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Definition

What is osteomyelitis?

Osteomyelitis is an infection in a bone. Infections can reach a bone by traveling through the bloodstream or spreading from nearby tissue. Infections can also begin in the bone itself if an injury exposes the bone to germs.

In children, osteomyelitis most commonly affects the long bones of the legs and upper arms. Adults are more likely to develop osteomyelitis in the bones that make up the spine (vertebrae). People who have diabetes may develop osteomyelitis in their feet if they have foot ulcers.

Once considered an incurable condition, osteomyelitis can be successfully treated today. Most people require surgery to remove parts of the bone that have died — followed by strong antibiotics, often delivered intravenously, typically for at least four to six weeks.

How common is osteomyelitis?

Osteomyelitis can affect patients at any age. It can be managed by reducing your risk factors. Please discuss with your doctor for further information.

Symptoms

What are the symptoms of osteomyelitis?

The common symptoms of osteomyelitis are:

  • Fever or chills
  • Irritability or lethargy in young children
  • Pain in the area of the infection
  • Swelling, warmth and redness over the area of the infection

Sometimes osteomyelitis causes no signs and symptoms or has signs and symptoms that are difficult to distinguish from other problems.

There may be some symptoms not listed above. If you have any concerns about a symptom, please consult your doctor.

When should I see my doctor?

If you have any signs or symptoms listed above or have any questions, please consult with your doctor. Everyone’s body acts differently. It is always best to discuss with your doctor what is best for your situation.

See your doctor if you experience worsening bone pain along with fever. If you’re at risk of infection because of a medical condition or recent surgery or injury, see your doctor right away if you notice signs and symptoms of an infection.

Causes

What causes osteomyelitis?

Most cases of osteomyelitis are caused by staphylococcus bacteria, types of germs commonly found on the skin or in the nose of even healthy individuals.

Germs can enter a bone in a variety of ways, including:

  • The bloodstream. Germs in other parts of your body — for example, in the lungs from pneumonia or in the bladder from a urinary tract infection — can travel through your bloodstream to a weakened spot in a bone. In children, osteomyelitis most commonly occurs in the softer areas, called growth plates, at either end of the long bones of the arms and legs.
  • Infected tissue or an infected prosthetic joint. Severe puncture wounds can carry germs deep inside your body. If such an injury becomes infected, the germs can spread into a nearby bone.
  • Open wounds. Germs can enter the body if you have broken a bone so severely that part of it is sticking out through your skin. Direct contamination can also occur during surgeries to replace joints or repair fractures.

Risk factors

What increases my risk for osteomyelitis?

There are many risk factors for osteomyelitis, such as:

Recent injury or orthopedic surgery

A severe bone fracture or a deep puncture wound gives infections a route to enter your bone or nearby tissue. Surgery to repair broken bones or replace worn joints also can accidentally open a path for germs to enter a bone.

Implanted orthopedic hardware is a risk factor for infection. Deep animal bites also can provide a pathway for infection.

Circulation disorders

When blood vessels are damaged or blocked, your body has trouble distributing the infection-fighting cells needed to keep a small infection from growing larger. What begins as a small cut can progress to a deep ulcer that may expose deep tissue and bone to infection.

Diseases that impair blood circulation include:

  • Poorly controlled diabetes
  • Peripheral arterial disease, often related to smoking
  • Sickle cell disease

Problems requiring intravenous lines or catheters

There are a number of conditions that require the use of medical tubing to connect the outside world with your internal organs. However, this tubing can also serve as a way for germs to get into your body, increasing your risk of an infection in general, which can lead to osteomyelitis.

Examples of when this type of tubing might be used include:

  • Dialysis machine tubing
  • Urinary catheters
  • Long-term intravenous tubing, sometimes called central lines

Conditions that impair the immune system

If your immune system is affected by a medical condition or medication, you have a greater risk of osteomyelitis. Factors that may suppress your immune system include:

  • Chemotherapy
  • Poorly controlled diabetes
  • Needing to take corticosteroids or drugs called tumor necrosis factor (TNF) inhibitors

Illicit drugs

People who inject illicit drugs are more likely to develop osteomyelitis because they typically use nonsterile needles and don’t sterilize their skin before injections.

Diagnosis & treatment

The information provided is not a substitute for any medical advice. ALWAYS consult with your doctor for more information.

How is osteomyelitis diagnosed?

Your doctor may feel the area around the affected bone for any tenderness, swelling or warmth. If you have a foot ulcer, your doctor may use a dull probe to determine the proximity of the underlying bone.

Your doctor may order a combination of tests and procedures to diagnose osteomyelitis and to determine which germ is causing the infection, such as:

Blood tests

Blood tests may reveal elevated levels of white blood cells and other factors that may indicate that your body is fighting an infection. If your osteomyelitis was caused by an infection in the blood, tests may reveal what germs are to blame.

No blood test exists that tells your doctor whether you do or do not have osteomyelitis. However, blood tests do give clues that your doctor uses to decide what further tests and procedures you may need.

Imaging tests

  • X-rays. X-rays can reveal damage to your bone. However, damage may not be visible until osteomyelitis has been present for several weeks. More-detailed imaging tests may be necessary if your osteomyelitis has developed more recently.
  • Computerized tomography (CT) scan. A CT scan combines X-ray images taken from many different angles, creating detailed cross-sectional views of a person’s internal structures.
  • Magnetic resonance imaging (MRI). Using radio waves and a strong magnetic field, MRI scans can produce exceptionally detailed images of bones and the soft tissues that surround them.

Bone biopsy

A bone biopsy is the gold standard for diagnosing osteomyelitis, because it can also reveal what particular type of germ has infected your bone. Knowing the type of germ allows your doctor to choose an antibiotic that works particularly well for that type of infection.

An open biopsy requires anesthesia and surgery to access the bone. In some situations, a surgeon inserts a long needle through your skin and into your bone to take a biopsy. This procedure requires local anesthetics to numb the area where the needle is inserted. X-ray or other imaging scans may be used for guidance.

How is osteomyelitis treated?

The most common treatments for osteomyelitis are surgery to remove portions of bone that are infected or dead, followed by antibiotics. Hospitalization is usually necessary.

Depending on the severity of the infection, osteomyelitis surgery may include one or more of the following procedures:

  • Drain the infected area. Opening up the area around your infected bone allows your surgeon to drain any pus or fluid that has accumulated in response to the infection.
  • Remove diseased bone and tissue. In a procedure called debridement, the surgeon removes as much of the diseased bone as possible, and takes a small margin of healthy bone to ensure that all the infected areas have been removed. Surrounding tissue that shows signs of infection also may be removed.
  • Restore blood flow to the bone. Your surgeon may fill any empty space left by the debridement procedure with a piece of bone or other tissue, such as skin or muscle, from another part of your body. Sometimes temporary fillers are placed in the pocket until you’re healthy enough to undergo a bone graft or tissue graft. The graft helps your body repair damaged blood vessels and form new bone.
  • Remove any foreign objects. In some cases, foreign objects, such as surgical plates or screws placed during a previous surgery, may have to be removed.
  • Amputate the limb. As a last resort, surgeons may amputate the affected limb to stop the infection from spreading further.

A bone biopsy will reveal what type of germ is causing your infection, so your doctor can choose an antibiotic that works particularly well for that type of infection. The antibiotics are usually administered through a vein in your arm for at least four to six weeks. An additional course of oral antibiotics may be needed for more-serious infections.

Lifestyle changes & Home remedies

What are some lifestyle changes or home remedies that can help me manage osteomyelitis?

The following lifestyles and home remedies might help you cope with osteomyelitis:

If you’ve been told that you have an increased risk of infection, talk to your doctor about ways to prevent infections from occurring. Reducing your risk of infection will also reduce your risk of developing osteomyelitis.

In general, take precautions to avoid cuts and scrapes, which give germs easy access to your body. If you do get any cuts and scrapes, clean the area immediately and apply a clean bandage. Check wounds frequently for signs of infection.

If you have any questions, please consult with your doctor to better understand the best solution for you.

Hello Health Group does not provide medical advice, diagnosis or treatment.

Review Date: June 26, 2017 | Last Modified: June 26, 2017

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