{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,5,5]],"date-time":"2025-05-05T00:47:01Z","timestamp":1746406021582,"version":"3.37.3"},"reference-count":32,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2021,11,23]],"date-time":"2021-11-23T00:00:00Z","timestamp":1637625600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2021,11,23]],"date-time":"2021-11-23T00:00:00Z","timestamp":1637625600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100001801","name":"University of Western Australia","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100001801","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Sci Rep"],"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Management of diabetes-related foot ulceration (DFU) includes pressure offloading resulting in a period of reduced activity. The metabolic effects of this are unknown. This study aims to investigate changes in bone mineral density (BMD) and body composition 12\u00a0weeks after hospitalisation for DFU. A longitudinal, prospective, observational study of 22 people hospitalised for DFU was conducted. Total body, lumbar spine, hip and forearm BMD, and total lean and fat mass were measured by dual-energy X-ray absorptiometry (DXA) during and 12\u00a0weeks after hospitalisation for DFU. Significant losses in total hip BMD of the ipsilateral limb (\u2212\u20091.7%, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001), total hip BMD of the contralateral limb (\u2212\u20091.4%, <jats:italic>p<\/jats:italic>\u2009=\u20090.005), femoral neck BMD of the ipsilateral limb (\u2212\u20092.8%, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001) and femoral neck BMD of the contralateral limb (\u2212\u20092.2%, <jats:italic>p<\/jats:italic>\u2009=\u20090.008) were observed after 12\u00a0weeks. Lumbar spine and forearm BMD were unchanged. HbA1c improved from 75\u00a0mmol\/mol (9.2%) to 64\u00a0mmol\/mol (8.0%) (<jats:italic>p<\/jats:italic>\u2009=\u20090.002). No significant changes to lean and fat mass were demonstrated. Total hip and femoral neck BMD decreased bilaterally 12\u00a0weeks after hospitalisation for DFU. Future research is required to confirm the persistence and clinical implications of these losses.<\/jats:p>","DOI":"10.1038\/s41598-021-02233-y","type":"journal-article","created":{"date-parts":[[2021,11,23]],"date-time":"2021-11-23T11:02:49Z","timestamp":1637665369000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Reduction in femoral neck and total hip bone mineral density following hospitalisation for diabetes-related foot ulceration"],"prefix":"10.1038","volume":"11","author":[{"given":"Marcel M.","family":"Nejatian","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Salar","family":"Sobhi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Blake N.","family":"Sanchez","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kathryn","family":"Linn","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Laurens","family":"Manning","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shuen-Chyn","family":"Soh","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jonathan","family":"Hiew","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"J. Carsten","family":"Ritter","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bu B.","family":"Yeap","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Emma J.","family":"Hamilton","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2021,11,23]]},"reference":[{"key":"2233_CR1","doi-asserted-by":"publisher","first-page":"16","DOI":"10.1186\/s13047-020-00383-2","volume":"13","author":"DG Armstrong","year":"2020","unstructured":"Armstrong, D. G. et al. Five year mortality and direct costs of care for people with diabetic foot complications are comparable to cancer. J. Foot Ankle Res. 13, 16. https:\/\/doi.org\/10.1186\/s13047-020-00383-2 (2020).","journal-title":"J. Foot Ankle Res."},{"key":"2233_CR2","doi-asserted-by":"publisher","first-page":"2367","DOI":"10.1056\/NEJMra1615439","volume":"376","author":"DG Armstrong","year":"2017","unstructured":"Armstrong, D. G., Boulton, A. J. M. & Bus, S. A. Diabetic foot ulcers and their recurrence. N. Engl. J. Med. 376, 2367\u20132375. https:\/\/doi.org\/10.1056\/NEJMra1615439 (2017).","journal-title":"N. Engl. J. Med."},{"issue":"Suppl 1","key":"2233_CR3","doi-asserted-by":"publisher","DOI":"10.1002\/dmrr.3274","volume":"36","author":"SA Bus","year":"2020","unstructured":"Bus, S. A. et al. Guidelines on offloading foot ulcers in persons with diabetes (IWGDF 2019 update). Diabetes Metab. Res. Rev. 36(Suppl 1), e3274. https:\/\/doi.org\/10.1002\/dmrr.3274 (2020).","journal-title":"Diabetes Metab. Res. Rev."},{"issue":"Suppl 1","key":"2233_CR4","doi-asserted-by":"publisher","DOI":"10.1002\/dmrr.3266","volume":"36","author":"NC Schaper","year":"2020","unstructured":"Schaper, N. C. et al. Practical Guidelines on the prevention and management of diabetic foot disease (IWGDF 2019 update). Diabetes Metab. Res. Rev. 36(Suppl 1), e3266. https:\/\/doi.org\/10.1002\/dmrr.3266 (2020).","journal-title":"Diabetes Metab. Res. Rev."},{"key":"2233_CR5","doi-asserted-by":"publisher","first-page":"427","DOI":"10.1007\/s00198-006-0253-4","volume":"18","author":"P Vestergaard","year":"2007","unstructured":"Vestergaard, P. Discrepancies in bone mineral density and fracture risk in patients with type 1 and type 2 diabetes\u2014A meta-analysis. Osteoporos. Int. 18, 427\u2013444. https:\/\/doi.org\/10.1007\/s00198-006-0253-4 (2007).","journal-title":"Osteoporos. Int."},{"key":"2233_CR6","doi-asserted-by":"publisher","first-page":"551","DOI":"10.1210\/jc.2016-3570","volume":"102","author":"E Hamilton","year":"2017","unstructured":"Hamilton, E., Davis, W. A., Bruce, D. G. & Davis, T. M. Influence of premature mortality on the link between type 2 diabetes and hip fracture: The fremantle diabetes study. J. Clin. Endocrinol. Metab. 102, 551\u2013559. https:\/\/doi.org\/10.1210\/jc.2016-3570 (2017).","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"2233_CR7","doi-asserted-by":"publisher","first-page":"153","DOI":"10.1016\/j.diabres.2017.10.011","volume":"134","author":"EJ Hamilton","year":"2017","unstructured":"Hamilton, E. J., Davis, W. A., Bruce, D. G. & Davis, T. M. E. Risk and associates of incident hip fracture in type 1 diabetes: The Fremantle Diabetes Study. Diabetes Res. Clin. Pract. 134, 153\u2013160. https:\/\/doi.org\/10.1016\/j.diabres.2017.10.011 (2017).","journal-title":"Diabetes Res. Clin. Pract."},{"key":"2233_CR8","doi-asserted-by":"publisher","first-page":"430","DOI":"10.1002\/dmrr.1197","volume":"27","author":"S Kurra","year":"2011","unstructured":"Kurra, S. & Siris, E. Diabetes and bone health: The relationship between diabetes and osteoporosis-associated fractures. Diabetes Metab. Res. Rev. 27, 430\u2013435. https:\/\/doi.org\/10.1002\/dmrr.1197 (2011).","journal-title":"Diabetes Metab. Res. Rev."},{"key":"2233_CR9","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1007\/s00223-017-0324-x","volume":"102","author":"H Miyake","year":"2018","unstructured":"Miyake, H., Kanazawa, I. & Sugimoto, T. Association of bone mineral density, bone turnover markers, and vertebral fractures with all-cause mortality in type 2 diabetes mellitus. Calcif. Tissue Int. 102, 1\u201313. https:\/\/doi.org\/10.1007\/s00223-017-0324-x (2018).","journal-title":"Calcif. Tissue Int."},{"key":"2233_CR10","doi-asserted-by":"publisher","first-page":"853","DOI":"10.1016\/j.jamda.2014.10.001","volume":"15","author":"JE Morley","year":"2014","unstructured":"Morley, J. E., Malmstrom, T. K., Rodriguez-Ma\u00f1as, L. & Sinclair, A. J. Frailty, sarcopenia and diabetes. J. Am. Med. Dir. Assoc. 15, 853\u2013859 (2014).","journal-title":"J. Am. Med. Dir. Assoc."},{"key":"2233_CR11","doi-asserted-by":"publisher","first-page":"8372","DOI":"10.1038\/s41598-017-08972-1","volume":"7","author":"Q Cheng","year":"2017","unstructured":"Cheng, Q. et al. Sarcopenia is independently associated with diabetic foot disease. Sci. Rep. 7, 8372. https:\/\/doi.org\/10.1038\/s41598-017-08972-1 (2017).","journal-title":"Sci. Rep."},{"key":"2233_CR12","volume-title":"Clinical Assessment Recommendations","author":"J MacDermid","year":"2015","unstructured":"MacDermid, J., Solomon, G. & Valdes, K. Clinical Assessment Recommendations (American Society of Hand Therapists, 2015)."},{"key":"2233_CR13","doi-asserted-by":"publisher","first-page":"40","DOI":"10.1097\/00005650-199401000-00004","volume":"32","author":"CA McHorney","year":"1994","unstructured":"McHorney, C. A., Ware, J. E. Jr., Lu, J. F. & Sherbourne, C. D. The MOS 36-item Short-Form Health Survey (SF-36): III. Tests of data quality, scaling assumptions, and reliability across diverse patient groups. Med. Care 32, 40\u201366. https:\/\/doi.org\/10.1097\/00005650-199401000-00004 (1994).","journal-title":"Med. Care"},{"key":"2233_CR14","first-page":"147","volume":"48","author":"S Takata","year":"2001","unstructured":"Takata, S. & Yasui, N. Disuse osteoporosis. J. Med. Investig. 48, 147\u2013156 (2001).","journal-title":"J. Med. Investig."},{"key":"2233_CR15","doi-asserted-by":"publisher","first-page":"121","DOI":"10.1016\/j.fas.2012.12.007","volume":"19","author":"T-K Pakarinen","year":"2013","unstructured":"Pakarinen, T.-K. et al. Effect of immobilization, off-loading and zoledronic acid on bone mineral density in patients with acute Charcot neuroarthropathy: A prospective randomized trial. Foot Ankle Surg. 19, 121\u2013124 (2013).","journal-title":"Foot Ankle Surg."},{"key":"2233_CR16","doi-asserted-by":"publisher","first-page":"194","DOI":"10.1034\/j.1600-0838.2003.20205.x","volume":"13","author":"M Therbo","year":"2003","unstructured":"Therbo, M., Petersen, M., Nielsen, P. & Lund, B. Loss of bone mineral of the hip and proximal tibia following rupture of the Achilles tendon. Scand. J. Med. Sci. Sports 13, 194\u2013199 (2003).","journal-title":"Scand. J. Med. Sci. Sports"},{"key":"2233_CR17","doi-asserted-by":"publisher","first-page":"131","DOI":"10.1016\/S8756-3282(98)00153-7","volume":"24","author":"EV van der Poest Clement","year":"1999","unstructured":"van der Poest Clement, E. V., Van der Wiel, H., Patka, P., Roos, J. & Lips, P. Long-term consequences of fracture of the lower leg: Cross-sectional study and long-term longitudinal follow-up of bone mineral density in the hip after fracture of lower leg. Bone 24, 131\u2013134 (1999).","journal-title":"Bone"},{"key":"2233_CR18","doi-asserted-by":"publisher","first-page":"S147","DOI":"10.1301\/nr.2007.dec.S147-S151","volume":"65","author":"GR Mundy","year":"2007","unstructured":"Mundy, G. R. Osteoporosis and inflammation. Nutr. Rev. 65, S147\u2013S151 (2007).","journal-title":"Nutr. Rev."},{"key":"2233_CR19","first-page":"6605","volume":"17","author":"G Luo","year":"2018","unstructured":"Luo, G., Li, F., Li, X., Wang, Z. G. & Zhang, B. TNF-\u03b1 and RANKL promote osteoclastogenesis by upregulating RANK via the NF-\u03baB pathway. Mol. Med. Rep. 17, 6605\u20136611 (2018).","journal-title":"Mol. Med. Rep."},{"key":"2233_CR20","doi-asserted-by":"publisher","first-page":"1938","DOI":"10.1017\/S0007114514003018","volume":"112","author":"S Tiwari","year":"2014","unstructured":"Tiwari, S., Pratyush, D. D., Gupta, S. K. & Singh, S. K. Vitamin D deficiency is associated with inflammatory cytokine concentrations in patients with diabetic foot infection. Br. J. Nutr. 112, 1938\u20131943 (2014).","journal-title":"Br. J. Nutr."},{"key":"2233_CR21","doi-asserted-by":"publisher","first-page":"24","DOI":"10.1038\/ncpuro0995","volume":"5","author":"CS Higano","year":"2008","unstructured":"Higano, C. S. Androgen-deprivation-therapy-induced fractures in men with nonmetastatic prostate cancer: What do we really know?. Nat. Clin. Pract. Urol. 5, 24\u201334. https:\/\/doi.org\/10.1038\/ncpuro0995 (2008).","journal-title":"Nat. Clin. Pract. Urol."},{"key":"2233_CR22","doi-asserted-by":"publisher","first-page":"592","DOI":"10.1007\/s001980070080","volume":"11","author":"LJ Melton 3rd","year":"2000","unstructured":"Melton, L. J. 3rd. et al. Cross-sectional versus longitudinal evaluation of bone loss in men and women. Osteoporos. Int. 11, 592\u2013599. https:\/\/doi.org\/10.1007\/s001980070080 (2000).","journal-title":"Osteoporos. Int."},{"key":"2233_CR23","doi-asserted-by":"publisher","first-page":"105","DOI":"10.1007\/s001980200001","volume":"13","author":"L Warming","year":"2002","unstructured":"Warming, L., Hassager, C. & Christiansen, C. Changes in bone mineral density with age in men and women: A longitudinal study. Osteoporos. Int. 13, 105\u2013112. https:\/\/doi.org\/10.1007\/s001980200001 (2002).","journal-title":"Osteoporos. Int."},{"key":"2233_CR24","doi-asserted-by":"publisher","first-page":"153","DOI":"10.1007\/s00592-011-0324-7","volume":"49","author":"EJ Hamilton","year":"2012","unstructured":"Hamilton, E. J. et al. A five-year prospective study of bone mineral density in men and women with diabetes: The Fremantle Diabetes Study. Acta Diabetol. 49, 153\u2013158. https:\/\/doi.org\/10.1007\/s00592-011-0324-7 (2012).","journal-title":"Acta Diabetol."},{"key":"2233_CR25","doi-asserted-by":"publisher","first-page":"3531","DOI":"10.1210\/jc.2018-00850","volume":"103","author":"EJ Hamilton","year":"2018","unstructured":"Hamilton, E. J. et al. A 10-year prospective study of bone mineral density and bone turnover in males and females with type 1 diabetes. J. Clin. Endocrinol. Metab. 103, 3531\u20133539. https:\/\/doi.org\/10.1210\/jc.2018-00850 (2018).","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"2233_CR26","doi-asserted-by":"publisher","first-page":"1547","DOI":"10.2337\/diacare.27.7.1547","volume":"27","author":"TH Keegan","year":"2004","unstructured":"Keegan, T. H. et al. Effect of alendronate on bone mineral density and biochemical markers of bone turnover in type 2 diabetic women: The fracture intervention trial. Diabetes Care 27, 1547\u20131553. https:\/\/doi.org\/10.2337\/diacare.27.7.1547 (2004).","journal-title":"Diabetes Care"},{"key":"2233_CR27","doi-asserted-by":"publisher","first-page":"596","DOI":"10.1359\/JBMR.041219","volume":"20","author":"AV Schwartz","year":"2005","unstructured":"Schwartz, A. V. et al. Diabetes and bone loss at the hip in older black and white adults. J. Bone Miner. Res. 20, 596\u2013603. https:\/\/doi.org\/10.1359\/JBMR.041219 (2005).","journal-title":"J. Bone Miner. Res."},{"key":"2233_CR28","doi-asserted-by":"publisher","first-page":"62","DOI":"10.3389\/fendo.2013.00062","volume":"4","author":"AV Schwartz","year":"2013","unstructured":"Schwartz, A. V. et al. Diabetes and change in bone mineral density at the hip, calcaneus, spine, and radius in older women. Front. Endocrinol. (Lausanne) 4, 62. https:\/\/doi.org\/10.3389\/fendo.2013.00062 (2013).","journal-title":"Front. Endocrinol. (Lausanne)"},{"key":"2233_CR29","first-page":"28","volume":"10","author":"E Gibon","year":"2017","unstructured":"Gibon, E., Lu, L. Y., Nathan, K. & Goodman, S. B. Inflammation, ageing, and bone regeneration. J. Orthop. Transl. 10, 28\u201335 (2017).","journal-title":"J. Orthop. Transl."},{"key":"2233_CR30","doi-asserted-by":"publisher","first-page":"1195","DOI":"10.1359\/JBMR.050215","volume":"20","author":"TV Nguyen","year":"2005","unstructured":"Nguyen, T. V., Center, J. R. & Eisman, J. A. Femoral neck bone loss predicts fracture risk independent of baseline BMD. J. Bone Miner. Res. 20, 1195\u20131201. https:\/\/doi.org\/10.1359\/JBMR.050215 (2005).","journal-title":"J. Bone Miner. Res."},{"key":"2233_CR31","doi-asserted-by":"publisher","first-page":"30","DOI":"10.25270\/owm.2017.08.3043","volume":"63","author":"L Allen","year":"2017","unstructured":"Allen, L., Powell-Cope, G., Mbah, A., Bulat, T. & Njoh, E. A retrospective review of adverse events related to diabetic foot ulcers. Ostomy Wound Manag. 63, 30\u201333 (2017).","journal-title":"Ostomy Wound Manag."},{"key":"2233_CR32","doi-asserted-by":"publisher","DOI":"10.1155\/2010\/629020","volume":"2010","author":"KM Knapp","year":"2010","unstructured":"Knapp, K. M., Rowlands, A. V., Welsman, J. R. & MacLeod, K. M. Prolonged unilateral disuse osteopenia 14\u00a0years post external fixator removal: A case history and critical review. Case Rep. Med. 2010, 629020 (2010).","journal-title":"Case Rep. Med."}],"container-title":["Scientific Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.nature.com\/articles\/s41598-021-02233-y.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41598-021-02233-y","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41598-021-02233-y.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,12,3]],"date-time":"2022-12-03T17:44:10Z","timestamp":1670089450000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.nature.com\/articles\/s41598-021-02233-y"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,11,23]]},"references-count":32,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2021,12]]}},"alternative-id":["2233"],"URL":"https:\/\/doi.org\/10.1038\/s41598-021-02233-y","relation":{},"ISSN":["2045-2322"],"issn-type":[{"type":"electronic","value":"2045-2322"}],"subject":[],"published":{"date-parts":[[2021,11,23]]},"assertion":[{"value":"23 April 2021","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"8 November 2021","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"23 November 2021","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The authors declare no competing interests.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"22742"}}