Bone Marrow Edema

What is bone marrow edema?

Bone marrow edema (BME) happens when fluid builds up in the soft tissue inside your bones (bone marrow). Bone marrow is spongy tissue that contains blood stem cells. Edema is swelling due to fluid. Another name for bone marrow edema is bone marrow lesions.

Bone marrow edema may occur due to:

• Certain health conditions, such as osteoarthritis or osteoporosis.
• Injury or infection.

Bone marrow edema is one of the most common findings during an MRI investigating another condition. BME may be very painful, but it usually goes away over time. Treatments focus on managing your symptoms.

What are the types of bone marrow edema?

There are two types of bone marrow edema:

• Secondary, when you have another condition that causes BME. This type can be symptomatic or asymptomatic, meaning you don’t have any symptoms. That’s why this condition is often found in an MRI while examining another condition.
• Spontaneous or primary, when providers don’t know the cause of BME, but you have specific pain. This is also called bone marrow edema syndrome.

What is the difference between BME and bone marrow edema syndrome?

Bone marrow edema syndrome (BMES) is a rare type of BME with an unknown cause. It’s most common in men between the ages of 30 and 60. BMES may be related to health concerns such as high cholesterol (hyperlipidemia) and low vitamin D. It can show up in one bone or in many bones and most commonly occurs in the lower part of the body.

While BMES is related to bone marrow edema, it’s a separate condition. Your provider will use different techniques to diagnose and manage BMES.

Who might have bone marrow edema?

People of any age, race or sex might have bone marrow edema. You’re at greater risk of BME if you have:

• Arthritis.
• Bone cancer.
• Bone infections (osteomyelitis).
• Osteoporosis.

What causes bone marrow edema?

Several types of health conditions may lead to bone marrow edema:

Cancer

Types of cancer that may cause BME include:

• Acute myeloid leukemia (AML).
• Bone metastasis.
• Chondrosarcoma.
• Ewing sarcoma.
• Osteosarcoma.
• Radiation therapy for cancer.

Degenerative conditions

Problems where the health of your tissues becomes worse over time and may lead to BME include:

• Osteoarthritis.
• Tendinopathy.

Infections

Infections of the bones or joints that may lead to BME include:

• Bone infections (osteomyelitis).
• Septic arthritis.

Ischemic conditions

Conditions where organs don’t get enough blood or oxygen that may lead to BME include:

• Avascular necrosis (osteonecrosis).
• Charcot foot.

Metabolic conditions

Issues with metabolism that may cause BME include:

• Cushing syndrome.
• Hyperparathyroidism.
• Mastocytosis.
• Mineral and bone disorders due to chronic kidney disease.
• Osteomalacia.
• Osteoporosis, especially of the hip and knee.
• Vitamin D deficiency.

Musculoskeletal inflammation

Inflammation in your bones, ligaments, muscles, nerves and tendons that may cause BME include:

• Ankylosing spondylitis (AS).
• Enthesitis (inflammation where tendons and ligaments attach to bones).
• Psoriatic arthritis.
• Rheumatoid arthritis.
• Sacroiliitis.

Trauma

Types of injuries that may cause bone marrow edema include:

• ACL (anterior cruciate ligament) tears.
• Complex regional pain syndrome (CRPS).
• Compression fractures.
• Hip dislocation that causes the death of bone tissue (osteonecrosis).
• Other bone or joint injuries, especially of the ankle, hip, knee or spine.
• Stress fractures, especially in the ankle, foot, hip or knee.

What are the symptoms of bone marrow edema?

The main symptom of bone marrow edema is pain around or in your bone. Other symptoms may include:

• Joint effusion (swollen joints).
• Warm joints.

Some people with BME may not have any symptoms.

How is bone marrow edema diagnosed?

Your healthcare provider will do a physical examination. They’ll ask about your symptoms and medical history. Providers often diagnose bone marrow edema when someone has a related health condition.

If they suspect BME, your provider may suggest tests including:

• Blood tests, to look for signs of inflammation.
• Bone marrow biopsy.
• DEXA (DXA) scan, to look for osteoporosis.
• MRI.
• Ultrasound.

CT scans and X-rays don’t show bone marrow edemas.

How is bone marrow edema treated?

Bone marrow edema usually goes away on its own over time. Your provider will probably recommend that you rest, often for several months.

To manage your symptoms, your provider may also suggest:

• Nonsteroidal anti-inflammatory drugs (NSAIDs).
• Physical therapy.

If you have a more serious form of bone marrow edema, your provider may recommend:

• Steroid injections.
• Surgery.

If you need surgery, your surgeon may suggest core depression surgery. During this surgery, they’ll drill small holes into your bone. These holes help to lessen pressure and reduce pain.

To encourage the growth of healthy bone marrow, your surgeon may:

• Recommend a bone marrow transplant with stem cells, especially if there’s a cancerous condition identified as the cause.
• Fill the holes with bone grafts.

How soon after treatment for BME will I see results?

Results will depend on the cause of the bone marrow edema, the severity of your condition and the treatment you use. Symptoms often go away in four to 12 months. But sometimes bone marrow edema can last for two years or more.

How can I reduce my risk of bone marrow edema?

You can’t reduce your risk of bone marrow edema. But seeing your provider as soon as you have symptoms helps you begin treatment promptly.

What can I expect if I have bone marrow edema?

BME usually goes away over time.

How do I take care of myself with bone marrow edema?

Be sure to rest the bones affected by BME and follow your health provider’s instructions.

When should I see my healthcare provider?

See your provider if your symptoms return or worsen.

Also, see your provider with any concerns about side effects from your treatments or if you don’t notice any results after some time. They’ll be able to recommend other treatments that may help.