problendoПроблемы ЭндокринологииProblems of Endocrinology0375-96602308-1430Endocrinology Research Centre10.14341/probl13362problendo-13362Research ArticleНарушения углеводного обменаCarbohidrates metabolism disturbanciesЭтиопатогенетические особенности костного метаболизма пациентов с сахарным диабетом, осложненным диабетической нейроостеоартропатиейEtiopathogenetic features of bone metabolism in patients with diabetes mellitus and Charcot foothttps://orcid.org/0000-0003-3797-9788ЯрославцеваМ. В.YaroslavcevaM. V.

Ярославцева Марианна Викторовна - к.м.н.

Москва

Marianna V. Yaroslavceva - MD, PhD, Department of Diabetic foot.

Moscow

Yaroslavceva.Mariana@endocrincentr.ruhttps://orcid.org/0000-0002-2654-9451БондаренкоО. Н.BondarenkoO. N.

Бондаренко Ольга Николаевна - к.м.н.

Москва

Olga N. Bondarenko - MD, PhD, Department of Diabetic foot.

Moscow

Bondarenko.Olga@endocrincentr.ruhttps://orcid.org/0000-0002-4218-4456Эль-ТаравиЯ. А.El-TaraviYa. A.

Эль-Тарави Ясмин Ахмед Али

Москва

Yasmin A. El-Taravi - medical resident.

Moscow

yasmin.el-taravi@bk.ruhttps://orcid.org/0000-0002-8860-8509МагеррамоваС. Т.MagerramovaS. T.

Магеррамова Сара Тофиковна

117292, Москва, ул. Дмитрия Ульянова, д. 11

Sara T. Magerramova - medical resident.

Moscow

sara.magerramova@mail.ruhttps://orcid.org/0000-0001-6539-466XПигароваЕ. А.PigarovaE. A.

Пигарова Екатерина Александровна - д.м.н.

Москва

Ekaterina A. Pigarova - MD, PhD, Department of Neuroendocrinology.

Moscow

pigarova.ekaterina@endocrincentr.ruУльяноваИ. Н.UlyanovaI. N.

Ульянова Ирина Николаевна - к.м.н., главный врач.

Москва

Irina N. Ulyanova - MD, Chief Physician.

Moscow

Ulyanova.Irina@endocrincentr.ruhttps://orcid.org/0000-0001-6581-4521ГалстянГ. Р.GalstyanG. R.

Галстян Гагик Радикович - д.м.н., профессор.

Москва

Gagik R. Galstyan - MD, PhD, Professor, PhD, Head of Department of Diabetic foot.

Moscow

Galstyan.Gagik@endocrincentr.ruНациональный медицинский исследовательский центр эндокринологииРоссияEndocrinology Research CentreRussian Federation2024150920247045764Copyright © Ярославцева М.В., Бондаренко О.Н., Эль-Тарави Я.А., Магеррамова С.Т., Пигарова Е.А., Ульянова И.Н., Галстян Г.Р., 20242024Ярославцева М.В., Бондаренко О.Н., Эль-Тарави Я.А., Магеррамова С.Т., Пигарова Е.А., Ульянова И.Н., Галстян Г.Р.Yaroslavceva M.V., Bondarenko O.N., El-Taravi Y.A., Magerramova S.T., Pigarova E.A., Ulyanova I.N., Galstyan G.R.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.probl-endojournals.ru/jour/article/view/13362

Дистальная диабетическая нейропатия является одним из наиболее распространенных осложнений сахарного диабета (СД) и ассоциируется с медиакальцинозом артерий нижних конечностей, значительным снижением минеральной плотности костной ткани стоп и высокой частотой сердечно-сосудистых заболеваний (ССЗ). Медиакальциноз является индикатором тяжести и/или продолжительности заболевания, поскольку тесно связан с осложнениями диабета, в особенности с автономной нейропатией. Наличие медиакальциноза является важным маркером будущих сердечно-сосудистых нарушений у пациентов с СД. Изменения фосфорного-кальциевого обмена встречаются у пациентов с диабетической нейроостеоартропатией или стопой Шарко, когда наблюдается локальный остеопороз стоп и в 90% случаев происходит обызвествление сосудов нижних конечностей, а также изменение уровня витамина D и его метаболитов. Длительность течения СД и состояние компенсации значительно влияют на процесс минерально-костных нарушений. В данном обзоре обсуждаются особенности метаболизма витамина D, важность своевременной диагностики фосфорно-кальциевых нарушений и особенности терапии данной категории больных. Уделяется внимание своевременной диагностике острой стадии стопы Шарко на основании оценки отека костного мозга при проведении МРТ и возможности уменьшения срока иммобилизации пораженной конечности за счет его регресса.

Diabetic neuropathy is one of the most common diabetes mellitus complications associated with mediocalcinosis of the lower extremities, a significant decrease in feet bone mineral density, and a high incidence of cardiovascular disease. In most cases, calcium-phosphorus metabolism changes occur in patients with diabetic neuroarthropathy, or Charcot foot, when we can observe feet local osteoporosis, which in 90% of cases associated with a vessel’s calcification of the lower extremities in the majority of diabetes population. A large number of studies presented literature have demonstrated that patients with Charcot foot can have accelerated bone metabolism and increased bone resorption. Patients with Charcot foot often have crucial abnormalities in the calcium-phosphorus parameters, bone metabolism, and levels of vitamin D and its metabolites. In addition, the duration of diabetes mellitus, the degree of its compensation widely affects the development of its micro- and macrovascular complications, which could also accelerate the development of mineral and bone disorders in these types of patients. Multifactorial pathogenesis of these disorders complicates the management of patients with a long and complicated course of diabetes mellitus. This review discusses the peculiarities of vitamin D metabolism, the importance of timely diagnosis in phosphorus-calcium disorders, and the specifics of therapy in these patients. Special attention is paid to the timely diagnosis of the Charcot’s foots acute stage based on the bone marrow edema by MRI evaluation and the possibility of reducing the immobilization period.

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The authors declare that there are no conflicts of interest present.