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Research
Bone Markers in Charcot Neuroarthropathy
Komal Patel
St. Lukes University Hospital
Corresponding Author
ORCiD: https://orcid.org/0000-0001-5484-1612
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background
There have been multiple studies evaluating the effectiveness of pharmaceuticals in the treatment of acute Charcot neuroarthropathy (CNA). The effectiveness of most pharmaceuticals historically has been based on the levels of certain biomarkers of bone turnover. Previous research has shown bone turnover markers are increased in acute phase of CNA. However, biomarkers activity in chronic phase of CNA and its utility for monitoring treatment response remains to be established. In this article, we evaluated the relationship of such biomarkers to disease severity. We hypothesized that biomarkers such as BSAP and DPD:CRT levels will be directly proportional to disease severity i.e. increased in acute CNA and decreased in chronic CNA. Hence pharmacologic treatment in acute CNA with reference to levels of such biomarkers potentially could be beneficial in clinical settings.
Methods
We retrospectively reviewed 41 patients diagnosed with acute and chronic CNA in our Charcot clinic. Disease severity was determined via pedal temperature difference between affected and unaffected limbs using an OMEGA Surface Temperature Scanner in conjugation with radiographic films and clinical presentation. Temperature of 2 degrees Celsius or greater is considered acute CNA, temperature less than 2 degree Celsius is considered chronic CNA. Urine and serum blood samples were collected at baseline to evaluate the levels of BSAP and DPD:CRT via immunoassays. Statistical analysis was performed via separate Mann Whitney rank sums tests to determine between-group differences in BSAP and DPD:CRT in acute versus chronic CNA.
Results
Bone formation marker BSAP (p = 0.46) and bone resorption marker DPD:CRT (p = 0.92) were not significantly different in acute versus chronic CNA. In acute CNA patients (n = 31) median BSAP was 11.9 (range 3.8–41.3) versus 15.2 (range 4.4–40.7) in chronic CNA patients. In acute CNA patients, median DPD:CRT was 7.8 (range 3.1–38.4) versus 8.8 (range 3.3–18.6) in chronic CNA patients.
Conclusion
The lack of significant between-group differences in BSAP and DPD:CRT calls into question their reliability in monitoring pharmaceuticals effectiveness in acute versus chronic CNA.
Keywords
Charcot neuroarthropathy(CNA), bone markers, deoxypyridinoline crosslinks (DPD), bone specific alkaline phosphatase (BSAP)
Figure 1
Figure 2
Figure 3
Figure 4
Figure 5
Due to technical limitations, Tables 1-4 are provided in the Supplementary Files section.
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This is a preprint. It has not completed peer review.
Research
Bone Markers in Charcot Neuroarthropathy
Komal Patel
St. Lukes University Hospital
Corresponding Author
ORCiD: https://orcid.org/0000-0001-5484-1612
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
History
CURRENT STATUS: Posted
Version 1
Posted 27 May, 2020
No community comments so far
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Orthopedics
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background
There have been multiple studies evaluating the effectiveness of pharmaceuticals in the treatment of acute Charcot neuroarthropathy (CNA). The effectiveness of most pharmaceuticals historically has been based on the levels of certain biomarkers of bone turnover. Previous research has shown bone turnover markers are increased in acute phase of CNA. However, biomarkers activity in chronic phase of CNA and its utility for monitoring treatment response remains to be established. In this article, we evaluated the relationship of such biomarkers to disease severity. We hypothesized that biomarkers such as BSAP and DPD:CRT levels will be directly proportional to disease severity i.e. increased in acute CNA and decreased in chronic CNA. Hence pharmacologic treatment in acute CNA with reference to levels of such biomarkers potentially could be beneficial in clinical settings.
Methods
We retrospectively reviewed 41 patients diagnosed with acute and chronic CNA in our Charcot clinic. Disease severity was determined via pedal temperature difference between affected and unaffected limbs using an OMEGA Surface Temperature Scanner in conjugation with radiographic films and clinical presentation. Temperature of 2 degrees Celsius or greater is considered acute CNA, temperature less than 2 degree Celsius is considered chronic CNA. Urine and serum blood samples were collected at baseline to evaluate the levels of BSAP and DPD:CRT via immunoassays. Statistical analysis was performed via separate Mann Whitney rank sums tests to determine between-group differences in BSAP and DPD:CRT in acute versus chronic CNA.
Results
Bone formation marker BSAP (p = 0.46) and bone resorption marker DPD:CRT (p = 0.92) were not significantly different in acute versus chronic CNA. In acute CNA patients (n = 31) median BSAP was 11.9 (range 3.8–41.3) versus 15.2 (range 4.4–40.7) in chronic CNA patients. In acute CNA patients, median DPD:CRT was 7.8 (range 3.1–38.4) versus 8.8 (range 3.3–18.6) in chronic CNA patients.
Conclusion
The lack of significant between-group differences in BSAP and DPD:CRT calls into question their reliability in monitoring pharmaceuticals effectiveness in acute versus chronic CNA.
Figure 1
Figure 2
Figure 3
Figure 4
Figure 5
Due to technical limitations, Tables 1-4 are provided in the Supplementary Files section.