• 
• 

Three Part Question

In [a diabetic patient with Charcot's arthropathy] is there [any benefit to prescribing pamidronate immediatly (<24h) compared to delayed administration] in [reducing joint destruction?]

Clinical Scenario

A 60 year old male patient in the Emergency Department has just been diagnosed with Charcot's arthropathy. You know that pamidronate is used to reduce joint destruction and wonder if there is any additional benefit to administering the drug before you discharge the patient compared to him recieving it a day later from the diabetes team.

Search Strategy

(exp diabetes mellitus OR exp diabetic neuropathies OR exp diabetic foot) AND (exp diphosphonates OR pamidronate.mp. OR bisphosphonate.mp.) LIMIT to humans AND English language AND adult.
Medline from 1950 to June 2007 using the Ovid interface and Embase from 1996 to week 25 2007

Search Outcome

The search located located 93 papers, none of which answered the question.

Relevant Paper(s)

Author, date and country	Patient group	Study type (level of evidence)	Outcomes	Key results	Study Weaknesses

Comment(s)

There were numerous studies located in the search which gave evidence for the use of pamidronate in the reduction of joint destruction in the diabetic Charcot foot (e.g. Jude et al). However, none looked at the timing of drug administration.

Clinical Bottom Line

At the present time there is no evidence that early administration of pamidronate confers benefit over late administration in the reduction of joint destruction in the Charcot foot. The research remains to be done. Therefore there can be no recommendation for its use in the Emergency Department setting.Clinicians should follow local guidance.

References

1. Jude E et al. Bisphosphonates in the treatment of Charcot neuroarthropathy: a double-blind randomised controlled trial. Diabetologia 2001;44:2032-7