A comparative study of zoledronic acid and once weekly Alendronate in the management of acute Charcot arthropathy of foot in patients with diabetes mellitus

Abstract

Aim:The aim of this study was to assess and compare the response to two forms of treatment-immobilization with zoledronic acid injection and immobilization with oral weekly Alendronate, in patients with diabetes mellitus and acute Charcot arthropathy (CA) of foot in terms of clinical and radiological parameters.Material and Methods:Patients attending the endocrinology and podiatry clinic with history of diabetes mellitus and Acute CA were taken for study. The patients were randomized into two treatment groups. Group Z-zoledronic acid injection along with total contact cast (TCC). Group A-Tab. Alendronate 70 mg. once a week till the complete clinical resolution of acute CA along with TCC. Forty-five patients were randomized and 40 of them completed the study. The primary end point was complete clinical resolution of acute CA-defined as temperature difference between normal and affected foot <1°F.Results:Among the 40 patients, 30 (75%) had complete clinical resolution. The mean number of days taken for complete clinical resolution since the initiation of treatment (either Zoledronic acid or Alendronate) was approximately 122 days. There was no significant difference in a number of days required for complete clinical resolution, between the two forms of therapy. There was more than 50% reduction in the visual score between the baseline and the final scan. The target to non-target ratio in the skeletal phase also showed an average of 40% reduction from the baseline to the final skeletal scintigraphy.Conclusion:Both Intravenous Zoledronic acid and oral alendronate had comparable efficacy with respect to the time taken for attaining complete clinical resolution of acute CA of foot. However, Alendronate therapy was cost effective among the two. 99mTc MDP bone scan can be used as an adjuvant to the clinical parameters in assessing the response to therapy.

Polyarticular charcot: A rare case report and a literature review in Indian context

“…7 Many surgical techniques and medical management were evaluated for usefulness in DM Charcot joint patients in India. 9,16,20 One Indian study by Durgia et al reviewed bisphosphonates, calcitonin, and denosumab in management of acute Charcot arthropathies. 41 A systemic review by Richard et al showed the effectiveness of bisphosphates in the management of acute Charcot joints, but the evidence was not strong due to insufficient data.…”

Role of bisphosphonates in the management of acute Charcot foot

“…The latest randomized comparative study evaluating the effects of zoledronate and alendronate concluded that both medications had the same response in terms of clinical resolution time and scintigraphic changes. When cost was taken into account, however, alendronate was much less expensive than zoledronate[ 68 ].…”

“…In 2013, Bharath et al[ 68 ] were the first to compare the effects of two BPs in a prospective randomized comparative study of 45 type 2 diabetic patients with acute CF. Patients were randomized into two groups, Z and A receiving a single IV infusion of 5 mg zoledronate (diluted in 100 mL normal saline over 30 min) and oral alendronate 70 mg once weekly, respectively, until resolution of the disease.…”

Ab0864 the Effect of Zoledronic Acid on Charcot Neuroarthropathy

“…Some studies had emphasized the beneficial effect of bisphosphonates such as pamidronate and alendronate on the reduction in bone turnover markers in this disease. Though, the use of Zoledronic acid in the treatment of Charcot foot was only evaluated in two clinical trials and its efficacy remains controversial (1,2).…”