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Pamidronate infusion timing in Charcot Rx

Discussion in 'Diabetic Foot & Wound Management' started by nicpod1, Dec 15, 2005.

  1. nicpod1

    nicpod1 Active Member

    Members do not see these Ads. Sign Up.
    Within my Diabetic foot team, we tend to infuse Pamidronate asap at the same time as immobilisation upon detection of an acute Charcot.

    However, after chatting to a member of a local Orthopaedic team recently, they have been using the osteopaenia that comes with the Charcot to their advantage by casting the foot and ankle (normal 'serial' type casting) with the Charcot still active until they acheive a 'good' position. I don't even think they use Pamidronate.

    This 'moulding' whilst the process is still active would seem to me to make a lot of sense and if you infused with Pamidronate only once the foot/ankle was in a good position, this would seem perfect!?

    I haven't done a lit. search on this yet, but if anyone had any evidence-based rationale for timing of Pamidronate infusion or has had similarly good results with 'moulding', I'd be pleased to hear!

    Thanks all!
  2. Armstrong

    Armstrong Member

    Charcot and bisphosphonates

    Dear Nicpod:

    While the use of a bisphosphonate like pamidronate makes some degree of sense in the early stages of Charcot, there are few data to identify when or if it has significant benefit. Recent discussions surrounding modulation of another pathway, this one involving osteoprotegerin (OPG) and RANK-L, might prove more therapeutically beneficial. The best potential pharmaceutical candidate presently available for this is intranasal calcitonin. If you want a bit more on this, I would direct you to:

    Jeffcoate, W. (2004). Vascular calcification and osteolysis in diabetic neuropathy-is RANK-L the missing link? Diabetologia, 47(9), 1488-1492.

    Jeffcoate WJ, Game F, Cavanagh PR The role of proinflammatory cytokines in the cause of neuropathic osteoarthropathy (acute Charcot foot) in diabetes. Lancet. 366(9502):2058-61, 2005 Dec 10.



    David G. Armstrong, DPM, PhD
    Chicago, IL, USA
  3. Michael Bilinsky

    Michael Bilinsky Welcome New Poster

    Bisphosponate drugs including, Zometa, Aredia & Fosamax , plus others are quite helpful, if the patient doesn't get "Dead Jaw" Osteonecrosis of the jaw and potentially affecting other joints. It has been reported by the International Multiple Myeloma Foundation that 1+/10 will get the condition and it is devastating to the patient's life. Much worse than the underlying condition. Read the articles on mpowelllaw.com and decide if you are comfortable prescribing these medications.
    Michael Bilinsky D.P.M
  4. nicpod1

    nicpod1 Active Member

    Thank you Michael and David,

    It would certainly seem that intranasal calcitonin would be a better arrangement, purely from a delivery point of view more than anything else as it takes 3-4 hours to inffuse the Pamidronate and it has to be done as a day-case appointment, incurring a waiting list of sorts!

    As I am a Podiatrist in the UK, I do not prescribe this drug myself, rather the Consultant Diabetologists within the team instigate it. I have to say, it is used on all active Charcot (we probably see between 1 and 3 every month), but there has been no lock-jaw and the BNF (British National Formulary) does not list it as a complication (though it does have associated complications like myalgia etc), but I will look on the website for more info!

    Have either of you had experience of serial casting the foot/ankle into a 'better' position whilst the Charcot is still active and before trying to stabilise the bone pharmacologically?

    Many thanks for your help!
  5. NewsBot

    NewsBot The Admin that posts the news.

    Thats now the subject of litigation:

    CTV.ca are reporting:
    Fosamax users seek class-action status
    Full story
  6. NewsBot

    NewsBot The Admin that posts the news.

    The FDA have just issued this warning:
    Information for Healthcare Professionals
    Bisphosphonates (marketed as Actonel, Actonel+Ca, Aredia, Boniva, Didronel, Fosamax, Fosamax+D, Reclast, Skelid, and Zometa)

  7. NewsBot

    NewsBot The Admin that posts the news.

    A comparative study of zoledronic acid and once weekly Alendronate in the management of acute Charcot arthropathy of foot in patients with diabetes mellitus.
    Bharath R, Bal A, Sundaram S, Unnikrishnan AG, Praveen VP, Bhavani N, Nair V, Jayakumar RV, Kumar H.
    Indian J Endocrinol Metab. 2013 Jan;17(1):110-6
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