Charcot neuroarthropathy (CN) is a devastating condition affecting the feet in patients with diabetes. The
pathophysiology of (CN) is still incompletely understood, although main etiological components have been identified.
The cornerstone of treatment of acute CN is immediate effective offloading, typically with total contact casting, and
reduction in weight-bearing. The main current targets of pharmacological intervention are the inhibition of excess
osteoclast activation and suppression of an excess pro-inflammatory cytokine response. Anti-resorption therapy,
especially with bisphosphonates, has been used in randomized trials. The trials so far have demonstrated improved symptom
control, a more rapid decline in foot temperature and a significant decrease in bone turnover markers. An understanding
of the molecular pathways of bone resorption will help in the development of novel adjunctive pharmacological therapies
which might further improve the outcome in patients with CN.