An Overview of Osteomyelitis

Symptoms, Causes, Diagnosis, Treatment, and More

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Osteomyelitis is a rare type of bone infection. Most cases are caused by bacteria called Staphylococcus aureus. Certain diseases, such as diabetes, might increase a person’s risk for osteomyelitis. Affecting 2 out of every 10,000 people, both children and adults, osteomyelitis may cause pain and swelling in affected areas, fever and drainage, in addition to other symptoms.

If left untreated, this condition may become chronic and cause blood supply loss—this may eventually lead to the death of bone tissues.

Symptoms of osteomyelitis
Illustration by Emily Roberts, Verywell.

Symptoms

Since osteomyelitis is an infection, symptoms are similar to what you would see with other types of infections, including:

  • pain.
  • fever and chills.
  • redness and swelling in the affected area.
  • a general feeling of sickness.
  • lack of energy or fatigue.
  • irritability.
  • drainage or pus.
  • stiffness and inability to move the affected limb.

Causes

Osteomyelitis is either acute or chronic. When it is acute, it is the result of a new infection that develops over a shorter period of time. Acute osteomyelitis is more common in children, and usually occurs when a bacterial infection enters the bloodstream and then becomes established in bone tissue.

Chronic osteomyelitis tends to be related to an open injury near a bone, such as a bone fracture, allowing for bacteria to spread. This type of osteomyelitis is more common in adults and takes many months to develop. Chronic osteomyelitis may cause bone cells to die.

People at risk for osteomyelitis are those who have:

  • skin infections.
  • open wounds near a broken bone that breaks into skin.
  • puncture wounds through the skin.
  • recently had surgery.
  • diabetes.
  • poor blood circulation.

Some diseases that increase your risk may include those that lower the body’s ability to fight infections, including autoimmune diseases. Smoking may also increase a person’s risk for osteomyelitis.

Older adults and very young children have the highest risk for osteomyelitis because their immunities are easily compromised.

Diagnosis

Tests to diagnose osteomyelitis include blood tests, wound cultures, bone scans, and X-rays. Blood work will show signs of infection. Samples of drainage from the wound or affected bone may help determine the type of bacteria causing the infection. 

Plain X-rays and bone scans may also show signs of infection and reveal any damage to bones. Once diagnosed, treatment can begin.

Treatment

The infection is usually treated with antibiotics over a period of four to six weeks. Most of the time, antibiotics are given by IV (intravenously, meaning through a vein). After some time, antibiotic treatment is switched to pills or liquid. Chronic osteomyelitis may require surgery to remove any dead tissue or dead pieces of bone from the infected area. In some cases, bone may need to be surgically repaired. 

When chronic osteomyelitis is not responding to treatments or affects the spine, skull, or chest, hyperbaric oxygen treatment (HBOT) is considered. HBOT treatment involves putting the patient in a chamber that increases pressure throughout the body and allows the lungs to absorb pure oxygen. More oxygen in the blood and tissues will help the body to fight infection and heal quicker. 

Research shows HBOT is safe and effective for managing chronic osteomyelitis.

Complications

If left untreated or in very serious cases, osteomyelitis can lead to osteonecrosis (bone death). This usually happens when the infection impedes blood flow to the bone. Septic arthritis is another consequence of osteomyelitis causing infection to spread to nearby joints. 

Impaired growth in children may occur if osteomyelitis affects growth plates, especially at the end of the legs and arms.  

Open sores from osteomyelitis that need to be drained may increase the risk for a type of skin cancer called squamous cell cancer. This type of skin cancer affects more than one million people in the United States yearly and forms in the middle and outer layers of the skin.

Prevention

Prevention of osteomyelitis is possible and starts by avoiding wound and skin infections. Skin wounds should be cleaned well and covered with a clean and sterile bandage. If there are signs of infection, see your doctor as soon as possible. Immediate medical attention for deep wounds and bone injuries is vital.

People who have diseases that make it harder for them to fight off infection should talk to their doctors about the best ways to reduce their infection risk.

Tips for Preventing Osteomyelitis

  • Wash hands often
  • Make sure immunizations and vaccinations are up-to-date (including tetanus shots)
  • Don't smoke
  • Make healthy lifestyle choices (diet and exercise)

A Word From Verywell 

The outcome for people with acute osteomyelitis who receive prompt treatment is a positive one. People with chronic osteomyelitis may have worse outcomes if the condition is left untreated or worsens without appropriate treatment. It is a good idea to contact your doctor if you think you have symptoms of osteomyelitis or if you have been diagnosed and your symptoms continue despite treatment. People with weakened immune systems should work with their doctors to find the best ways to prevent risk of infection.

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