Teriparatide (recombinant human parathyroid hormone [1-34]) increases foot bone remodeling in diabetic chronic Charcot neuroarthropathy: a randomized double-blind placebo-controlled study

Ashu Rastogi, Abhishek Hajela, Mahesh Prakash, Niranjan Khandelwal, Rajender Kumar, Anish Bhattacharya, Bhagwant R. Mittal, Anil Bhansali, David G Armstrong

Research output: Contribution to journalArticle

3 Scopus citations

Abstract

Background: Currently, there is no consensus regarding the medical treatment of chronic Charcot neuroarthropathy (CN) of foot, except for effective off-loading. Because tarsal bones are predominantly trabecular, teriparatide may improve the macroarchitecture of foot bones in chronic CN. Methods: People with diabetes and chronic CN were randomized to receive either 20 μg teriparatide or placebo subcutaneous daily for 12 months. Thirty-eight patients were screened and data were analyzed for 20. The maximum standardized uptake (SUV max ) value of FDG-PET/CT the region of interest, bone turnover markers and foot bone mineral density BMD were determined. The primary outcome measure was change in SUV max g/ml. Results: Mid-foot was the most common region involved. After 12 months, SUV max increased from 30.6 ± 14.7 to 37.7 ± 18.0 (P = 0.044) in the teriparatide group, but decreased from 27.6 ± 12.2 to 22.9 ± 10.4 with placebo (P = 0.148). The estimated treatment difference (ETD) was 11.9 ± 4.3 (95% CI 2.9, 20.8; P = 0.012). Similarly, P1NP increased with teriparatide (19.8 ± 5.5; P = 0.006) but decreased with placebo (−5.1 ± 3.8 ng/mL; P = 0.219); ETD was 24.8 ± 6.6 (95% CI 10.8, 38.8; P < 0.001) and CTX increased in both the teriparatide and placebo groups. Foot BMD increased by 0.06 ± 0.04 g/cm 2 (P = 0.192) with teriparatide, but decreased by −0.06 ± 0.08 g/cm 2 with placebo (P = 0.488; intergroup comparison, P = 0.096). Conclusion: Teriparatide increases foot bone remodeling by an osteoanabolic action in people with CN.

Original languageEnglish (US)
JournalJournal of Diabetes
DOIs
Publication statusPublished - Jan 1 2019
Externally publishedYes

    Fingerprint

Keywords

  • bone mineral density
  • bone turnover markers
  • Charcot neuroarthropathy
  • diabetic foot
  • teriparatide

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism

Cite this