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Osteomyelitis Symptoms, Diagnosis, and Treatment

Osteomyelitis is an infection of the bone. It's a rare disease, but it can be serious.

It can occur when bacteria (or less commonly, fungi) enter the body through a wound, surgery, or diabetic foot ulcers.

Doctors treat osteomyelitis with antibiotics and sometimes surgery.

Call the UPMC Center for Care of Infectious Diseases to learn more or make an appointment at 412-647-7228 or 1-877-788-7228.

What Is Osteomyelitis?

Osteomyelitis is a painful bone infection. The National Organization for Rare Disorders estimates that two to five per 10,000 people in the U.S. get osteomyelitis each year.

Osteomyelitis affects men and women equally and can occur at any age, but often happens in:

  • Preschool-age children.
  • The elderly.
  • People with diabetes.

Osteomyelitis can be acute (comes on quickly) or chronic (long-term).

In kids, it's mostly acute. In adults, it can be acute or chronic.

People with diabetes, chronic vascular disease, or a weakened immune system are more likely to have chronic osteomyelitis.

In children, osteomyelitis usually occurs in the long bones of the arms or legs. In adults, it's most often in the spine, feet, or hips.

Osteomyelitis causes

Osteomyelitis forms when an infection from bacteria or fungi spreads to the bone. Most often, the cause is a staph infection. These germs live on the skin of even healthy people.

Bacteria can enter the bone through:

  • Injuries. A traumatic injury (such as a puncture wound) may let germs travel deep into the body.
  • IV lines or catheters. Medical tubing can be a pathway for germs to enter your body through the blood and, in time, cause a bone infection.
  • Surgery. There's a chance of infection with joint replacement surgery or any other surgery that involves bones or joints.
  • The bloodstream. Germs can sometimes travel through the blood from a place of infection to a weak or compromised part of the bone.

Osteomyelitis risk factors and complications

You're at greater risk for osteomyelitis if you:

  • Have diabetes, especially if it causes foot ulcers.
  • Inject illicit drugs.
  • Are having dialysis for chronic kidney failure.
  • Have had a recent traumatic bone or joint injury.
  • Have had bone or joint surgery (such as a hip replacement).
  • Have a weakened immune system.
  • Have pressure injuries (bedsores).

If left untreated, complications from osteomyelitis include:

  • Bone fractures. The infection weakens the bone, making it more prone to fractures.
  • Bone death. If the infection stops blood flow in the bone, the bone will wear down and finally collapse. You'll then need surgery to remove those parts of the bone.
  • Septic arthritis. The infection can spread from the bone into an adjacent joint. This causes an infected joint that's painful, swollen, and warm to the touch.
  • Skin cancer. Untreated osteomyelitis can, in rare cases, lead to squamous cell carcinoma, a type of skin cancer.

How to prevent osteomyelitis

While you can't always prevent this bone infection, you can take steps to lower your risk.

  • Clean any wound thoroughly. Bacteria enter the body through open wounds. Flush any open wound with water for five minutes before bandaging and see a doctor for severe wounds.
  • If you have diabetes, work to keep it under control. Pay careful attention to your feet and call your doctor at the first sign of infection.

Osteomyelitis Symptoms and Diagnosis

Call your doctor if you have any of these symptoms:

  • Bone pain without any clear cause.
  • Fever and chills.
  • Swelling, redness, or warmth of a joint.
  • An open wound that's draining pus.
  • New, refractory, or worsening back pain.
  • Ulcers with visible bone present.

Diagnosing osteomyelitis

To diagnose osteomyelitis, your doctor will:

  • Ask about your symptoms and medical history.
  • Do a physical exam, focusing on bone tenderness or swelling.
  • Ask about any recent medical procedures, chronic diseases, and any history of illicit drug use.

You may need tests such as:

  • A complete blood count (CBC) to check for signs of inflammation and infection.
  • Blood cultures to look at organisms in the blood that might be causing infection.
  • A bone biopsy to take samples of involved bone or tissue that may show signs of infection.
  • Imaging scans to show pictures of your bones, tissues, and muscles.
  • A bone scan to learn the cause of bone pain or swelling.

Osteomyelitis Treatment

The doctors at UPMC Center for Care of Infectious Diseases are experts at treating acute and chronic osteomyelitis. Their goal is to get rid of the infection and reduce damage to your bones and surrounding areas.

Treatments may include:

  • Antibiotics. You'll likely need at least four to six weeks of antibiotics to kill the bacteria that caused the bone infection. Based on your condition, you may need to continue taking them for weeks or months.
  • Antifungals. If fungi caused your osteomyelitis, your doctor will give you either oral or IV antifungal drugs. You may need to take this medicine for several weeks to months.
  • Nonsteroidal anti-inflammatory drugs (NSAIDs). Your doctor may give you NSAIDs to help with pain and inflammation as needed.
  • Needle aspiration. If you have an abscess, your doctor may drain the pus with a fine needle.
  • Surgery. Often, you may need surgery to help control your osteomyelitis. Surgery prevents the infection from spreading further and decreases the chance of amputation.

Early treatment of osteomyelitis can keep it from becoming a chronic condition. Be sure to tell your doctor about any symptoms of bone infection.

Contact the UPMC Center for Care of Infectious Diseases

To learn more about the UPMC Center for Care of Infectious Diseases or to make an appointment, call 412-647-7228 or 1-877-788-7228.