropathic diabetic patients. It can lead to foot deformity, ulceration, and lower extremity amputation. The pathogenesis of CN is not clear, but 1 possible predisposing factor is increased bone turnover and increased osteoclastic activity. Although the affect of diabetes on bone is not entirely clear, studies have shown increased bone fragility in diabetics with neuropathy. The purpose of the present study was to compare the bone quality histologic findings and trabecular histomorphometry, including the cellular characteristics, between normal subjects (N = 7), diabetics without CN (N = 8), and diabetics with CN (N = 8). Histologically, the bone in diabetics with CN displayed an inflammatory, myxoid infiltrate. We also observed a statistically significant decrease in the number of trabeculae in bone in diabetics with CN compared with normal controls (p < .02). However, the difference between the trabeculae in diabetics with CN and diabetics without CN was not statistically significant (p > .05). Histologically, the CN bone appeared to be infiltrated with inflammatory myxoid tissue and had a disorganized trabecular pattern compared with diabetic bone without CN and normal bone. The trabeculae in patients with CN appeared to have poor quality characteristics compared with that of the other groups. The findings from the present study might indicate that diabetes mellitus bone is fragile, and the decrease in the cellular component might impair the reparative process in those with CN foot.Level of Clinical Evidence: 3

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