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.
Smokers and people with chronic health conditions, such as diabetes or kidney failure, are more at risk of developing osteomyelitis. People who have diabetes may develop osteomyelitis in their feet if they have foot ulcers.
Although once considered incurable, osteomyelitis can now be successfully treated. Most people need surgery to remove areas of the bone that have died. After surgery, strong intravenous antibiotics are typically needed.
Signs and symptoms of osteomyelitis include:
Sometimes osteomyelitis causes no signs and symptoms or the signs and symptoms are hard to distinguish from other problems. This may be especially true for infants, older adults and people whose immune systems are compromised.
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.
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:
Your bones are normally resistant to infection, but this protection lessens as you get older. Other factors that can make your bones more vulnerable to osteomyelitis may include:
A severe bone fracture or a deep puncture wound gives bacteria a route to enter your bone or nearby tissue. A deep puncture wound, such as an animal bite or a nail piercing through a shoe, can also provide a pathway for infection.
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.
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:
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:
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:
People who inject illegal drugs are more likely to develop osteomyelitis because they may use nonsterile needles and are less likely to sterilize their skin before injections.
Osteomyelitis complications may include:
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 help your risk of developing osteomyelitis.
In general, take precautions to avoid cuts, scrapes and animal scratches or bites, which give germs easy access to your body. If you or your child has a minor injury, clean the area immediately and apply a clean bandage. Check wounds frequently for signs of infection.
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. Tests may include:
Blood tests may reveal elevated levels of white blood cells and other factors that may indicate that your body is fighting an infection. If osteomyelitis is caused by an infection in the blood, tests may reveal which germs are to blame.
No blood test can tell your doctor whether you do or don't have osteomyelitis. However, blood tests can give clues to help your doctor decide what additional tests and procedures you may need.
A bone biopsy can reveal what 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.
The most common treatments for osteomyelitis are surgery to remove portions of bone that are infected or dead, followed by intravenous antibiotics given in the hospital.
Depending on the severity of the infection, osteomyelitis surgery may include one or more of the following procedures:
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.
A bone biopsy will reveal what type of germ is causing your infection so your doctor can choose an antibiotic that works well against that type of infection. The antibiotics are usually administered through a vein in your arm for about six weeks. An additional course of oral antibiotics may be needed for more-serious infections.
If you smoke, quitting smoking can help speed healing. It's also important to take steps to manage any chronic conditions you may have, such as keeping your blood sugar controlled if you have diabetes.
While you might first discuss your signs and symptoms with your family doctor, you may be referred to a doctor specializing in infectious diseases or to an orthopedic surgeon.
Here's some information to help you get ready for your appointment, and what to expect from your doctor.
For osteomyelitis, some basic questions to ask your doctor include:
Your doctor is likely to ask you a number of questions, such as:
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