Diabetic foot osteomyelitis: Bone markers and treatment outcomes
ABSTRACT Novel bone turnover markers could help with the diagnosis and monitoring of osteomyelitis patients. We compared levels of two bone turnover markers, serum amino-terminal telopeptides (NTx) and bone alkaline phosphatase (BAP), in diabetic patients with and without osteomyelitis.
Matched case-control study was conducted with diabetic patients with and without osteomyelitis. Cases not undergoing immediate amputation were followed with repeat measurements after osteomyelitis treatment and for outcome determination.
Analysis included 54 subjects, 27 cases and 27 controls. Median BAP levels were similar between cases and controls at enrollment (p=.55) as were median NTx levels (p=.43). Cases with follow-up data (n=18) had similar bone marker levels at enrollment and 6 weeks. No significant differences in BAP or NTx levels at enrollment or follow-up were seen between cases with poor versus favorable outcomes.
No differences in NTx or BAP levels were seen between cases and controls. Cases with follow-up data had similar levels at enrollment and 6 weeks. Lack of difference may be due to small sample size, small areas of bone involved in foot osteomyelitis, or limitations of these specific markers. More research is needed.
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ABSTRACT: Osteomyelitis of the foot and ankle is a common, potentially devastating condition with diagnostic and treatment challenges. Understanding the epidemiology and pathogenesis of osteomyelitis can raise clinical suspicion and guide testing and treatments. History and physical examination, laboratory studies, vascular studies, histologic and microbiologic analyses, and various imaging modalities contribute to diagnosis and treatment. Treatment including empiric broad-spectrum antibiotics and surgery should take a multidisciplinary approach to optimize patient factors, ensure eradication of the infection, and restore function. Optimization of vascular status, soft tissues, limb biomechanics, and physiologic state of the patient must be considered to accelerate and ensure healing.
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ABSTRACT: AimsTo assess markers of inflammation and bone turnover at presentation and at resolution of Charcot osteoarthropathy.Methods We measured serum inflammatory and bone turnover markers in a cross-sectional study of 35 people with Charcot osteoarthropathy, together with 34 people with diabetes and 12 people without diabetes. In addition, a prospective study of the subjects with Charcot osteoarthropathy was conducted until clinical resolution.ResultsAt presentation, high-sensitivity C-reactive protein (P=0.007), tumour necrosis factor-α (P=0.010) and interleukin-6 (P=0.002), but not interleukin-1β, (P=0.254) were significantly higher in people with Charcot osteoarthropathy than in people with and without diabetes. Serum C-terminal telopeptide (P=0.004), bone alkaline phosphatase (P=0.006) and osteoprotegerin (P<0.001), but not tartrate-resistant acid phosphatase (P=0.126) and soluble receptor activator of nuclear factor-κβ ligand (P=0.915), were significantly higher in people with Charcot osteoarthropathy than in people with and without diabetes.At follow-up it was found that tumour necrosis factor-α (P=0.012) and interleukin-6 (P=0.003), but not high-sensitivity C-reactive protein (P=0.101), interleukin-1β (P=0.457), C-terminal telopeptide (P=0.743), bone alkaline phosphatase (P=0.193), tartrate-resistant acid phosphatase (P=0.856), osteoprotegerin (P=0.372) or soluble receptor activator of nuclear factor-kβ ligand (P=0.889), had significantly decreased between presentation and the 3 months of casting therapy time point, and all analytes remained unchanged from 3 months of casting therapy until resolution. In people with Charcot osteoarthropathy, there was a positive correlation between interleukin-6 and C-terminal telopeptide (P=0.028) and tumour necrosis factor-α and C-terminal telopeptide (P=0.013) only at presentation.Conclusions At the onset of acute Charcot foot, serum concentrations of tumour necrosis factor-α and interleukin-6 were elevated; however, there was a significant reduction in these markers at resolution and these markers may be useful in the assessment of disease activity.This article is protected by copyright. All rights reserved.Diabetic Medicine 09/2014; DOI:10.1111/dme.12590 · 3.06 Impact Factor