What Is Bone Tuberculosis?

Published on February 27, 2023

Medically reviewed by Anju Goel, MD, MPH

While tuberculosis (TB) usually affects the lungs, it can attack any part of the body, including the bones. When TB occurs outside the lungs, it is called extrapulmonary tuberculosis.

Bone tuberculosis, or osteoarticular tuberculosis, is a type of extrapulmonary TB. Most often, bone TB affects the spine, but it can also spread to other bones and joints.

This article discusses bone tuberculosis, its symptoms, causes, how it's diagnosed, and treatment options.

A healthcare provider discussing the spine with an older man. — ADAM GAULT/SPL / Getty Images

Incidence of Extrapulmonary TB

Extrapulmonary tuberculosis (TB affecting areas of the body other than the lungs) accounts for about 20% of all TB cases.

Bone Tuberculosis Symptoms

Bone tuberculosis typically affects joints in the spine. Only 2% to 3% of cases occur in other joints—most often the hips and knees.

Symptoms of joint and bone tuberculosis typically include:

Joint pain
Deformities
Loss of muscle mass
Decreased range of motion
Swelling
Enlarged lymph nodes
Cold abscesses (collection of pus that occurs with TB)
Ulcers

Up to one-third of people with bone tuberculosis will also have classic symptoms of TB, such as:

Low-grade fever (occurring in the evenings)
Weight loss
Loss of appetite

Causes

Tuberculosis is caused by the bacterium Mycobacterium tuberculosis. This bacterium enters the air when an infected person speaks, coughs, or sings and is breathed in by another person.

Once the bacterium is in the lungs, it can grow and spread to other areas of the body through the bloodstream. However, tuberculosis that settles in places other than the lungs is not typically infectious.

Causes and Risk Factors of Tuberculosis

Diagnosis

The first step in diagnosing bone tuberculosis is to test for the presence of bacterium in the body. This can be done with a skin test and blood tests.

The Mantoux tuberculin skin test involves injecting a small amount of tuberculin underneath the skin (typically on the forearm). After 48 to 72 hours, the area is examined. If the skin presents with a raised, hard bump a healthcare provider measures the bump in millimeters (mm). A provider considers the size of the bump and the individual's risk factors when determining whether the person had a positive reaction.

Blood tests can also be performed to identify an immune response to TB bacteria in the blood. Bone tuberculosis, specifically, is diagnosed through biopsies and cultures of pus samples and tissue from the affected bone or joint.

Imaging tests, such as X-rays and magnetic resonance imaging (MRI), are also used to determine the extent of damage to the affected bone and/or joint.

How Tuberculosis (TB) Is Diagnosed

Latent Tuberculosis

People can be infected with the bacterium that causes tuberculosis without being sick or contagious. This condition is called latent tuberculosis. Approximately 25% of the world's population has latent tuberculosis, with 5% to 10% becoming sick at some point. People with human immunodeficiency virus (HIV) or other immune system diseases are more likely to develop active symptoms.

Treatment

Treatment of bone tuberculosis includes medication to treat the infection and sometimes surgery, depending on the amount of damage that has occurred to the bones or joints.

Medications

Tuberculosis is treated with antibiotics, but the specific drugs used depend on the particular type of bacteria present—some strains of bacteria that cause TB are resistant to certain antibiotics. Drug susceptibility testing is performed to determine the correct course of treatment.

Medication treatment of bone TB follows a specific frequency and dosage schedule that typically lasts six to 12 months, depending on the drugs used.

Drugs used in a nine- or 12-month RIPE treatment plan (named after the initials of the medications) include:

Rifampin
Isoniazid
Pyrazinamide
Ethambutol

Other Treatments

Bone damage and infection from TB can require surgery in addition to medication. Procedures can include:

Debridement: Surgical removal of dead, damaged, or infected bone
Bone grafting: Bone taken from another part of the body and placed in the damaged area
Internal fixation: Use of screws and/or plates to stabilize bones

Restoring Function After Surgery

Bone tuberculosis can lead to significant joint damage, causing decreased range of motion and significant pain. After surgery, you might require physical and/or occupational therapy to help regain lost function due to damage caused by the infection.

Prognosis

Mycobacterium tuberculosis is the leading cause of death by infection worldwide. Early detection is more likely to lead to a positive prognosis, while delays in diagnosis increase the chances that the infection will spread.

According to the World Health Organization (WHO), in 2020, approximately 10 million people became sick from tuberculosis worldwide. Of this population, 1.5 million people died from the disease.

Summary

Tuberculosis is an infectious disease that usually affects the lungs. However, it can also spread to other parts of the body, including the bones. This condition, called extrapulmonary tuberculosis, can lead to pain, decreased range of motion, loss of muscle mass, and joint deformities.

Bone tuberculosis is treated with medication and sometimes surgery, depending on the extent of bone damage.

13 Sources

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

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By Aubrey Bailey, PT, DPT, CHT
Aubrey Bailey is a physical therapist and professor of anatomy and physiology with over a decade of experience providing in-person and online education for medical personnel and the general public, specializing in the areas of orthopedic injury, neurologic diseases, developmental disorders, and healthy living.

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