Increased uptake of bone radiopharmaceutical in diabetic neuropathy

Uptake of radiopharmaceutical was markedly abnormal in all phases of the bone scan in the feet of patients with diabetic neuropathy. Bone scans were performed in three groups of patients; diabetics with neuropathic osteoarthropathy (Charcot joints); diabetics with neuropathy but no evidence of osteoarthropathy and non-diabetic controls. Uptake was monitored in three phases; during the first 2 min after injection, then at 4 min and finally at 4 h. Uptake in all three phases was markedly increased in the neuropathic subjects, not only in those with osteoarthropathy but also in those with no radiological abnormalities. Increased uptake at 2 and 4 min indicates increased blood flow which can also result in increased uptake at 4 h. Increased blood flow secondary to peripheral neuropathy may lead to excessive bone resorption, susceptibility to fracture and finally the development of neuropathic osteoarthropathy of the diabetic foot.