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Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Diabetes. Jul 15, 2018; 9(7): 115-126
Published online Jul 15, 2018. doi: 10.4239/wjd.v9.i7.115
Role of bisphosphonates in the management of acute Charcot foot
Harsh Durgia, Jayaprakash Sahoo, Sadishkumar Kamalanathan, Rajan Palui, Kalyani Sridharan, Henith Raj
Harsh Durgia, Jayaprakash Sahoo, Sadishkumar Kamalanathan, Rajan Palui, Kalyani Sridharan, Henith Raj, Department of Endocrinology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry 605006, India
Author contributions: Durgia H, Sahoo J and Kamalanathan S designed the work and revised it critically for important intellectual content; Palui R, Sridharan K and Raj H interpreted the data and drafted the work; all authors approved the final version of the manuscript; Sahoo J is the guarantor.
Conflict-of-interest statement: No potential conflicts of interest relevant to this article were reported.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Jayaprakash Sahoo, Associate Professor, Department of Endocrinology, Jawaharlal Institute of Postgraduate Medical Education and Research, Room No. 5444, 4th floor, Superspeciality Block, Puducherry 605006, India. jppgi@yahoo.com
Telephone: +91-962-9158368
Received: March 29, 2018
Peer-review started: March 29, 2018
First decision: April 24, 2018
Revised: April 26, 2018
Accepted: June 13, 2018
Article in press: June 14, 2018
Published online: July 15, 2018
Abstract

Diabetes mellitus is the most common cause of Charcot neuropathy affecting foot and ankle. Acute Charcot foot (CF) presents with a red and swollen foot in contrast to the painless deformed one of chronic CF. Enhanced osteoclastogenesis plays a central role in the pathogenesis of acute CF. Many studies have shown elevated levels of bone turnover markers in patients with acute CF confirming it. These findings have led clinicians to use anti-resorptive agents [bisphosphonates (BP), calcitonin, and denosumab] along with immobilization and offloading in acute CF patients. The maximum evidence among all anti-resorptive agents is available for BPs, although its quality is low. Pamidronate has been shown to reduce the markers of activity of CF like raised skin temperature, pain, edema, and bone turnover markers in the majority of studies. Intravenous BPs are known to cause acute phase reactions leading to flu-like illness following their first infusion, which can be ameliorated by oral acetaminophen. Alendronate is the only oral BP used in these patients. It needs to be taken on an empty stomach with a full glass of water to avoid esophagitis. The side-effects and contraindications to BPs should be kept in mind while treating acute CF patients with them.

Keywords: Charcot foot, Diabetes mellitus, Charcot neuroarthropathy, Bisphosphonates, Pamidronate

Core tip: Bisphosphonate is an attractive treatment option for acute Charcot foot. This is based on the fact that increased osteoclastic activity plays a central role in the pathogenesis of acute Charcot foot. Among bisphosphonates, the maximum evidence in the literature is available for pamidronate. It has been shown to reduce the markers of Charcot foot activity, like raised skin temperature, pain, and edema. However, the quality of evidence is low. They should be used along with immobilization and offloading. The side effects of bisphosphonates and their contra-indications for use should be kept in mind while treating these patients with them.