# data[].attributes.body
Antibiotics

Intravenous - severe cases

Oral - minor cases

Surgical removing of infected tissue

Abscess draining

Pain management

# data[].attributes.attachment_link.description
Osteomyelitis is an inflammation or swelling of bone tissue that is usually the result of an infection.

# data[].attributes.body
Infections in the bloodstream

Weak immune system

Chronic Conditions (especially diabetes)

Open wounds or fractures

# data[].attributes.attachment_link.readable_text
Overview

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.

Products & Services

Symptoms

Signs and symptoms of osteomyelitis include:

Fever

Swelling, warmth and redness over the area of the infection

Pain in the area of the infection

Fatigue

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.

When to see a doctor

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.

Causes

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:

The bloodstream. Germs in other parts of your body - for example, in the lungs from pneumonia or in the bladder from a urinary tract infection - can travel through your bloodstream to a weakened spot in a bone.

Injuries. Severe puncture wounds can carry germs deep inside your body. If such an injury becomes infected, the germs can spread into a nearby bone. Germs can also enter the body if you have broken a bone so severely that part of it is sticking out through your skin.

Surgery. Direct contamination with germs can occur during surgeries to replace joints or repair fractures.

Risk factors

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:

Recent injury or orthopedic surgery

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.

Circulation disorders

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:

Poorly controlled diabetes

Peripheral artery disease, often related to smoking

Sickle cell disease

Problems requiring intravenous lines or catheters

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:

Dialysis machine tubing

Urinary catheters

Long-term intravenous tubing, sometimes called central lines

Conditions that impair the immune system

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:

Cancer treatment

Poorly controlled diabetes

Needing to take corticosteroids or drugs called tumor necrosis factor inhibitors

Illicit drugs

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.

Complications

Osteomyelitis complications may include:

Bone death (osteonecrosis). An infection in your bone can impede blood circulation within the bone, leading to bone death. Areas where bone has died need to be surgically removed for antibiotics to be effective.

Septic arthritis. Sometimes, infection within bones can spread into a nearby joint.

Impaired growth. Normal growth in bones or joints in children may be affected if osteomyelitis occurs in the softer areas, called growth plates, at either end of the long bones of the arms and legs.

Skin cancer. If your osteomyelitis has resulted in an open sore that is draining pus, the surrounding skin is at higher risk of developing squamous cell cancer.

Prevention

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.

# data[].attributes.attachment_link.description
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.

# data[].attributes.body
Swelling and redness at the infection site

Pain in the impacted bone

Limitations in range of motion

Fever and/or chills from the infection

# data[].attributes.attachment_link.readable_text
Definition

Osteomyelitis is a bone infection. It is mainly caused by bacteria or other germs.

Alternative Names

Bone infection

Causes

Bone infection is most often caused by bacteria. But it can also be caused by fungi or other germs. When a person has osteomyelitis:

Bacteria or other germs may spread to a bone from infected skin, muscles, or tendons next to the bone. This may occur under a skin sore.

The infection can start in another part of the body and spread to the bone through the blood.

The infection can also start after bone surgery. This is more likely if the surgery is done after an injury or if metal rods or plates are placed in the bone.

In children, the long bones of the arms or legs are most often involved. In adults, the feet, spine bones (vertebrae), and hips (pelvis) are most commonly affected.

Risk factors are:

Diabetes

Hemodialysis

Poor blood supply

Recent injury

Use of injected illicit drugs

Surgery involving bones

Weakened immune system

Symptoms

Symptoms of osteomyelitis are not specific and vary with age. Main symptoms include:

Bone pain

Excessive sweating

Fever and chills

General discomfort, uneasiness, or ill feeling (malaise)

Local swelling, redness, and warmth

Open wound that may show pus

Pain at the site of infection

Exams and Tests

The health care provider will examine you and ask about your symptoms. The exam may show bone tenderness and possible swelling and redness in the area around the bone.

Tests may include:

Blood cultures

Bone biopsy (the sample is cultured and examined under a microscope)

Bone scan

Bone x-ray

Complete blood count (CBC)

C-reactive protein (CRP)

Erythrocyte sedimentation rate (ESR)

MRI of the bone

Needle aspiration of the area of the affected bones

Treatment

The goal of treatment is to get rid of the infection and reduce damage to the bone and surrounding tissues.

Antibiotics are given to destroy the bacteria causing the infection:

You may receive more than one antibiotic at a time.

Antibiotics are taken for at least 4 to 6 weeks, often at home through an IV (intravenously, meaning through a vein).

Surgery may be needed to remove dead bone tissue if the above methods fail:

If there are metal plates near the infection, they may need to be removed.

The open space left by the removed bone tissue may be filled with bone graft or packing material. This promotes resolution of the infection.

Infection that occurs after joint replacement may require surgery. This is done to remove the replaced joint and infected tissue in the area. A new prosthesis may be implanted in the same operation. More often, doctors wait until the antibiotic course is finished and the infection has gone away.

If you have diabetes, it will need to be well controlled. If there are problems with blood supply to the infected area, such as the foot, surgery may be needed to improve blood flow in order to get rid of the infection.

Outlook (Prognosis)

With treatment, the outcome for acute osteomyelitis is often good.

The outlook is worse for those with long-term (chronic) osteomyelitis. Symptoms may come and go for years, even with surgery. Amputation may be needed, especially in people with diabetes or poor blood circulation.

The outlook for people with an infection of a prosthesis depends partly on:

The person's health

The type of infection

Whether the infected prosthesis can be safely removed

When to Contact a Medical Professional

Contact your provider if you:

Develop symptoms of osteomyelitis

Have osteomyelitis that continues even with treatment

References

Matteson EL, Osmon DR. Infections of bursae, joints, and bones. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 26th ed. Philadelphia, PA: Elsevier; 2020:chap 256.

Raukar NP, Zink BJ. Bone and joint infections. In: Walls RM, Hockberger RS, Gausche-Hill M, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 9th ed. Philadelphia, PA: Elsevier; 2018:chap 128.

Tande AJ, Steckelberg JM, Osmon DR, Berbari EF. Osteomyelitis. In: Bennett JE, Dolin R, Blaser MJ, eds. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. 9th ed. Philadelphia, PA: Elsevier; 2020:chap 104.

Version Info

Last reviewed on 3/10/2022

Jatin M. Vyas, MD, PhD, Associate Professor in Medicine, Harvard Medical School; Associate in Medicine, Division of Infectious Disease, Department of Medicine, Massachusetts General Hospital, Boston, MA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org). URAC's accreditation program is the first of its kind, requiring compliance with 53 standards of quality and accountability, verified by independent audit. A.D.A.M. is among the first to achieve this important distinction for online health information and services. Learn more about A.D.A.M.'s editorial process. A.D.A.M. is also a founding member of Hi-Ethics (www.hiethics.com) and subscribes to the principles of the Health on the Net Foundation (www.hon.ch).

The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. Copyright 2002 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.

# data[].attributes.attachment_link.title
Bone Infection (Osteomyelitis) - Symptoms and Causes

# data[].attributes.attachment_link.description
Bone Infection (Osteomyelitis) is a bone infection. It is mainly caused by bacteria or other germs.

# data[].attributes.body
Physical examination

Medical history particularly regarding chronic illnesses

X-ray, CT-scan, or MRI

Bione biopsy

# data[].attributes.attachment_link.readable_text
pain, swelling, redness and a warm sensation over an area of bone

a very high temperature (or you feel hot and shivery) and feel generally unwell

had osteomyelitis before and you think symptoms have come back

Take your child to a GP if:

they do not want to use an arm or leg and seem irritable - young children do not always get a high temperature with osteomyelitis

Osteomyelitis can permanently damage bones if it's not treated quickly.

# data[].attributes.attachment_link.description
pain, swelling, redness and a warm sensation over an area of bone a very high temperature (or you feel hot and shivery) and feel generally unwell had osteomyelitis before and you think symptoms have come back they do not want to use an arm or leg and seem irritable - young children do not always get a high temperature with osteomyelitis Osteomyelitis can permanently damage bones if it's not treated quickly.