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Subjects With Diabetes and DFU With a Suspicion of DFOBOLBOCNCT06066801

Bedside Bone Biopsy in Diabetic Foot Osteomyelitis

A study testing Bedside blind bone biopsy procedure in people with Subjects With Diabetes and DFU With a Suspicion of DFO, run by Assistance Publique - Hôpitaux de Paris at 1 site in France.

Recruiting

Looking for participants now. Contact the study team or a site below to ask about taking part.

Sites and contacts
Official record
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Trial summary

During their lifetime, 15 to 25% of patients with diabetes mellitus will develop a Diabetic Foot Ulcer (DFU) related to neuropathy and/or peripheral arterial disease. DFU is the leading cause of non-traumatic lower-extremity amputation worldwide. Read more about this study

Who is it for?
Ages 18 years and older
What is being tested?
Bedside blind bone biopsy procedure
Could I receive a placebo?
No, everyone receives an active treatment
How many people
320 participants
Where
1 siteFrance
Study dates
14 Mar 2024to Oct 2027
Phase
Interventional
Are there results?
Not yet: the study is under way

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Patients eligible for inclusion in this study must fulfill all of the following criteria:
  • Aged >18 years
  • Diabetes mellitus
  • At least one of the following signs of osteomyelitis according to IWGDF 2019 guidelines:
  • A positive probe to bone test and abnormalities on plain X-ray suggestive for osteomyelitis Signs of osteomyelitis on CT-scan and/or MRI and/or white blood cell SPECT/CT and/or FDG-PET/CT-scan
  • Absence of antibacterial therapy within 14 days before inclusion

Who cannot join

  • Patients fulfilling any of the following criteria are not eligible for inclusion in this study:
  • Urgent need for surgery
  • Critical limb ischemia which cannot be corrected by revascularization procedure
  • Subjects that (are likely to) undergo surgical or percutaneous revascularization are not excluded
  • Antibiotic treatment in the last 15 days before bone biopsy
  • Osteomyelitis in the area of the Charcot foot destructive process
Show all 12Show fewer
  • Unlikely to live at least 1 year
  • Not being able to give informed consent and willing to comply with the research protocol
  • Pregnant or breastfeeding women
  • Absence of affiliation to French social insurance
  • State medical aid (AME)
  • Deprivation of liberty, being under a legal protective measure

Trial locations and contacts

1 site in 1 country. Contact the study team or a site near you to ask about taking part.

Louis Potier, MD, PhD contact

01 40 25 88 03

louis.potier@aphp.fr

France1 site, 1 recruiting
  • Bichat - Claude Bernard Hospital

    Paris, 75018

    Louis Potier, MD, PhD, 01 40 25 88 03, louis.potier@aphp.fr

    Recruiting

Other trials in France

About this study

Official title: Bedside Bone Biopsy Versus Conventional Bone Biopsy for Management of Diabetic Foot Osteomyelitis: an Open-label Controlled Randomized Non-inferiority Trial

During their lifetime, 15 to 25% of patients with diabetes mellitus will develop a Diabetic Foot Ulcer (DFU) related to neuropathy and/or peripheral arterial disease. DFU is the leading cause of non-traumatic lower-extremity amputation worldwide. Diabetic foot osteomyelitis (DFO), which complicates up to 60% of DFU, is a major trigger of amputation in over 80% of persons with diabetes resulting in subsequent loss of quality of life. It has been shown that medical treatment of DFO may prevent amputations with early diagnosis of osteomyelitis and appropriate use of antibiotics. Empirical antimicrobial treatment is not recommended for DFO as for other chronic infections. Surgically or radiologically acquired bone sample for culture is the reference standard recommended by the International Working Group of Diabetic Foot (IWGDF) to diagnose DFO and to determine the causative bacteria and their susceptibility. However, defining appropriate antimicrobial therapy directed to the causative bacteria in DFO is challenging since it requires bone biopsy (BB) procedures which are underused in clinical practice for various reasons: lack of availability, cost, and delay. Some clinicians also find bone biopsy cumbersome or too invasive.

To overcome these barriers, we have set up for a few years a bedside blind BB procedure performed by diabetologists at the bedside in the clinical ward. Since then, this method has been used in more than 200 patients with DFO in the diabetology departments of Lariboisiere Hospital and Bichat Hospital (Paris). We have recently published our observational data of 79 patients showing that bedside BB is a simple, safe and efficient procedure for the diagnosis of DFO with a similar rate of complete healing at 12 months compared to conventional surgical or radiological bone biopsies. In order to extend and confirm these preliminary and observational results, the aim of this study is to compare the efficiency and safety of bedside BB versus conventional bone biopsy in a randomized controlled trial (RCT) of patients with DFO. Our hypothesis is that bedside BB is non-inferior to conventional bone biopsy in DFO and can be used as a simpler alternative procedure to document DFO

Read the detailed description

During their lifetime, 15 to 25% of patients with diabetes mellitus will develop a Diabetic Foot Ulcer (DFU) related to neuropathy and/or peripheral arterial disease1. DFU is the leading cause of non-traumatic lower-extremity amputation worldwide. DFO, which complicates up to 60% of DFU, is a major trigger of amputation in over 80% of persons with diabetes resulting in subsequent loss of quality of life2. It has been shown that medical treatment of DFO may prevent amputations with early diagnosis of osteomyelitis and appropriate use of antibiotics3. Empirical antimicrobial treatment is not recommended for DFO as for other chronic infections. Surgically or radiologically acquired bone sample for culture is the reference standard recommended by the International Working Group of Diabetic Foot (IWGDF) to diagnose DFO and to determine the causative bacteria and their susceptibility4. However, defining appropriate antimicrobial therapy directed to the causative bacteria in DFO is challenging since it requires bone biopsy (BB) procedures which are underused in clinical practice for various reasons including lack of availability, cost, and delay. Some clinicians also find bone biopsy cumbersome or too invasive.

To overcome these barriers, we have set up for a few years a bedside blind BB procedure performed by a physician at the bedside in the clinical ward. Since then, this method has been used in more than 200 patients with DFO in the diabetology departments of Lariboisiere Hospital and Bichat Hospital (Paris). We have recently published our observational data of 79 patients showing that bedside BB is a simple, safe and efficient procedure for the diagnosis of DFO with a similar rate of complete DFU healing at 12 months compared to conventional surgical or radiological bone biopsies6. In order to extend and confirm these preliminary and observational results, the aim of this study is to compare the efficiency and safety of bedside versus conventional BB in a randomized controlled trial (RCT) of patients with DFO. Our hypothesis is that bedside BB is non inferior to conventional BB in DFO outcomes and can be used as a simpler alternative procedure to document DFO.

The main objective is to demonstrate non-inferiority of beside blind bone biopsy compared to conventional bone biopsy (surgical or radiological) on DFO remission without surgery at 1 year.

The secondary objectives of this study are to:

  1. compare clinical efficacy between groups of bone biopsy
  2. compare microbiological culture results between groups
  3. compare the safety of both procedures
  4. compare DFO remission according to results of BB (negative or positive)

The health economic of this study are to:

  1. to estimate total costs for the intervention and total medical costs in each groups
  2. to estimate total quality adjusted life years (QALYs) based upon EQ5D5L scores
  3. to calculate the point estimate of the incremental cost utility ratio and estimate the probability of decremental cost effectiveness for the beside blind bone biopsy compared to conventional biopsy.

In this study, we will include subjects with diabetes and DFU with a suspicion of DFO. DFO is a complication of a large amount of DFU and is a major trigger of lower limb amputations. As we will include participants before bacteriological confirmation of DFO through bone biopsy, we will use the clinical and radiological criteria for DFO according to IWGDF 2019 guidelines4.

These criteria include having at least one of the following signs:

  • A positive probe to bone test and abnormalities on plain X-ray suggestive for osteomyelitis
  • Signs of osteomyelitis on CT-scan and/or MRI and/or white blood cell SPECT/CT and/or 18Fluor-2-fluoro-2-deoxy-D-glucose fluorodeoxyglucose-positron emission tomography (FDG-PET)/CT- scan
Being tested
Bedside blind bone biopsy procedure
Keywords
Bedside bone biopsy, conventional bone biopsy, diabetes, Diabetic Foot Ulcer (DFU), diabetic foot osteomyelitis (DFO)
Medical subject headings
Diabetes Mellitus, Diabetic Foot

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Bedside blind bone biopsy procedureProcedure or surgery

    It was performed in the patient's room under aseptic conditions. Pain relievers were given orally within the hour preceding the procedure. Superficial anesthesia was performed firstly subcutaneously and then on the periosteum, Inhaled anesthesia was started concomitantly. Following a short incision with a scalpel, the trocar inside a cannula was inserted through healthy skin at a minimum distance of 2 cm from the ulcer edge, close to the bone, preferentially on dorsal foot side. When the trocar was firmly inserted into the bone, it was pulled out from the cannula. Biopsy needle was then slipped into the cannula and twisted into the bone clockwise. Biopsy needle was then pulled out and the bone was pushed out with the ejector pin into a sterile surgical drape and divided in two parts.

Study groups in NCT06066801
Study groupRoleWhat they receive
Bedside blind bone biopsy procedureExperimentalBedside blind bone biopsy procedure performed by a physician of the participating center through healthy skin with bone trocar following local and light systemic anesthesia. Samples will be analyzed for microbiology and histopathology
Receives: Procedure: Bedside blind bone biopsy procedure
Standard bone biopsy procedureActive comparatorStandard BB procedure (surgical or radiological) performed according to the local standard of care of each participating center and done through healthy skin and under locoregional anesthesia. Samples will be analyzed for microbiology and histopathology
Receives: Procedure: Bedside blind bone biopsy procedure

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. the remission of DFO

    The remission of DFO at 12 months and is defined by a composite criterion as:

    • an epithelialized ulcer for 28 consecutive days
    • and absence of local inflammation and/or stabilization or improvement of radiologic abnormalities
    • and no need for surgery of the foot to treat DFO during follow-up

    Measured: 12 months

Secondary outcomes (16)
  1. Clinical efficacy

    Remission of DFO at 6 months

    Measured: 12 months

  2. Clinical efficacy

    Need for surgery for initial DFU during follow-up

    Measured: 12 months

  3. Clinical efficacy

    Recurrence of DFU during follow-up

    Measured: 12 months

  4. Clinical efficacy

    Death during follow-up

    Measured: 12 months

  5. Clinical efficacy

    Number of hospitalizations

    Measured: 12 months

  6. Clinical efficacy

    length of hospitalizations

    Measured: 12 months

  7. Clinical efficacy

    Length of stay of the initial hospitalization (in days)

    Measured: 12 months

  8. Microbiological results

    Number of microorganisms per biopsy

    Measured: 12 months

  9. Microbiological results

    Number of resistant microorganisms per biopsy

    Measured: 12 months

  10. Microbiological results

    Total duration of the antibacterial therapy (mean in days)

    Measured: 12 months

  11. Occurrence of adverse events during the study

    Measured: 12 months

  12. Remission rate of DFO

    Remission rate of DFO at 12 months according to microbiological results of BB (positive or negative)

    Measured: 12 months

  13. costs: Average costs of the biopsies

    Measured: 1 month

  14. costs: Average total 1-year costs

    Measured: 12 months

  15. Average 1 year QALY

    Measured: 12 months

  16. Incremental cost effectiveness ratio

    defined as the difference in average total costs/ average total QALY

    Measured: 12 months

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted4 Oct 2023
  2. Study start14 Mar 2024
  3. Primary completionMar 2027 (estimated)
  4. Study completionOct 2027 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Diagnosis
Allocation
Randomised
Intervention model
Parallel groups
Masking
None (open label)
Enrolment
320 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT06066801
Sponsor's protocol ID
PHRC-21-0179
Other IDs
2022-A02754-39
Acronym
BOLBOC
Status last verified
Nov 2025
First submitted
27 Sep 2023
Last updated
24 Nov 2025
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
Undecided

Questions about this trial

What is this clinical trial studying?

A study testing Bedside blind bone biopsy procedure in people with Subjects With Diabetes and DFU With a Suspicion of DFO, run by Assistance Publique - Hôpitaux de Paris at 1 site in France.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 6 inclusion and 12 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: looking for participants now, as of the sponsor's last update on 24 Nov 2025. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in France. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

This study is still under way. Results are not available in the source record yet.

How can a doctor refer a patient or contact the research team?

Contact Louis Potier, MD, PhD (01 40 25 88 03, louis.potier@aphp.fr), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

the remission of DFO (time frame: 12 months). It is what the study was designed to measure, not a finding.

Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 24 Nov 2025; AzTrials last refreshed its copy on 1 Nov 2026.

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