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What is osteomyelitis?

Osteomyelitis is an inflammation or swelling of bone tissue. It’s most often caused by an infection. Bone infection may occur for many reasons and can affect children or adults.

What causes osteomyelitis?

Some of the causes of osteomyelitis include:

  • Osteomyelitis may be caused by a bacterial infection of the blood. This is sometimes called bacteremia or sepsis. This infection can spread to the bone. It’s most common in infants and children and usually affects their long bones such as the thighbone or upper arm bone. When it affects adults, it often involves the bones in the spine. The source of the blood infection is usually Staphylococcus aureus, although it may be caused by other organisms.
  • Osteomyelitis can also occur:
    • After an injury
    • From frequent medication injections
    • After a surgery
    • With use of a prosthetic device
    • In people with diabetes
    • In people with weak immune systems (such as those with HIV, or who are getting cancer treatment)

Osteomyelitis can have a sudden start, a slow and mild start, or may be a chronic problem, depending on the source of the infection.

Who is at risk for osteomyelitis?

Osteomyelitis can affect anyone. But, it is more common in infants, children, and older adults. People at greater risk include those with weak immune systems, recent injury, or diabetes.

What are the symptoms of osteomyelitis?

Symptoms of osteomyelitis vary, depending on the cause and whether it starts quickly or slowly. These are the most common:

  • Fever (high fever with blood infection)
  • Pain and tenderness in the affected area
  • Irritability
  • Feeling ill
  • Swelling of the affected area
  • Redness in the affected area
  • Warmth in the affected area
  • Trouble moving joints near the affected area
  • Trouble bearing weight or walking
  • A new limp
  • A stiff back (if the spine is affected)

The symptoms of osteomyelitis may look like other medical conditions or problems. Always consult your doctor for a diagnosis.

How is osteomyelitis diagnosed?

Your health care provider will review your medical history and do a physical exam. Other tests may include:

  • Blood tests, such as:
    • Complete blood count (CBC). This test measures the size, number, and maturity of  blood cells. It’s done to check for increased white blood cells that may signal an infection.
    • Erythrocyte sedimentation rate (ESR). This test measures how quickly red blood cells fall to the bottom of a test tube. When swelling and inflammation are present, the blood's proteins clump together and become heavier than normal. So,  they fall and settle faster at the bottom of the test tube. Generally, the faster the blood cells fall, the more severe the inflammation.
    • C-reactive protein (CRP). A blood test to help find inflammation or an infection.
  • Needle aspiration or bone biopsy. A small needle is inserted into the affected area to take a tissue biopsy.
  • X-ray. This test uses invisible electromagnetic energy beams to make images of tissues, bones, and organs onto film.
  • Radionuclide bone scans. Pictures or X-rays are taken of the bone after a dye is injected and absorbed by the bone tissue. These are used to find tumors and bone abnormalities.
  • Computed tomography scan (also called CT or CAT scan). This test uses X-rays and a computer to make images (often called slices) of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general X-rays.
  • Magnetic resonance imaging (MRI). This test uses large magnets, radiofrequencies, and a computer to make detailed images of organs and structures in the body.
  • Ultrasound. This test uses high-frequency sound waves and a computer to make images of blood vessels, tissues, and organs. Ultrasounds are used to view organs as they work, and to check blood flow through blood vessels.

How is osteomyelitis treated?

Your health care provider will figure out the best treatment based on:

  • How old you are
  • Your overall health and medical history
  • How sick you are
  • How well you can handle specific medications, procedures, or therapies
  • How long the condition is expected to last
  • Your opinion or preference

The goal for treatment of osteomyelitis is to cure the infection and minimize any long-term problems. Treatment may include:

  • Medications. You may be give intravenous (IV) antibiotics. This often calls for hospital stay.  Or, you may be given antibiotics an outpatient. In either case, treatment may last for many weeks.
  • Monitoring X-rays and blood tests
  • Pain management
  • Bed rest (or restricted movement of the affected area)
  • Surgery. In some cases, surgery may be needed to drain fluid, or remove damaged tissue and bone.

What are the complications of osteomyelitis?

Osteomyelitis calls for long-term care to prevent complications such as:

  • Fractures of the affected bone
  • Stunted growth in children (if the infection has involved the growth plate)
  • Tissue death (gangrene) in the affected area

Key points about osteomyelitis

  • Osteomyelitis is an inflammation or swelling of bone tissue. It’s most often the result of an infection. It can affect all people, but is more common in infants, children, and older adults.
  • Causes of osteomyelitis include:
  • Bacterial infection in the blood
  • Injury
  • Frequent medication injections
  • After surgery
  • With use of a prosthetic device.
  • People with weak immune systems or diabetes
  • The goal for treatment of osteomyelitis is to cure the infection and minimize any long-term complications.
  • Osteomyelitis calls for long-term care to prevent complications.

Next steps

Tips to help you get the most from a visit to your health care provider:
  • Before your visit, write down questions you want answered.
  • Bring someone with you to help you ask questions and remember what your provider tells you.
  • At the visit, write down the names of new medicines, treatments, or tests, and any new instructions your provider gives you.
  • If you have a follow-up appointment, write down the date, time, and purpose for that visit.
  • Know how you can contact your provider if you have questions.

Medical Reviewers:

  • Berry, Judith, PhD, APRN
  • Fetterman, Anne, RN, BSN