Osteomyelitis

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What is osteomyelitis?

Osteomyelitis is an infection of the bone, caused by bacteria or fungi. Symptoms include bone pain, swelling, fever, aches and pains, and headache.

The infection may occur at areas near the bone where there was trauma, such as a skin ulcer, surgery, or other injuries. It can start at the bone and spread to surrounding areas, such as the skin, muscles or tendons. Having implanted devices such as a plate, rod or prosthesis can increase the risk of infection. Infections may also spread to the bone from the bloodstream, and the use of injected drugs is also a risk factor.

In children, the long bones of the arms and legs are most commonly involved. When the infection occurs in adults, the spine, hips and feet are most often involved.

The standard treatment for osteomyelitis is antibiotics, although surgery is sometimes performed to remove dead bone tissue. Complications of osteomyelitis include chronic osteomyelitis, spread of infection to the bloodstream (sepsis), reduced limb function and, in severe cases, amputation.

In some cases, osteomyelitis can be a serious condition that should be immediately evaluated in an emergency setting. Seek immediate medical care (call 911) if you, or someone you are with, have serious symptoms, including difficulty breathing, fainting, change in level of consciousness, lethargy, high fever, or symptoms of osteomyelitis that persist despite treatment.

What are the symptoms of osteomyelitis?

Symptoms of osteomyelitis include bone pain and swelling in areas affected by the infection. You may also feel as if you have the flu, with fever and general discomfort. For diabetic patients the classic signs and symptoms of infection may be masked due to vascular disease and neuropathy.

Common symptoms of osteomyelitis

  • The most common symptoms of osteomyelitis include:
  • Back pain
  • Bone pain at any affected site
  • Fatigue
  • Fever and chills
  • Malaise
  • Skin swelling and redness
  • Sweating
  • Swelling of the legs or feet
  • Warmth of skin over the affected area

Symptoms that might indicate a serious condition

In some cases, osteomyelitis can be a serious condition that should be immediately evaluated in an emergency setting. Osteomyelitis may spread to the bloodstream and lead to a widespread infection. Seek immediate medical care if you, or someone you are with, have any of these serious symptoms including:

  • Difficulty breathing
  • Fainting or change in level of consciousness or lethargy
  • High fever (higher than 101 degrees Fahrenheit)
  • Osteomyelitis symptoms that persist despite treatment

What causes osteomyelitis?

Osteomyelitis is a bone infection that can be caused by a number of different bacteria or fungi. It can originate from an injury, skin ulcer, surgery, or other trauma to the bone. Osteomyelitis sometimes begins as an infection in other areas of the body and spreads through the blood to the bone. The infection can also involve the areas surrounding the affected bone, such as the skin, muscles or tendons. Foreign objects near the bone, such as an implanted plate or rod, can also cause the infection.

People susceptible to osteomyelitis include those with diabetes and other problems that could restrict or compromise blood flow. Wounds, injuries, or other trauma to the bone can also make it vulnerable to infection.

What are the risk factors for osteomyelitis?

A number of factors increase your risk of developing osteomyelitis. Not all people with risk factors will get osteomyelitis. Risk factors for osteomyelitis include:

  • Diabetes (chronic disease that affects your body’s ability to use sugar for energy)

  • Foreign objects, such as surgically implanted plates or rods, in or near the bone

  • Hemodialysis

  • Immunosuppression from any cause

  • Injected drug use

  • Neuropathy

  • Peripheral artery disease (PAD, also called peripheral vascular disease, or PVD, which is a narrowing or blockage of arteries due to a buildup of fat and cholesterol on the artery walls, which limits blood flow to the extremities)

  • Poor circulation

  • Previous osteomyelitis

  • Recent orthopedic surgery

  • Recent trauma to bones

  • Sickle cell anemia

Reducing your risk of osteomyelitis

If you have diabetes, compromised immunity, or other risk factors for osteomyelitis, you should regularly visit your health care provider and inform him or her if you develop symptoms of osteomyelitis.

You may be able to lower your risk of osteomyelitis by:

  • Seeing your health care provider at the first signs of osteomyelitis

  • Visiting your health care provider regularly if you are at high risk

How is osteomyelitis treated?

Antibiotics are the standard treatment for osteomyelitis. They are given to treat the infection and minimize damage to the bone and tissues. Antibiotics may be administered orally or intravenously (through the vein), although they are usually given intravenously. It may be necessary for you to take more than one antibiotic, and treatment can last for up to six weeks.

Surgery designed to clean the area of infection and remove dead bone tissue is another treatment option. The tissue is extracted and replaced with bone graft or a synthetic packing material.

Artificial prostheses, such as an artificial hip, may become infected and require removal of the device and its surrounding tissue. A new one is then implanted. In rare and severe cases, amputation of a limb may be required to stop the spread of the infection.

Treatments for osteomyelitis

Depending on your health and the extent of the infection, your health care provider may prescribe one or more of the following treatments:

  • Antibiotics, which are usually administered intravenously
  • Removal or replacement of surgically implanted plates, pins or prostheses
  • Surgery to remove dead tissue

What are the potential complications of osteomyelitis?

Infections to the bone can result in a collection of pus, causing an abscess. The abscess can divert needed blood supply to the bone, producing a state of chronic osteomyelitis, which can go on indefinitely. Other complications are related to the loss of function of the affected sites or to the spread of the infection.

Complications of osteomyelitis can result from a failure of the infection to heal properly and include:

  • Adverse effects of osteomyelitis treatment
  • Amputation
  • Chronic osteomyelitis
  • Decreased limb or joint function
  • Disability
  • Spread of infection to surrounding tissues or the bloodstream
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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2021 Jan 11
  1. Osteomyelitis. Medline Plus, a service of the National Library of Medicine National Institutes of Health. http://www.nlm.nih.gov/medlineplus/ency/article/000437.htm
  2. Osteomyelitis. PubMed Health. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001473/
  3. Spellberg B, Lipsky BA. Systemic antibiotic therapy for chronic osteomyelitis in adults. Clin Infect Dis 2012; 54:393
  4. Bope ET, Kellerman RD (Eds.) Conn’s Current Therapy. Philadelphia: Saunders, 2013
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