Osteopenia, Neurological Dysfunction, and the Development of Charcot Neuroarthropathy

OBJECTIVE: To determine factors that might be associated with the development of Charcot neuroarthropathy. RESEARCH DESIGN AND METHODS: This cross-sectional prevalence study examined neurological function and bone density in matched groups of neuropathic diabetic patients with and without radiological evidence of Charcot neuroarthropathy. RESULTS: Patients with Charcot neuroarthropathy had a global impairment of neurological function that was significantly greater than that of otherwise matched non-Charcot neuropathic patients. All 17 Charcot patients had evidence of autonomic neuropathy compared with 10 of the control subjects (P = 0.03). The Charcot patients had evidence of reduced bone density in the lower limbs compared with the neuropathic control subjects (P = 0.009), but relatively preserved bone density in the spine (P = 0.4 vs. control subjects). CONCLUSIONS: We conclude that minor trauma in diabetic patients with peripheral neuropathy might result in a fracture in those with a reduced bone density and thus trigger the development of Charcot neuroarthropathy.