Osteomyelitis: Symptoms, Causes, & Treatments

Osteomyelitis is a serious infection and inflammation of the bone, but the prognosis (outlook) is good when it is diagnosed and treated quickly. Please continue reading to find out what causes osteomyelitis as well as the symptoms and treatment options.

What is the main cause of osteomyelitis?

Healthy bones are generally resistant to infections. Osteomyelitis occurs when germs gain access to the bones from other parts of the body (for example, the lungs or urinary tract) through the bloodstream. Bone infection can also occur through the spread of an infection from nearby tissues such as the skin, muscles, or tendons. Other causes of osteomyelitis include deep puncture wounds that can allow germs to reach the bones, for example, animal bites or nail piercing injuries. Osteomyelitis can also be a complication of bone surgery to repair an injury or replace joints with orthopedic hardware. Bone infections are commonly caused by bacteria but can also be caused by fungi and other germs.

Where does osteomyelitis usually begin?

Osteomyelitis usually begins in the long bones of the arms and legs in children and in the pelvis (hips), vertebrae (spine), and feet in adults.

Who is at risk of a bone infection?

Risk factors to develop osteomyelitis include certain medical conditions and treatments for a medical condition, such as:

Recent traumatic injury or bone surgery.
Circulatory disorders or illnesses such as poorly controlled diabetes, peripheral vascular disease in smokers, or sickle cell disease. In people with these conditions, small infections, such as skin ulcers, can progress due to poor blood flow and eventually extend to bone.
Long-term use of tubes and catheters, such as urinary catheters, central lines, or dialysis machine tubes in people with kidney failure. They can result in a blood infection, which can spread to bones.
Older adults and people with weak immune systems, for example, due to cancer treatment, steroid medicines, or poorly controlled diabetes.
Illicit drug use. This can lead to infectious diseases of the skin or blood that can spread to the bones.

What is the first stage of osteomyelitis?

The first stage of osteomyelitis is when the bone infection is limited to the medullary cavity of the bone (the hollow part that contains the bone marrow). The second stage involves cortical bone (the dense solid part of the bone that surrounds the marrow space), and it usually occurs from a direct infection from nearby tissues. Third-stage osteomyelitis involves both medullary and cortical bone but does not affect the full diameter of the bone and does not affect bone stability. Stage 4 osteomyelitis involves the entire bone along with a loss of bone stability. Additionally, healthcare providers add A, B, or C to the staging of osteomyelitis based on the absence or presence of local or systemic complicating factors.

Acute osteomyelitis refers to an infection of less than 4 weeks’ duration. Chronic osteomyelitis is a bone infection that has lasted more than 4 weeks.

What are the symptoms of bone infection?

Symptoms of osteomyelitis include fever, chills, sweating, fatigue, feeling unwell, and bone pain, swelling, redness, and warmth in the infected area.

What are the complications of osteomyelitis?

Osteomyelitis can cause serious health complications such as osteonecrosis (bone death), septic arthritis (spread of the infection to nearby joints), slowed growth in children if the growth plates of the long bones are affected by osteomyelitis, and skin cancer if osteomyelitis causes an open wound that is draining pus. It can also spread and cause a disseminated multiorgan infection.

How is osteomyelitis diagnosed?

Healthcare providers can make a diagnosis of osteomyelitis based on your medical history, symptoms, physical exam, and tests, including blood tests, blood cultures, imaging studies (X-ray, MRI, CT scan), bone scan, bone biopsy, and/or needle aspiration.

Do you need bone surgery to treat osteomyelitis?

Most people with osteomyelitis need surgery to drain pus from the area, remove the infected and dead portion of bone, remove foreign objects such as orthopedic hardware (metal screws, plates, or rods), and restore blood supply to the area. Rarely is it necessary to amputate a limb to prevent the bone infection from spreading.

Surgery for osteomyelitis is usually followed by medication treatment with antibiotics. Your physician will use your bone biopsy to identify which organism has caused the bone infection and which antibiotic medicine will work against it. Antibiotic treatment for osteomyelitis is usually given intravenously over a period of 6 weeks. Your doctor may prescribe a further course of oral antibiotic medications for serious bone infections.

How to prevent osteomyelitis?

You can lower your risk of developing osteomyelitis by taking precautions to prevent infections in other parts of your body. As much as possible, avoid injuries such as cuts, scrapes, and animal bites that can give germs access to your bones. If you or your child have minor injuries, make sure you clean the wound and seek follow-up care. It is especially important to seek timely treatment from a healthcare provider if you develop signs of infection, such as bone pain, redness, swelling, or warmth.

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