{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,22]],"date-time":"2026-01-22T23:38:27Z","timestamp":1769125107311,"version":"3.49.0"},"reference-count":29,"publisher":"Oxford University Press (OUP)","issue":"12","license":[{"start":{"date-parts":[[2019,11,5]],"date-time":"2019-11-05T00:00:00Z","timestamp":1572912000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["R03 HD068660"],"award-info":[{"award-number":["R03 HD068660"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["R21 DK079457"],"award-info":[{"award-number":["R21 DK079457"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["asbmr.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["JBMR Plus"],"published-print":{"date-parts":[[2019,12]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:p>Metatarsals are frequent sites of stress and fragility fractures in younger athletic populations and aging older adults. Metatarsal fractures are particularly common in Charcot neuroarthropathy (CN), a complication of diabetes mellitus (DM) and peripheral neuropathy (PN). Neuropathic metatarsal fractures may be caused by an accelerated cortical bone osteolysis and may be reflected as geometric\u2010derived strength estimates from standard foot radiographs. The purpose of this cross\u2010sectional study was to determine geometry and strength\u2010derived estimates of the metatarsals in individuals with DM, PN, and CN compared with younger and older adult controls who were nondiabetic and nonneuropathic. We studied 62 participants: 20 young adult controls (YACs), 22 older adult controls (OACs), and 20 diagnosed with DMPN&amp;CN. From weight\u2010bearing radiographs, we measured the outer diaphysis diameter and inner marrow diameter at the distal, middle, and proximal diaphysis sites of the second and fifth metatarsal. From these diameters, we derived strength estimates of combined cortical width (CCt.Wi), percent cortical area (%Ct.rA), buckling ratio (BR), moment of inertia (MOI), and section modulus (SM) at each site in both metatarsals. DMPN&amp;CN participants had an accelerated cortical thinning, decreased %Ct.Ar, increased BR, and lower MOI and SM compared with OACs and YACs. The OACs showed age\u2010related decreases in CCt.Wi and % Ct.Ar, and increased BR. The BR demonstrated significant group\u2009\u00d7 bone\u2009\u00d7 site interaction with the distal fifth metatarsal in the DMPN&amp;CN group having the lowest bone strength. The BR in the distal fifth metatarsal of DMPN&amp;CN participants was 36% and 49% greater than in the OAC and YAC groups, respectively. DMPN&amp;CN participants have lower metatarsal bone strength estimates compared with younger and older adult controls. Standard foot radiographs demonstrate an accelerated cortical osteolysis in DMPN&amp;CN individuals, particularly in the distal fifth metatarsal diaphysis. \u00a9 2019 The Authors.<jats:italic>JBMR Plus<\/jats:italic>published by Wiley Periodicals, Inc. on behalf of American Society for Bone and Mineral Research \u00a9 2019 The Authors.<jats:italic>JBMR Plus<\/jats:italic>published by Wiley Periodicals, Inc. on behalf of American Society for Bone and Mineral Research.<\/jats:p>","DOI":"10.1002\/jbm4.10243","type":"journal-article","created":{"date-parts":[[2019,10,11]],"date-time":"2019-10-11T17:14:48Z","timestamp":1570814088000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Accelerated Cortical Osteolysis of Metatarsals in Charcot Neuroarthropathy: A Cross\u2010Sectional Observational Study"],"prefix":"10.1093","volume":"3","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7242-3585","authenticated-orcid":false,"given":"David R.","family":"Sinacore","sequence":"first","affiliation":[{"name":"Department of Physical Therapy High Point University High Point NC USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kirk E.","family":"Smith","sequence":"additional","affiliation":[{"name":"Department of Biomedical Informatics UAMS Medical Center Little Rock AR USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kathryn L.","family":"Bohnert","sequence":"additional","affiliation":[{"name":"Program in Physical Therapy Washington University St. Louis MO USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David J.","family":"Gutekunst","sequence":"additional","affiliation":[{"name":"Department of Physical Therapy St. Louis University St. Louis MO USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jeffrey E.","family":"Johnson","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, St. Louis School of Medicine Washington University St. Louis MO USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael J.","family":"Strube","sequence":"additional","affiliation":[{"name":"Department of Psychology, St. Louis School of Medicine Washington University St. Louis MO USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2019,11,5]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-2008-1025659"},{"key":"e_1_2_7_3_1","doi-asserted-by":"crossref","first-page":"737","DOI":"10.1016\/S0278-5919(20)31190-X","article-title":"Stress fractures in runners","volume":"4","author":"McBryde AM","year":"1985","journal-title":"Clin Sports Med."},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1007\/s002560050573"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1186\/ar126"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.rcl.2010.02.013"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1097\/00004728-198008000-00018"},{"key":"e_1_2_7_8_1","unstructured":"American College of Radiology. 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