الفهرس 
Diabetes MellitusOnly 14 pages are availabe for public view
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Abstract
Charcot arthropathy (CA) is a non-infectious destructive process affecting the bone and joint structure that results from significant peripheral neuropathy, It develops in up to 16% of patients with diabetic neuropathy. It is a devastating limb threatening condition resulting in dramatic deformities and recurrent ulceration that may ultimately lead to amputation. Moreover, CA is associated with a high mortality rate. The pathophysiology of CA is poorly understood, but is considered to be a multifactorial and neuropathy is regarded as mandatory. Osteoporosis has been postulated to play a role in the development of charcot arthropathy, but it is still controversial.
In this study we aimed to assess the role of osteoporosis in charcot arthropathy in patients with type 2 diabetes.
This study was conducted on 60 patients with type 2 diabetes mellitus. They were divided into 2 groups: group 1: 30 diabetic patients with CA and group 2: 30 diabetic patients without CA.
Both groups were subjected to full history taking, thorough clinical examination including full assessment of the diabetic foot (presence of any bone deformities, neuropathy and vascular assessment), Laboratory investigations (FBS, 2hr PPBS, HbA1C, s. Ca, Po4 and ALP) and measurement of bone mineral density by Dual energy X-ray absorptiometry (DEXA) of the lumbar spine and hip.
Similar to old literatures, the study showed that the midfoot is the most commonly affected area in charcot arthropathy.
In addition, it showed that patients from both groups have normal central BMD (DEXA T-score of the spine) and are not in the osteopenic or osteoporotic category. However, BMD of the charcot patients are lower than diabetics without CA.
The present study showed that diabetic patients with charcot arthropathy showed more microvascular complications having more neuropathy and nephropathy than diabetic patients without CA. However, there was no statistical difference as regard retinopathy.
The results also showed that diabetic patients with CA showed more macrovascular complications having more Peripheral Arterial Disease (PAD) and Hypertension, while ischemic heart disease (IHD) showed no statistical significant difference but it showed higher incidence in chronic charcot patients rather than acute charcot patients.
In addition, the results showed that in comparison between groups there was no statistical difference as regard age, gender, BMI and diabetes duration as well as line of treatment and glycemic control.
In an attempt to study the most important predictors of charcot arthropathy, Multiple Logistic regression analysis was performed. It showed that decreased BMD especially in female gender is a predictor of charcot arthropathy.
In conclusion, BMD play an important role in charcot arthropathy, it should be assesssed in diabetic individuals especially those with evident microvascular or macrovascular complications. In addition, evaluation of peripheral BMD may be useful in diabetics to assess fracture risk and risk for CA.