What is osteomyelitis? 

Osteomyelitis is a rare infection that occurs in the bone after the bone has become exposed to germs. The infection can occur from within the bone or through the bloodstream from surrounding tissue. Swelling and inflammation result in the bone from the infection. While some cases of osteomyelitis resolve and do not return, some people may develop chronic osteomyelitis that causes more frequent recurrences of the infection. 

Osteomyelitis has many causes and several risk factors that can increase a person’s chance of developing the condition. The infection most commonly occurs in the spine, legs, or arm and can be treated effectively with prompt medical attention and a strict antibiotic regimen and monitoring. Both children and adults can develop a bone infection, but children tend to develop osteomyelitis in their legs and arms through a bacterial bloodstream infection while adults tend to develop the infection in their spinal column. 

What causes osteomyelitis?

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The direct cause of osteomyelitis is bacteria, fungi, or other germs that enter or develop in your body and spread to the bone. Staphylococcus bacteria is the most common trigger of osteomyelitis. This type of bacteria often appears on the skin but does not cause problems unless the bacteria festers in your body’s system. In addition to bacteria, fungal spores or harmful germs may also find a way into your system and cause infection. 

Outside contaminants that cause osteomyelitis enter the bones mainly through the bloodstream, an injury, or through surgical procedures. 

Bloodstream: People who have active or recent infections in other parts of their body, such as pneumonia or a urinary tract infection, may develop osteomyelitis if the infection spreads beyond the affected area and into the bloodstream. Infection can enter the bones through weaker points and can overwhelm the immune system, preventing an effective response to the infection. 

Injury: Injuries that leave a bone exposed or that create deep wounds can expose the bones to infection. If severe injuries are not sufficiently disinfected or dressed, those wounds become susceptible to being a host for harmful germs that can easily spread throughout your system. Moreover, injuries that result in a bone fracture or break leave those bones especially vulnerable to infection. 

Surgery: Surgeries that involve replacing joints, repairing bone fractures, or installing prosthetics, like screws or plates, have the potential of introducing bacteria or fungi to your body if not properly sterilized.

What are the symptoms of osteomyelitis?

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The symptoms of osteomyelitis can be hard to distinguish from more generalized symptoms of illness, so it is important to keep track of your symptoms and consult your doctor for a potential osteomyelitis diagnosis. 

The most common symptoms and signs of osteomyelitis are the following: 

  • Fatigue or a feeling of illness
  • Tenderness or pain the in area of infection
  • Redness, swelling, or warmth around the infected area
  • Fever 
  • A stiff back or a new limp 
  • Difficulty moving joints, bearing weight, or walked on affected joints
  • Irritability in infants 

Depending on the severity of the osteomyelitis, you may experience many of these symptoms or no symptoms at all. It can be challenging to identify osteomyelitis from its symptoms given their similarity to other conditions and infections. Also, symptoms may appear rapidly or develop over a slow onset.

Are there any risk factors or groups for osteomyelitis?

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There are key risk factors and risk groups that make a person more likely to develop osteomyelitis. Having a higher risk does not mean that a person will develop an infection. However, a person can lower their risk by avoiding certain factors and activities. 

Risk Factors

  • Smoking: Smoking can weaken a person’s immune and circulatory systems and allow infections to start and spread in the body. 
  • Using illicit drugs: People who take illicit drugs through intravenous injection put themselves at a higher risk of infection because of unsterilized needles. 
  • Sustaining a severe bone fracture, break, or deep wound: Severe injuries can welcome outside infection that can easily spread in the body and reach the bones. 

Risk Groups 

  • Age: As you age, your chances of osteomyelitis increase since your bone density and strength lessen over time, making your bones more susceptible to infection. 
  • Circulation disorders: Poor circulation slows your body’s response to infection and makes the body take longer to heal wounds and other forms of damage, leaving a person more likely to develop infections and have the infection spread.  
  • Weakened immune systems: Having a weakened immune system makes a person more likely to develop osteomyelitis because the body cannot effectively respond to the infection. 

How is osteomyelitis diagnosed?

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An osteomyelitis diagnosis attempts to identify the presence of an infection and pinpoint the cause of the infection. To confirm a diagnosis, your doctor will use a combination of physical examinations and tests. 

During a physical examination, your doctor will inspect the affected area and feel the surface of the impacted area to look for signs of infection, swelling, or tenderness. In addition to a physical examination, blood tests can help detect elevated white blood cell counts to confirm the presence of an infection as well as identifying what germs are causing the infection.  

Often, blood tests and physical examinations are not enough to confirm an osteomyelitis diagnosis. Your doctor may order imaging tests like x-rays, MRIs, or CT scans to assess potential damage to the bones and surrounding tissue. Finally, your doctor may conduct a bone biopsy to confirm what is causing the infection to be able to prescribe the right antibiotic treatment. Most bone biopsies require anesthesia to collect a sample from the bone.

How is osteomyelitis treated?

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A person’s specific treatment plan for osteomyelitis depends on that person’s conditions, their risk factors, and the extent of the damage from the infection. All treatment plans are meant to treat the infection and prevent future issues of the infection. The two main treatment options are medicine and surgery. 

Medications: Most cases of osteomyelitis are treated with a rigorous course of antibiotics administered intravenously in an outpatient setting for several weeks. The antibiotics tend to be more aggressive to ensure the infection gets resolved and stays away.  

Surgery: Surgery attempts to remove portions of affected bone or tissue that had been infected or have died. If the infection has caused a buildup of fluid, surgery will drain the area of pus or fluid. In some cases, your surgeon may perform a bone or tissue graft to replace the lost bone or tissue with healthy bone and tissue from another part of your body.

Should you see a doctor for osteomyelitis?

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You should see a doctor if you begin to notice signs of an infection or fever associated with pain in your bones. The best way to treat osteomyelitis is with early intervention and a strong course of antibiotics. People who are at a higher risk of developing osteomyelitis should pay close attention to their symptoms and communicate with their doctor if they notice new or worsening symptoms of osteomyelitis. You should also see a doctor if a previous case of osteomyelitis persists after treatment.

What is the outlook for people living with osteomyelitis?

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Most people with osteomyelitis make a full recovery with prompt treatment, so the outlook is generally positive. People who have one-time, acute cases of osteomyelitis may not develop the condition again with the right preventative measures. However, some people do develop chronic osteomyelitis that makes the prognosis more complicated. 

A person’s individual outlook depends on their overall health and lifestyle. If left untreated, osteomyelitis can lead to extensive bone and tissue damage that may require more intensive treatment, including amputation. Bone infections take time to heal as well as diligent adherence to a treatment schedule to ensure the infection is removed. People may deal with lingering symptoms of the infection for a while after treatment. 

What are the complications of osteomyelitis?

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Certain complications of osteomyelitis are possible after an infection, including: 

Skin cancer: A person may develop or may become more likely to develop skin cancer resulting from abscesses in the skin. Abscesses form when the infection spreads to the surrounding soft tissue, creating pus-filled pockets in the skin. As these abscesses drain, they can create open sores that make the skin more vulnerable to cancer. 

Bone death: Osteomyelitis can restrict blood flow to the bone, causing the bone to die. In some cases, the impacted limb needs to be amputated to remove all the dead bone. Less serious cases may require targeted surgery to remove dead bone to restore proper blood flow to the area. 

Impaired or stunted growth: Stunted growth is a primary concern of cases of osteomyelitis in babies or young children. If the infection occurs on a growth plate, the child’s impacted bone may not be able to grow properly. 

Can you prevent osteomyelitis?

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The best way to prevent osteomyelitis infections is to take extra caution in cleaning and tending to wounds to prevent any dangerous germs from entering your system and possibly causing an infection. If you use a prosthesis, be sure to thoroughly clean and dry amputation sites to avoid infection. You can also reduce your risk by not smoking and taking protective measures to avoid injury.