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    Calcium metabolism disorders in the pathogenesis of diabetic foot syndrome in elderly patients
    (Maltepe Üniversitesi, 2018) Anatolyevna, Postolaki Marina; Evgenyevich, Shapkin Vadym
    Introduction: “Diabetic foot” syndrome (DF) is one of the common problem of modern diabetology and geriatrics. However, we do not have adequate pathogenetic therapy, which requires further investigation of DF pathogenesis. The aim: to study role of the calcium metabolism disorders at the formation of DF at patients of old age. Methodology: The study included 78 patients with Diabetes mellitus Type II aged from 58 to 80 years. Patients agreed to participate in the study. We determined calcemia, alkaline phosphatase activity in serum; excretion of pyridinoline and deoxypyridinoline with the urine. Sensomotor disorders were studied. Achilles, patellar, plantar tendon reflexes were investigated. It was identified circulation status of the lower extremities blood vessels by using skin thermometry, capillary refill test, pulse determining on a. dorsalis pedis, a. tibialis posterior, foot vessels dopplersonografy. Feet X-ray was also used. Patients were separated into two groups. 36 patients of the first group did`t have signs of DF. 42 patients of the second group have I stage of DF - non-infected superficial ulcers of the foot (Wagner classification). Results: Neuropathy and angiopathy were present at all patients of both groups. Osteoarthropathy was detected at all patients of second group. X-ray examination identified pathological signs at bones and joints of the phalanges, metatarsus, tarsus, ankle joints. Ankle joints, metatarsal-tarsal and metatarsal-phalangeal joints changes dominated. We identified prevalence of resorptive processes - osteoporosis, osteolysis, erosions at the metatarsus and phalanges and prepotency of destructive processes at tarsus and ankle joints. Calcium metabolism changes were: hypocalcemia (Group I - 2.3 mmol / l in Group II - 1.8 mmol / l), reduction of the alkaline phosphatase activity (Group I - 1.5 mmol / h l, in Group II - 1.3 mmol / h l). Ionized calcium fraction was significantly decreased mainly in Group II (0.9 mmol / l). Pyridinoline and deoxypyridinoline excretion increasing took place in both groups, but more in second. The results we obtained allow to conclude influence of calcium metabolism disorders to formation of pathological changes in bones and joints as well as diabetic neuropathies and angiopathies. Osteoarthropathy signs, especially bone resorption are an important part of the DF syndrome. That is why it is necessary to pay attention of the necessity of the osteoarthroprotector treatment at the complex diabetes mellitus therapy.