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Osteomyelitis - Types, Causes, Symptoms, and Treatment

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Osteomyelitis - Types, Causes, Symptoms, and Treatment

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Osteomyelitis is an infection of the bone due to bacteria or fungi, leading to a painful swelling of the bone marrow. Read the following article to know more.

Written by

Dr. Geethika. B

Medically reviewed by

Dr. Suman Saurabh

Published At July 18, 2022
Reviewed AtMay 22, 2024

What Is Osteomyelitis?

Bacteria and fungi travel through the bloodstream or from adjacent tissues, infecting the bone and causing osteomyelitis. In some cases, where the bone is exposed to microorganisms due to an injury, the infection can begin in the bone itself.

Initially, osteomyelitis was thought to be incurable. However, through recent developments, osteomyelitis can be treated successfully. The majority of the patients require surgery to remove the dead bone associated with osteomyelitis. The surgery is followed by intravenous administration of antibiotics.

Who Is More Prone to Develop Osteomyelitis?

Osteomyelitis shows equal predilection among all age groups and genders. The population that is at the highest risk of developing osteomyelitis are those who smoke, infants and elderly, and chronically ill patients, like those with diabetes or kidney failure. Diabetic patients often develop osteomyelitis through the non-healing foot ulcers that they may develop. The condition more commonly affects long bones in children and the spine in adults.

Other people associated with a risk for osteomyelitis are:

  • People with prosthetic joints, like those who have undergone a hip replacement and those with metal implants.

  • Those with infections of the blood or hematological conditions like sickle cell anemia.

  • Those with pressure injuries like bedsores.

  • Those who had recent trauma and an associated fracture or surgery.

  • Those with weakened immune systems.

What Are the Types of Osteomyelitis?

The different types of osteomyelitis include:

  • Acute Osteomyelitis: The onset of this form is sudden and may be associated with fever and pain that develops in the infected region a few days later.

  • Chronic Osteomyelitis: The symptoms of chronic osteomyelitis do not recede easily with treatment. The patient presents with chronic bone pain and recurring drainage of pus. In rare circumstances, a patient with chronic osteomyelitis does not show symptoms where the infection cannot be undetected for months or even years.

  • Vertebral Osteomyelitis: This particular type of osteomyelitis affects the spine, causing chronic back pain that gets worse with movement. This condition mostly develops in people who have the habit of drug abuse and those on dialysis.

What Are the Causes of Osteomyelitis?

Osteomyelitis occurs when bacteria from an infected tissue or an open wound enter the blood circulation and reach and multiply in the bone. The most commonly associated bacteria with osteomyelitis is Staphylococcus aureus. Other organisms like fungi or other microorganisms causing a bone infection may be associated as well.

What Are the Symptoms of Osteomyelitis?

The symptoms and signs of osteomyelitis vary from person to person, depending on the type of presentation and the causative agent. Few patients do not show any signs or symptoms. Patients can present with symptoms of pain, redness, warmth, inflammation, and tenderness to touch.

Other signs of osteomyelitis include:

  • Drainage of yellow-colored pus.

  • Irritability or lethargy.

  • Fever.

  • Loss of appetite.

  • Nausea and vomiting.

  • Limited and painful movement.

  • Sweating or chills.

  • Lower back pain.

How Is Osteomyelitis Diagnosed?

Once the symptoms are assessed and the physical examination is performed, the diagnosis is made with the help of the following tests:

  • Blood Tests: Blood tests like complete blood count (CBC) and blood culture are performed. A CBC detects signs of inflammation and infection, like erythrocyte sedimentation rate (ESR) and the count of different blood cells. A blood culture aims to detect a particular species of bacteria in the bloodstream.

  • Radiographic Tests: Different radiographic modalities may be used. The bone generally shows an inflamed bone marrow area with a combination of dead and newly formed bone, giving rise to a typical “onion peel appearance.”

  • Biopsy: A needle biopsy can be used to obtain samples of the infected tissue, bone, or fluid to confirm the diagnosis further.

What Are the Complications of Osteomyelitis?

Complications associated with osteomyelitis can include:

  • Formation of Abscess: In people with chronic osteomyelitis, the infection can spread from the bones to muscles and soft tissue, leading to the formation of an abscess. People with chronic osteomyelitis are more likely to have recurring abscesses. Treatment to drain these abscesses may slightly increase the risk of skin cancer.

  • Death of Bone: The inflammation associated with the infection reduces the blood supply to the bone, leading to the death of bone tissues.

  • Stunted Growth: If osteomyelitis occurs in the long bones of children, it can lead to stunting of growth.

What Is the Treatment of Osteomyelitis?

Treatment options include:

  • Antibiotics: Antibiotic therapy destroys the bacteria that cause osteomyelitis. The medications need to be taken for four to eight weeks, and in the case of intravenous (IV) antibiotics, they might need to be taken for one to two weeks. Depending on the severity of the disease, the treatment duration is deduced. Chronic infections may require treatment for weeks, if not months.

  • Antifungals: If the infection has a fungal etiology, then the patient might be required to take antifungal medication over a few days or months to cure the condition.

  • Needle Aspiration: A needle aspiration may be prescribed to drain the infectious fluid or pus from the abscess.

  • Analgesics: Pain relievers, like nonsteroidal anti-inflammatory drugs (NSAIDs), may be prescribed to treat the pain and inflammation.

Surgery is considered in advanced cases when medications do not work.

The surgical treatments are:

  • Bone Surgery: During this process, the dead bone is removed, but it may result in the formation of bone deformities.

  • Spine Surgery: Patients with osteomyelitis of the spine may require surgery of the spine. This surgery protects the spinal cord by preventing the vertebral bones from damage and collapsing, thereby protecting the nerves as well.

Some risk factors are:

  • Recent injury and orthopedic surgery.

  • Issues with circulation.

  • Problems with catheters.

  • A condition that affects the immune system.

  • Illegal drugs.

How Can Osteomyelitis Be Prevented?

If the person has a higher risk of osteomyelitis, they should consult the doctor to know the preventive method. Reducing the risk of infection can also help to reduce the risk of osteomyelitis. Prevention of cuts, scratches, or bites needs to be taken, which provides easy access to the germs. If any minor injury occurs, it needs to be cleaned immediately.

The prognosis of osteomyelitis is good. However, in case of new trauma, the condition can recur years after successful treatment.


In osteomyelitis, the organism can infect the tissues due to an injury, frequent injections, surgery, or the use of a prosthesis. The infection of bone due to osteomyelitis can take a long time to heal. However, if the symptoms are noticed early and the treatment is commenced, the symptoms recede much earlier. The prognosis of the disease is good, with early treatment as well. Chronic osteomyelitis and untreated osteomyelitis have the ability to damage muscles, bones, and tissues permanently. The majority of patients with osteomyelitis recover on prompt treatment.

Frequently Asked Questions


Is Osteomyelitis Life-Threatening?

Osteomyelitis is a severe bone infection. Proper diagnosis and treatment with antibiotics are essential in preventing the following complications:
- Sepsis.
- Abscess.
- Recurrent infections.
- Poor wound healing, etc.


What Causes Osteomyelitis?

The following factors can cause osteomyelitis:
- Bacterial infection mainly by Staphylococcus aureus.
- Bacterial contamination through surgery or injuries may also cause osteomyelitis.
- Fungi or other microorganisms.


Who Is at Risk of Osteomyelitis?

The risk of osteomyelitis is high in individuals with:
- Poor immune system.
- Illegal drugs.
- Uncontrolled diabetes.
- Sickle cell disease.
- Those who use catheters or dialysis machines.


How to Treat Osteomyelitis?

The management of osteomyelitis is as follows:
- Medications - The doctor may suggest antibiotics, antifungals, and analgesics based on the causative factor.
- Surgical treatment mainly focuses on removing the dead bone tissue and restoring the blood flow.


What Happens if Osteomyelitis Is Left Untreated?

Osteomyelitis may lead to the following complications if left untreated:
- Necrosis (death) of bone.
- Joint infection (septic arthritis).
- Restricted growth.
- Chronic infection.
- Cellulitis.
- Abscess.


What Are the Features of Osteomyelitis Pain?

The characteristics of osteomyelitis pain may differ from one to another based on their age. However, most commonly, the pain is accompanied by:
- Swelling.
- Redness.
- Warmth over the area of infection.
- The pain is intense and sharp in the infected bone.


Can Osteomyelitis Be Cured Without Surgery?

The main treatment option for osteomyelitis is surgery. However, if the osteomyelitis is less severe or acute, the doctor may suggest antibiotics to treat it. The antibiotics are chosen based on the type of infection (bacterial or fungal). In addition, the chances of recurrence are high without surgery. Therefore, combining surgery and antibiotic treatment is crucial in managing osteomyelitis.


Can Osteomyelitis Lead to Sepsis?

If osteomyelitis is not treated at the earliest, the infection from the affected bone may spread to the blood and cause sepsis. The risk factors include:
- Poor immunity.
- Hospitalized individuals.
- Chronic medical condition.
- Overaged.


Is Osteomyelitis Very Painful?

Yes, osteomyelitis may cause severe pain, as the bone marrow is infected due to bacteria or other microorganisms. In addition, the bone pain is significantly more intense and sharp than others. However, the doctor may suggest antibiotics and analgesics to overcome such pain. The decrease in infection with antibiotics helps in pain relief. In cases of increased pain, the specialist may plan surgery to remove the dead bone tissue, thus improving the blood flow.


What Is the Best Antibiotic for Osteomyelitis?

Initially, the doctor may suggest antibiotics to treat osteomyelitis, which significantly helps reduce the severity of infection. The most preferred antibiotics for osteomyelitis are:
- Vancomycin.
- Linezolid.
- Daptomycin.
- Cefepime and Ciprofloxacin.
- Tazobactam and Ciprofloxacin.


Is the Brain Affected by Osteomyelitis?

Osteomyelitis or bone infection may cause severe pain, redness, swelling, and warmth over the affected bone. The tibia and fibula are more commonly affected by it; rarely, the base of the skull is also affected. For which head trauma and sinusitis remain to be the cause. Due to osteomyelitis of the skull base, pus may accumulate within the brain causing brain abscess. It may lead to severe complications if unattended.


How Fast Can Osteomyelitis Spread?

Osteomyelitis can spread fast to surrounding tissue, that is, within seven to ten days. Therefore, it can spread quickly to cause the following complications:
- Abscess.
- Sepsis.
- Cellulitis.
- Squamous cell carcinoma of the skin.


Why Does Osteomyelitis Pain Become Worse at Night?

Most patients may complain of increasing bone pain during the night due to osteomyelitis because the body's anti-inflammatory response is low during the night. In addition, the level of cortisol also reduces, causing decreasing healing; thus, the bone pain elevates. In such cases, the specialist may suggest:
- Antibiotics such as Vancomycin, Linezolid, etc.
- Analgesics to reduce the pain.


Does Osteomyelitis Lead to Amputation?

The prognosis for chronic osteomyelitis is poor so the doctor may suggest amputation in high-risk patients such as:
- Individuals with a history of diabetes.
- Impaired blood circulation.
- Non-healing leg ulcers.
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Dr. Suman Saurabh
Dr. Suman Saurabh

Orthopedician and Traumatology


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