Glycemic Improvement and Active Charcot Neuroarthropathy: Osteocalcin as a Candidate Biomarker of Transient Skeletal Vulnerability

ARTICLE HIGHLIGHTS: Active Charcot neuroarthropathy remains difficult to predict, and its timing is not fully explained by neuropathy and mechanical stress alone. We asked whether a clinically meaningful HbA1c fall may temporally coincide with active Charcot neuroarthropathy and whether osteocalcin could mark transient skeletal vulnerability. Available observations support association and biological plausibility, not causation, and do not prove that osteocalcin is a pathogenic mediator. Prospective monitoring studies are warranted, but current evidence does not justify delaying evidence-based glycemic optimization.