CMT, Osteopenia and Osteoporosis

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Diabetes Care. 1995 Jan;18(1):34-8.

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Osteopenia, neurological dysfunction, and the development of Charcot

neuroarthropathy.

Young MJ, Marshall A, JE, Selby PL, Boulton AJ.

University Department of Medicine, Manchester Royal Infirmary, United Kingdom.

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.

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http://www.orthocenter.net/08orthoinfo/topics/AnkleFootTopics/

CharcotNeuroarthropathy.htm

Charcot Neuroarthropathy

What is Charcot Neuroarthropathy?

Charcot neuroarthropathy is a term to describe degenerative joint destruction as

a result

of the combination of trauma and impaired sensation.  The mechanism is one of

the

unrecognized mechanical microtrauma, such as everyday waling, in a joint that

has been

rendered insensitive to proprioception and pain.  Vascular insufficiency is also

believed to

aid bone resorption and ligamentous instability.  The disorder can progress to

joint

destruction, fractures, and collapse of the ankle and foot.

Symptoms

Charcot Neuroarthropathy initially causes warmth, swelling, and redness of the

foot.  It

may lead to changes in the shape of the ankle and foot, and ulcers over new bony

prominences.  Pain is rarely a presenting symptom.

Causes

Diabetes is by far the most common cause of Charcot joints.  The ratio of men to

women

is about equal, and the average duration of diabetes prior to the occurrence of

the Charcot

joint is over 10 years, with a range of zero to 45 years.  Charcot joints occur

bilaterally in

30% of cases.  There is no relationship between the severity of the neuropathy

and the

severity of the diabetes.  Other causes of Charcot neuroarthropathy include

alcoholism,

strokes, syringomyelia, congenital insensitivity to pain, hereditary

Charcot-Marie-Tooth

Disease, Fredrich's Ataxia, spinal cord injuries, and peripheral nerve injuries.