Table 5.

Bisphosphonate treatment

Jude et al. (62)	Compared saline vs. infused intravenous pamidronate, in random double-blinded placebo controlled study with acute Charcot osteoarthropathy patients	Found significant reductions in bone turnover markers, temperature, and pain symptoms	Significant findings in time to ambulation and time to radiographic consolidation not reported
Pakarinen et al. (63)	Investigated clinical effectiveness zoledronic acid in patients with diabetes and acute Charcot osteoarthropathy	Zoledronic acid group, median time for total immobilization 27 weeks, in placebo group 20 weeks	Zoledronic acid no beneficial effect on clinical resolution acute Charcot osteoarthropathy in total immobilization time, and may prolong time to clinical resolution
Pakarinen et al. (64)	Investigated effect immobilization and zoledronic acid on bone mineral density (BMD) changes during the treatment of acute midfoot Charcot osteoarthropathy	Significant fall BMD in placebo group at Charcot osteoarthropathy affected femoral neck, and Charcot osteoarthropathy free hip, with significant rise BMD in zoledronic acid group all measured areas Charcot osteoarthropathy free hip	Immobilization and off-loading does not lead to marked disuse osteoporosis in patients with acute Charcot osteoarthropathy after 6 months treatment
Bem et al. (65)	Randomized controlled study comparing bone turnover and temperature between study group received salmon calcitonin nasal spray daily with calcium supplementation and control group received only calcium supplementation	Study group significant reduction bone turnover compared with control group during 3-month follow-up	Advantage calcitonin may be direct impact on RANK-L/osteoprotegerin system, with fewer complications compared to bisphosphonate