Diabetes-related foot ulceration hospitalization leads to lower hip, femoral BMD

Hospitalization for diabetes-related foot ulcerations (DFU) seems to result in bilateral decreases in total hip and femoral bone mineral density (BMD), a recent study has found.

Researchers conducted a longitudinal, prospective, observational analysis of 22 patients (mean age 61.7 years, 82 percent men) hospitalized for DFU. BMD at various locations was measured using dual-energy X-ray absorptiometry during hospitalization and 12 weeks after discharge.

At baseline, patients had had diabetes for an average of 16.1 years and had a mean glycated haemoglobin (HbA1c) level of 75 mmol/mol. All participants were treated with inpatient antibiotics, while 73 percent (n=16) needed surgery interventions including either minor amputation or debridement.

For pressure-offloading, three participants were given knee-high devices and 15 received ankle-high devices; four participants were allowed to continue using normal footwear. Notably, 20 patients were advised to partially weight-bear until follow-up.

Twelve weeks after discharge, the researchers documented a significant loss in total hip BMD of the ipsilateral (–1.7 percent; p<0.001) and contralateral (–1.4 percent; p=0.005) limb, as well as in femoral neck BMD of the ipsilateral (–2.8 percent; p<0.001) and contralateral (–2.2 percent; p=0.008) limb. Those who needed surgical intervention saw greater bone loss at the ipsilateral femoral neck vs patients who did not undergo such procedures (–3.7 percent vs –0.5 percent; p=0.03).

Glycaemic control also improved significantly, with HbA1c levels dropping by 11 mmol/mol at follow-up (p=0.002). Meanwhile, no significant changes in body composition, grip strength, and quality of life measures were detected at 12 weeks.

“Future studies of longer duration and with an appropriate control population are required to investigate underlying mechanisms, including whether these changes were due to the offloading and reduced weight-bearing associated with DFU management,” the researchers said. “Furthermore, studies are required to confirm the clinical implications of these changes and the efficacy of fracture prevention measures in people with DFU.”