Alterations to Bone Mineral Composition as an Early Indication of Osteomyelitis in the Diabetic Foot

  1. Blake J. Roessler, MD1
  1. 1Department of Internal Medicine, Division of Rheumatology, University of Michigan Medical School, Ann Arbor, Michigan
  2. 2Department of Chemistry, University of Michigan, Ann Arbor, Michigan
  3. 3Department of Internal Medicine, Division of Metabolism, Endocrinology and Diabetes, University of Michigan Medical School, Ann Arbor, Michigan
  1. Corresponding author: Blake J. Roessler, roessler{at}


OBJECTIVE Osteomyelitis in the diabetic foot is a major risk factor for amputation, but there is a limited understanding of early stage infection, impeding limb-preserving diagnoses. We hypothesized that bone composition measurements provide insight into the early pathophysiology of diabetic osteomyelitis.

RESEARCH DESIGN AND METHODS Compositional analysis by Raman spectroscopy was performed on bone specimens from patients with a clinical diagnosis of osteomyelitis in the foot requiring surgical intervention as either a biopsy (n = 6) or an amputation (n = 11).

RESULTS An unexpected result was the discovery of pathological calcium phosphate minerals in addition to normal bone mineral. Dicalcium phosphate dihydrate, also called brushite, and uncarbonated apatite were found to be exclusively associated with infected bone.

CONCLUSIONS Compositional measurements provided a unique insight into the pathophysiology of osteomyelitis in diabetic foot ulcers. At-patient identification of pathological minerals by Raman spectroscopy may serve as an early stage diagnostic approach.

  • Received February 28, 2013.
  • Accepted May 24, 2013.

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