Osteomyelitis (Bone Infection)

What is osteomyelitis?

Osteomyelitis is a bone infection. It happens when a bacterial infection or a fungal infection spreads to your bones.

Osteomyelitis causes painful swelling in your bone marrow. It can affect any of your bones. Kids with osteomyelitis most commonly have it in their leg or arm bones. Adults usually develop it in their vertebrae (the bones that make up your spine) or hips.

If it’s not treated in time, osteomyelitis can cause permanent bone loss and necrosis (tissue death).

Types of osteomyelitis

There are a few types of osteomyelitis:

• Acute osteomyelitis: A bone infection that happens after an infection spreads to your bones. Acute osteomyelitis is the most common type.
• Vertebral osteomyelitis: Osteomyelitis that infects the vertebrae in your spine.
• Chronic osteomyelitis: Bone infections that aren’t completely cured after treatment can linger in your body and come back (recur) months or years later. Taking the full dose of any medication your healthcare provider prescribes to kill the initial infection is the best way to prevent chronic osteomyelitis.

How common is osteomyelitis?

Researchers think fewer than 25 per 100,000 people experience osteomyelitis each year. However, some studies have found it’s much more common among people who need to stay in the hospital — as high as 1 out of every 675 hospital admissions.

Experts think this difference may be because people who are admitted to the hospital often have health conditions or injuries that make them much more susceptible to bacteria and fungi getting into their blood and bones.

What are osteomyelitis symptoms?

Osteomyelitis symptoms can vary depending on which type you have and which of your bones are infected. The most common bone infection symptoms include:

• Fever.
• A general feeling of being sick or unwell.
• Bone pain.
• Chills.
• Sweating.
• Nausea and vomiting.
• Skin discoloration.
• Swelling (inflammation).
• A feeling of heat or warmth on your skin.
• Pus or discharge (if the infection is near a wound or surgery site).

Vertebral osteomyelitis also usually causes low back pain. Some people with chronic osteomyelitis don’t have symptoms.

What is the main cause of osteomyelitis?

Infections that spread to your bones cause osteomyelitis. It usually happens when an infection on the surface of your skin (like at a wound or a surgery site) gets into your bloodstream and spreads to your bone marrow (the spongy center of some bones).

What are the risk factors?

Anyone can develop an infection that causes osteomyelitis, but some people have a higher risk, including people who:

• Are younger than 20 or older than 50.
• Have open wounds after an injury or trauma.
• Have recently had surgery, especially arthroplasty (joint replacement) or other procedures where surgeons implant pieces into your body — including pins and screws to repair bone fractures (broken bones).
• Experience puncture injuries (something stabbing into your body).
• Have pressure injuries (bedsores).

People with health conditions or who need treatments that weaken their immune system are more likely to develop osteomyelitis, including:

• Sickle cell anemia.
• Diabetes (especially if you have diabetes-related foot ulcers).
• People who take immunosuppressants.
• People who need hemodialysis.

What are osteomyelitis complications?

Osteomyelitis complications can include:

• Abscesses: Bone infections can cause pockets of pus that break through your skin. Treatment to drain these abscesses may slightly increase your risk of skin cancer.
• Osteonecrosis: Osteonecrosis (bone death) can happen if swelling from the infection cuts off blood flow to your bone. It’s very rare, but some people with osteonecrosis need an amputation.
• Slowed growth: Osteomyelitis can cause children’s bones to grow and develop slower than usual.

How do providers diagnose osteomyelitis?

A healthcare provider will diagnose osteomyelitis with a physical exam and some tests. They’ll ask about your symptoms and when you first noticed them. Tell your provider if you’ve recently had surgery, an injury or if you’ve started new treatments for other health conditions.

Your provider will use some of the following tests to diagnose the infection and take pictures of your bones:

• Blood tests.
• X-ray.
• Magnetic resonance imaging (MRI).
• Computed tomography (CT) scan.
• Ultrasound.
• Bone scan.
• Bone marrow biopsy.

How is osteomyelitis cured?

Your provider will suggest treatments to kill the infection and prevent permanent bone damage. The most common osteomyelitis treatments include:

• Antibiotics: You’ll need antibiotics to cure a bacterial infection. You may need intravenous (IV) antibiotics for a few weeks before taking oral (pills you take by mouth) antibiotics for several weeks afterward.
• Antifungals: Antifungals treat fungal infections. You’ll probably need oral antifungal medications for several months.
• Over-the-counter pain relievers: Over-the-counter (OTC) NSAIDs or acetaminophen relieve pain and reduce inflammation. Your provider will tell you which kind of anti-inflammatory medicine is best for you, and how often it’s safe to take it.
• Needle aspiration: Your healthcare provider may use a needle to drain pus or fluid from any abscesses that develop.
• Surgery: You may need surgery if the bone infection is severe or you have a high risk of complications. It’s more common to need surgery if you have vertebral osteomyelitis.

How soon after treatment will I feel better?

It can take a long time for osteomyelitis to heal. You might need antibiotics or antifungals for a few months. You should start feeling better as medications start killing the infection and slowing its spread.

Ask your provider how long you’ll need to take antibiotics or antifungals. Make sure you take the full dose they prescribe for as long as they say, even if you start feeling better.

How can I prevent osteomyelitis?

Cleaning new wounds or cuts and keeping surgery sites sterile are the best ways to prevent bone infections. Wash your hands frequently, and clean scrapes and cuts with warm, soapy water. Go to the emergency room if you have a deep cut or puncture (stab) wound or experience trauma.

Ask your provider how to clean your surgery site after any type of procedure.

What can I expect if I have osteomyelitis?

Most people with osteomyelitis recover without long-term complications. But it’s important to get the infection diagnosed and start treatment right away. Contact your provider as soon as you notice any signs of an infection.

How long osteomyelitis lasts

Osteomyelitis can last for a long time. You might need treatment for several months to make sure the infection is completely cured. Ask your provider or surgeon what to expect.

How do I take care of myself?

Make sure you take the full course of your antibiotic or antifungal medication exactly as your provider prescribes. You need to finish the full dose, even if you feel better. If you stop taking your medications before you should, there’s a chance they won’t completely kill the infection. This increases your risk of chronic osteomyelitis and other complications.

Ask your surgeon how to keep incisions clean after surgery. They’ll tell you when it’s safe to shower or bathe, how to clean your surgical site and which kind of soap is best to use on it.

Contact your healthcare provider or surgeon right away if you notice signs of an infection, especially at a surgery site.

When should I see my healthcare provider?

Contact your provider or surgeon right away if you notice signs of an infection, especially if you notice pus or discharge at a wound or surgery site.

Which questions should I ask my provider?

You may want to ask your provider:

• Which type of osteomyelitis do I have?
• What caused the bone infection?
• Which treatments will I need?
• How long should I take antibacterial or antifungals?
• What are the best ways to keep my surgery site or wounds clean to prevent infections?

How serious is osteomyelitis?

Osteomyelitis is a serious condition that needs treatment right away. It usually responds very well to treatment, but you need to start treating it as soon as possible to prevent serious complications.

Once a provider diagnoses the infection and you start treatment, try not to worry. It might take a while to cure the infection, but the most important part is catching osteomyelitis early.

Does osteomyelitis go away on its own?

No, osteomyelitis won’t go away on its own. It’s extremely important to see a healthcare provider for a diagnosis and treatment. Your immune system does an amazing job of fighting off germs and other invaders, but you need antibiotics or antifungals to kill the infections that cause osteomyelitis.

Never ignore signs of infection around a wound, especially if you just had surgery. Contact your provider or surgeon right away if you notice any changes in your incisions. It’s always better to ask too many questions than not enough. Trust your instincts — if something doesn’t look or feel right, it’s worth checking out.

A note from Cleveland Clinic

Osteomyelitis is a bone infection that happens when bacterial or fungal infections spread from other parts of your body into your bone marrow. It can be very serious and cause permanent bone damage, but it’s very manageable if you start treatment within a few days. Contact a healthcare provider right away if you notice signs of infection like a feeling of warmth, pus or discharge or if you have a fever.

It’s especially important to keep your incisions clean after having surgery. Your surgeon will give you specific instructions on how to keep your surgery site clean. Don’t be afraid to ask lots of questions. Your providers are there to help you stay safe and healthy; they won’t be upset to explain things in a different way or show you exactly what you need to do.