Impact of Charcot neuroarthropathy on metatarsal bone mineral density and geometric strength indices

► Quantitative computed tomography image processing techniques were used to assess foot bone strength noninvasively in acute Charcot neuroarthropathy. ► BMD was lower in Charcot patients versus diabetic, neuropathic controls, but indices of compressive and bending strength were maintained. ► Geometric results may reflect an inflammation-mediated response to bone injury rather than true maintenance of bone strength. ► Clinical quantitative computed tomography precludes clear discernment between functional bone adaptation and injury response, such as woven bone apposition. ► Improved spatial resolution will clarify the effects of Charcot neuroarthopathy on lower extremity bone strength and fracture risk.