Effect of Single Dose of RANKL Antibody Treatment on Acute Charcot Neuro-osteoarthropathy of the Foot

Charcot neuro-osteoarthropathy is a rare condition that affects subjects with diabetes with neuropathy (1). Although the underlying pathophysiology is largely unknown, increased receptor activator of nuclear factor κ-B ligand (RANKL) activation in Charcot neuro-osteoarthropathy has been observed (2). As monoclonal RANKL antibody treatment (denosumab, Prolia) reduces osteoporosis-related fractures (3), we studied its effect on fracture resolution time and clinical outcomes in acute Charcot neuro-osteoarthropathy. All patients with diabetes seen at our foot clinic between 2012 and 2016 were categorized by modified Brodsky classification (4) and treated according to a standardized total contact cast (TCC) protocol. This comprises weekly TCC changes and subsequent conventional X-ray imaging every 4 weeks, as well as supplementation daily with calcium 500 mg/cholecalciferol 800 IE to achieve adequate plasma calcium (between 2.2 and 2.5 mmol/L) and vitamin D levels …