Osteomyelitis in Older People - Types, Causes, Symptoms, and Treatment

Introduction

Osteomyelitis is an infectious disease that causes bone swelling, leading to bone damage and bone loss. It is a very painful condition. Older adults are at increased risk for the disease because of associated disorders and various surgical procedures. However, it can affect all age groups. Osteomyelitis may be caused by both bacteria and fungi. In older people, pyogenic bacteria mainly cause osteomyelitis. Osteomyelitis causes inflammation in the soft tissue inside the bones or bone marrow. This swelling, if left untreated, may cut off the blood supply leading to the death of the bone.

What Are the Types of Osteomyelitis?

1. Acute: Acute osteomyelitis has a sudden onset. It involves the infection of the periosteum, cortex, and medullary cavity. Older adults with acute osteomyelitis may frequently fall, leading to trauma or bone injuries. The symptoms include pain and tenderness in the affected bone, fever, and chills. Acute osteomyelitis can be cured in 6 weeks.

2. Chronic: If the osteomyelitis is not treated within 6 weeks or if it recurs, then it can lead to chronic osteomyelitis. In older people, chronic osteomyelitis is common due to medical conditions such as diabetes mellitus and peripheral vascular disease. Different types of chronic osteomyelitis, such as sternal osteomyelitis, occur commonly after open heart surgery, and mandibular osteomyelitis results due to poor dental health or dental extraction.

3. Vertebral: This type of osteomyelitis is associated with prosthetic joint replacement. It is commonly caused by Staphylococcus aureus. Vertebral osteomyelitis may also occur rarely as a complication of disk space injections or spinal surgery.

What Are the Causes of Osteomyelitis in Older People?

The following are the causes of osteomyelitis in older people:

• Diabetes Mellitus: Uncontrolled diabetes is a common cause of osteomyelitis. Foot ulcers in diabetic patients may lead to osteomyelitis. If the bone is involved in the diabetic foot, then it may require amputation.

• Peripheral Vascular Disease: It is a medical condition in which the blood vessels outside the heart and brain become narrow or blocked. Elderly people with this disease have a high risk of developing peripheral gangrene and osteomyelitis. Poor blood circulation due to peripheral vascular disease may result in proliferation of bacteria in the bone leading to osteomyelitis.

• Malnutrition: Nutrition is an important factor for the recovery and strengthening of bones. It also promotes the growth of healthy tissues in bone. Hence, poor nutrition is considered a risk factor for osteomyelitis.

• Poor Dental Health: Poor dental health or periodontitis can increase the risk of mandibular osteomyelitis. In older people, the periapical abscess is common, which when extended, can also result in osteomyelitis in the mandible. Swelling and tenderness in the jaw, regional adenopathy, and fever are the common symptoms of mandibular osteomyelitis.

• Open Heart Surgery: In rare cases, an open heart surgery can cause the infestation of Escherichia coli bacteria in the sternum. Their proliferation in the sternum may lead to sternal osteomyelitis. Sternal osteomyelitis can be prevented with proper antibiotic prophylaxis and careful aseptic technique before heart surgery.

• Joint Replacement: After total knee replacement or hip replacement surgeries, older adults are at higher risk for developing osteomyelitis. Prosthetic joints are more prone to infections than natural joints.

• Pressure Ulcers: Pressure ulcers or decubitus ulcers are common in bedridden patients. When the pressure ulcers last for a long time, the underlying bony prominence becomes visible, which can result in osteomyelitis.

What Are the Clinical Manifestations of Osteomyelitis in Older People?

The clinical manifestations of osteomyelitis vary from person to person based on the type and cause. Following are some of the common signs and symptoms associated with osteomyelitis:

• Redness, warmth, and swelling over the area of infection.

• Pain while moving.

• Fever.

• Tiredness.

• Loss of appetite.

• Lower back pain.

• Nausea and vomiting.

• Sweating or chills.

How Is Osteomyelitis Diagnosed?

The doctor will examine the infected area to look for signs of inflammation. Following tests alone or in combination are advised for the proper diagnosis of osteomyelitis:

1. Blood Test: Blood tests are advised to check the levels of white blood cells. If their levels are higher than normal, it may indicate an infection. Blood culture will detect the presence of bacteria that causes the infection.

2. Imaging Tests: X-rays, MRIs (magnetic resource imaging), and CT (computed tomography) scans are used to view the bone, muscles, and tissues which are involved in osteomyelitis.

3. Bone Biopsy: It is done to detect the type of microbe that caused the bone infection. In an open biopsy procedure, anesthesia is provided to the patient, and minor surgery must be performed to access the bone. In other cases, a long needle is inserted into the skin and the bone to take a biopsy.

What Is the Treatment of Osteomyelitis in Older People?

Osteomyelitis is treated after identifying the causative factor in older people. They get affected by various types of osteomyelitis, and their treatment modalities differ in certain ways.

1. Vertebral Osteomyelitis: It is mainly associated with prosthetic joint replacement and is caused by Staphylococcus aureus. Oral antibiotics are prescribed for 4 to 6 weeks.

2. Sternal Osteomyelitis: It occurs as a complication of open heart surgery. The treatment of sternal osteomyelitis involves surgery with antimicrobial therapy. Surgical debridement is done at the affected part of the sternum.

3. Mandibular Osteomyelitis: It occurs commonly in older patients due to periodontitis or after tooth extraction. Removal of the affected tooth along with its root and debridement of the affected part of the mandible is the treatment.

4. Osteomyelitis Due to Pressure Ulcers: Pressure ulcers commonly occur in the sacral part, which can result in sacral osteomyelitis. Antibiotics, along with bone debridement, are the treatment for sacral osteomyelitis. In the areas of soft tissue deficits, plastic surgery flaps are used to cover them.

What Are the Complications of Osteomyelitis in Older People?

If left untreated, osteomyelitis in older people can result in:

• Abscess: Abscess is a collection of pus or infectious fluids. In osteomyelitis, it occurs when the infection spreads to muscles and soft tissues.

• Bone Death: Severe osteomyelitis may cut off the blood supply to the bone, resulting in bone death or osteonecrosis.

• Squamous Cell Carcinoma: It is a type of cancer that affects the outermost middle layer of the skin. Patients with chronic osteomyelitis due to diabetes mellitus may develop squamous cell carcinoma as a complication.

• Cellulitis: It is a disease that causes infection of the skin and underlying soft tissues. It can occur as a result of long-term osteomyelitis.

Conclusion

Osteomyelitis is a painful condition that affects the bone. It is common in older people due to various diseases, medications, and other causes. The affected person usually experiences fever, pain, swelling in the affected area, loss of appetite, difficulty moving, and so on. In most cases, antibiotic therapy is provided, while in some cases, surgery is required. If not treated, it can result in complications like bone death, abscess, cellulitis, etc. However, early diagnosis and proper treatment can prevent complications and return the patient to a healthy life.