Reduction in femoral neck and total hip bone mineral density following hospitalisation for diabetes-related foot ulceration

Marcel M Nejatian,Shuen-Chyn Soh,Salar Sobhi,J Carsten Ritter,Kathryn Linn,Bu B Yeap,Laurens Manning,Blake N Sanchez,Jonathan Hiew,Emma J Hamilton

doi:10.1038/s41598-021-02233-y

Marcel M Nejatian, Shuen-Chyn Soh + Show 8 more

Open Access

https://doi.org/10.1038/s41598-021-02233-y

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Abstract

Management of diabetes-related foot ulceration (DFU) includes pressure offloading resulting in a period of reduced activity. The metabolic effects of this are unknown. This study aims to investigate changes in bone mineral density (BMD) and body composition 12 weeks after hospitalisation for DFU. A longitudinal, prospective, observational study of 22 people hospitalised for DFU was conducted. Total body, lumbar spine, hip and forearm BMD, and total lean and fat mass were measured by dual-energy X-ray absorptiometry (DXA) during and 12 weeks after hospitalisation for DFU. Significant losses in total hip BMD of the ipsilateral limb (− 1.7%, p < 0.001), total hip BMD of the contralateral limb (− 1.4%, p = 0.005), femoral neck BMD of the ipsilateral limb (− 2.8%, p < 0.001) and femoral neck BMD of the contralateral limb (− 2.2%, p = 0.008) were observed after 12 weeks. Lumbar spine and forearm BMD were unchanged. HbA1c improved from 75 mmol/mol (9.2%) to 64 mmol/mol (8.0%) (p = 0.002). No significant changes to lean and fat mass were demonstrated. Total hip and femoral neck BMD decreased bilaterally 12 weeks after hospitalisation for DFU. Future research is required to confirm the persistence and clinical implications of these losses.

Highlights

Management of diabetes-related foot ulceration (DFU) includes pressure offloading resulting in a period of reduced activity
The accelerated bone mineral density (BMD) losses we describe here are significant and may have important clinical implications for people with DFU
We describe bilateral BMD losses, in which total hip and femoral neck BMD decreased by 1.7% and 2.8% on the ipsilateral side and by 1.4% and 2.2% on the contralateral side

Summary

Introduction

Management of diabetes-related foot ulceration (DFU) includes pressure offloading resulting in a period of reduced activity. This study aims to investigate changes in bone mineral density (BMD) and body composition 12 weeks after hospitalisation for DFU. Lumbar spine, hip and forearm BMD, and total lean and fat mass were measured by dualenergy X-ray absorptiometry (DXA) during and 12 weeks after hospitalisation for DFU. It is possible that these DFU management strategies may negatively impact bone mineral density (BMD) and body composition, existing data is limited. Both type 1 and type 2 diabetes are associated with an increased risk of fractures, at the hip[5–7]. Type 1 diabetes is associated with reduced BMD and a marked increase in hip fracture r isk[5,7]. It is possible that low muscle mass and increased fat mass may be a consequence of DFU and/or DFU treatment, prospective data is lacking

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