Vol 9, No 2 (2008): Practical Diabetology
Research paper
Published online: 2008-05-13

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Useful of bone turnover markers in estimation of dynamic bone changes in diabetic foot

Iwona Trznadel-Morawska, Teresa Koblik, Barbara Katra, Jacek Sieradzki
Diabetologia Praktyczna 2008;9(2):63-69.

Abstract

INTRODUCTION. The role of ultrasonographic examination in diagnostics of local osteoporosis and screening is widely confirmed. There is a lack of actual data concerning the role of resorption and creation markers in evaluation of bone changes dynamics in different forms of diabetic foot. Thus, bone markers in different forms of diabetic food were measured to predict a progress of bone changes.
MATERIAL AND METHODS. The research included 55 patients with type 1 diabetes (n = 7) and type 2 diabetes (n = 48) treated with intensive insulin therapy. Patients were divided into 4 groups: group 1 - with chronic Charcot neuroosteoarthropathy, group 2 - with chronic Charcot neuroosteoarthropathy with ulceration, group 3 - with acute Charcot neuroosteoarthropathy and group 4 - with chronic ulceration. In group 3 bone turnover markers were monitored each month, in groups 1, 2 and 4 only once. Following markers of bone formation - osteocalcin and bone alkaline phosphatase (blood), as well as marker of bone resorption - NTX, were measured. Markers were estimated by means of immunoenzymatic ELISA method. Bone mass was assessed by ultrasound method using an Achilles device. Chronic complications of diabetes were also evaluated.
RESULTS. In the study following chronic complications of diabetes in different groups of diabetic foot were evaluated: group 1 (n = 10): non-proliferative retinopathy - 7, proliferative retinopathy - 2, early-onset nephropathy - 3 and advanced nephropathy - 0, peripheral neuropathy - 9, autonomic neuropathy - 1; group 2 (n = 18): non-proliferative retinopathy - 7, proliferative retinopathy - 2, early-onset nephropathy - 2 and advanced nephropathy - 1, peripheral neuropathy - 10, autonomic neuropathy - 1; group 3 (n = 5): non-proliferative retinopathy - 2, early-onset nephropathy - 1 and advanced nephropathy - 1, peripheral neuropathy - 3, autonomic neuropathy - 0; group 4 (n = 17): non-proliferative retinopathy - 8, proliferative retinopathy - 8, early-onset nephropathy - 6 and advanced nephropathy - 5, peripheral neuropathy - 16, autonomic neuropathy - 3. Average time of diabetes: group 1 - 15.8 ± ± 9.0 years; group 2 - 12.6 ± 10.4 years; group 3 - 10 ± 6.16 years; group 4 - 12.8 ± 7.78 years. Average HbA1c level: group 1 - 6.9 ± 0.78%; group 2 - 8.1 ± ± 1.42%; group 3 - 7.75 ± 2.89%; group 4 - 8.1 ± ± 1.11%. Average T-score: -0.81, -1.94, 0.52, and -1.70 respectively. Differences in the mean osteocalcin levels (p < 0.05) were as follows: group 1 - 7.16 ± 2.06 ng/mL (n = 10); group 2 - 10.3 ± ± 7.6 ng/mL (n = 18); group 3 - 9.7 ± 3.05 ng/mL (n = 5); group 4 - 6.46 ± 1.27 ng/mL (n = 16). Differences in the mean bone alkaline phosphatase values were as follows: group 1 - 30.16 ± 19.2 U/L (n = 11); group 2 - 74.8 ± 35.7 U/L (n = 10); group 3 - 37.4 ± ± 0.08 U/L (n = 3); group 4 - 20.31 ± 7.24 U/L (n = 17). Differences in the mean NTX levels were as follows: group 1 - 56.0 ± 22.9 ng/mL (n = 11); group 2 - 74.8 ± 35.7 ng/mL (n = 10); group 3 - 95.2 ± 33.8 ng/mL (n = 4); group 4 - 64.8 ± ± 31.5 ng/mL (n = 17).
CONCLUSIONS. 1. The lowest level of bone formation markers and increased level of bone resorption markers in group 2 and 4 with the lowest value of bone mass (-1.94, -1.7 T-score) indicates the advantage of resorption over formation process in chronic ulceration with or without Charcot neuroosteoarthropathy. 2. The highest level of bone resorption marker (NTX = 95.2 ng/mL) and increased level of bone formation marker (alkaline phosphatase) with normal bone mass, suggest their usefulness in evaluation of increase in bone turnover (mainly resorption) prior to development of bone changes.

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