Osteomyelitis is an infection of the bone. It can happen in any bone in the body. But it most often affects the long bones (leg and arm), the spine, and foot bones. You can have a bacterial infection (usually from Staphylococcus) or, more rarely, a fungal infection.
Osteomyelitis is rare in the U.S. It tends to affect more men than women, and is most often seen in children and people over 50.
Bone can get infected when bacteria travels through the bloodstream from another spot in your body, or the bone itself can become infected directly. Osteomyelitis can be acute, meaning symptoms last a few months, or chronic, meaning symptoms last a long time. How the disease is treated depends on which type it is.
Osteomyelitis is a serious condition that needs medical treatment right away.
Symptoms of osteomyelitis include:
- Pain, swelling, warmth, and redness at the site of the affected bone
- Persistent back pain that doesn't get better with rest, heat, or painkillers
- Abscesses with pus in tissue around the painful bone
- Fever, in some cases
- Osteomyelitis in the hip, pelvis, or back may cause no symptoms
What Causes It?
An infection, caused by bacteria or a fungus, can develop in the bone or spread to the bone from elsewhere in the body. Osteomyelitis can happen after a broken bone or other injury, or because of a joint replacement. The infection can also spread beyond the bone, creating abscesses in muscles and other tissues outside the bone. The types of infections are:
- Those that travel through the bloodstream, which are most common in children
- Those that happen after an injury, such as broken bones that come through the skin, or surgery, such as joint replacement
- Those that happen due to poor circulation (caused by diabetes, for example), which keeps the body from getting rid of the infection
- Those that occur in the spine, called vertebral osteomyelitis
What to Expect at Your Doctor's Office
After you describe your symptoms, your doctor will feel your skin above the affected bone, to check for tenderness. You will get a blood test to check for infection.
Your doctor may do a bone biopsy, either through surgery or by using a needle to remove a small piece of the bone for testing.
Your doctor may need to order more than one imaging test to diagnose osteomyelitis. The first test may be an x-ray. You may have a bone scan, which uses a mildly radioactive compound to highlight infected areas. You may also need a computed tomography (CT) scan or magnetic resonance imaging (MRI) or positron emission tomography (PET) scan. Each of these tests gives more detailed information than x-rays. PET scans are very accurate for evaluating chronic osteomyelitis.
Chronic osteomyelitis is treated with surgery and antibiotics. Acute and vertebral osteomyelitis may be treated with antibiotics alone, depending on the condition. Your doctor may also put you in a cast or splint to keep the affected bones and joints from moving.
The medication you need depends on the type of bacteria or fungus that caused your osteomyelitis. You may need intravenous (IV) antibiotics, or you may take oral antibiotics. Taking antibiotics for several weeks usually clears up infections that are found early. With chronic osteomyelitis, you may need to take antibiotics for years, or even the rest of your life. Nonsteroidal anti-inflammatory medication may help relieve pain.
In some cases you may need surgery, such as:
- Draining the infected area, to get rid of pus or fluid.
- Removing bone and tissue, called debridement.
- Restoring circulation to the bone. The doctor may replace any diseased bone with a graft of bone or muscle from elsewhere in your body, to help restore blood flow to the bone.
- Removing any foreign objects, such as screws or pins used to set the bone before.
Complementary and Alternative Therapies
Osteomyelitis should be treated with prescription antibiotics. You can use alternative therapies along with conventional treatment to strengthen your immune system and help you recover, but never treat osteomyelitis with alternative therapies alone. Make sure to tell all of your health care providers about any alternative therapies or supplements you may be using.
While there are no nutritional supplements that specifically treat osteomyelitis, these supplements may help strengthen your immune system and may be good for your overall health:
- Vitamin C. Vitamin C supplements may interact with other medications, including chemotherapy drugs, estrogen, warfarin (Coumadin), and others.
- Vitamin E. Vitamin E can interact with a number of medications, including blood thinners, so ask your doctor before taking it.
- Vitamin A. DO NOT use if you are, or may become, pregnant. Vitamin A interacts with a number of medications, including some that are available over the counter. Some of these interactions can be dangerous. Ask your doctor before taking vitamin A.
- Selenium. High doses of vitamin C can make it hard for your body to absorb selenium. Too much selenium, however, can be dangerous. Talk to our doctor before taking selenium to make sure you know the right dose.
- Probiotics. Acidophilus and bifidobacteria. Taking antibiotics can often upset the balance of good and bad bacteria in your intestines. These "friendly" bacteria can help keep your intestinal tract healthy. If you take drugs to suppress your immune system, ask your doctor before taking probiotics.
Herbs are a way to strengthen and tone the body's systems. As with any therapy, it is important to work with your provider to diagnose your problem before you start treatment. You may use herbs as dried extracts (capsules, powders, or teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). People with a history of alcoholism should not take tinctures. Unless otherwise indicated, make teas with 1 tsp. of herb per cup of hot water. Steep covered 5 to 10 minutes for leaf or flowers, and 10 to 20 minutes for roots. Drink 2 to 4 cups per day.
While there are no herbs that specifically treat osteomyelitis, these herbs may help strengthen your immune system and reduce infection:
- Garlic (Allium sativum). Has antibacterial properties. Garlic may increase the risk of bleeding, especially if you also take blood thinners such as clopidogrel (Plavix), warfarin (Coumadin), or aspirin. Garlic may interact with a number of medications, including those used to treat HIV.
- Echinacea (Echinacea spp.). May help strengthen your immune system. People with autoimmune disease, such as lupus or rheumatoid arthritis, as well as those with HIV, should not take echinacea. People who have allergies to daisy and/or ragweed can be allergic to echinacea.
- Goldenseal (Hydrastis canadensis). Has antibacterial properties. Goldenseal interacts with a number of medications, including blood thinners. It may also lower blood sugar. Ask your doctor before taking goldenseal if you take any other medication or if you have diabetes.
- Siberian ginseng or eleuthero (Eleutherococcus senticosus). May help strengthen the immune system. Siberian ginseng interacts with many other medications, including those for diabetes. Take Siberian ginseng only under your doctor's supervision.
- Astragalus (Astragalus membranaceus). May help strengthen the immune system. People with autoimmune disease, such as rheumatoid arthritis or lupus, should not take astragalus. People who take lithium or cyclophosphamide (Cytoxan) should avoid astragalus, too.
- Barberry (Berberis vulgaris). Has antibacterial properties. Barberry may interact with a number of medications, including cyclosporine, so ask your doctor before taking it.
You may also want to ask a qualified herbal practitioner about an infusion of burdock root (Arctium lappa), yellow dock (Rumex crispus), yarrow (Achillea millefolium), cleavers (Galium aparine), and licorice root (Glycyrrhiza glabra). DO NOT use licorice if you have high blood pressure or congestive heart failure. Avoid burdock, licorice, and yarrow if you take blood thinners. DO NOT take yellow dock if you take digoxin or diuretics. Be sure to tell your medical doctor about the herbs before you take them.
To help abscesses heal, an experienced botanical medicine prescriber may make a paste from the powders of goldenseal root and slippery elm (Ulmus fulva). Ask your medical doctor how to use this paste without aggravating the infected area, and then apply as directed.
You can use homeopathy as a supportive therapy, but never alone to treat osteomyelitis. Although few studies have examined the effectiveness of specific homeopathic therapies, professional homeopaths may consider the following remedies for the treatment of osteomyelitis because they are commonly used to treat joint disorders, bone injuries, and wound infections. Before prescribing a remedy, homeopaths take into account a person's constitutional type, includes your physical, emotional, and psychological makeup. An experienced homeopath assesses all of these factors when determining the most appropriate treatment for each individual.
- Arnica Montana. Used after trauma or injury, especially when accompanied by a bruised, "beat up" feeling.
- Ledum. For puncture wounds that lead to an accumulation of pus, especially if they feel better with cold applications.
- Silicea. For enlarged, pus-filled glands, especially in people who are run down or exhausted.
Acupuncture may help stimulate your immune system, reducing inflammation, pain, swelling, and fever.
Avoid massage because it could spread the infection.
Expect your doctor to monitor you carefully during your treatment.
Canale ST, Beaty JH. Campbell's Operative Orthopaedics. 12th ed. Philadelphia, PA: Elsevier Mosby; 2013.
Concia E, Prandini N, Massari L, et al. Osteomyelitis: clinical update for practical guidelines. Nucl Med Commun. 2006 Aug;27(8):645-60.
El Maghraby TA, Moustafa HM. Nuclear medicine methods for evaluation of skeletal infection among other diagnostic modalities. Q J Nucl Med Mol Imaging. 2006;50(3):167-92.
Koslow M, Kuperstein R, Eshed I, Perelman M, Maor E, Sidi Y. The unique clinical features and outcome of infectious endocarditis and vertebral osteomyelitis co-infection. Am J Med. 2014;127(7):669.e9-669.e15.
Kremers HM, Nwojo ME, Ransom JE, Wood-Wentz CM, Melton LJ, Huddleston PM. Trends in the epidemiology of osteomyelitis: a population-based study, 1969 to 2009. J Bone Joint Surg Am. 2015;97(10):837-45.
Moenster RP, Linneman TW, Call WB, Kay CL, McEvoy TA, Sanders JL. The potential role of newer gram-positive antibiotics in the setting of osteomyelitis of adults. J Clin Pharm Ther. 2013;38(2):89-96.
Palestro CJ, Love C, Miller TT. Infections and musculoskeletal conditions: Imaging of musculoskeletal infections. Best Pract Res Clin Rheumatol. 2006;20(6)1197-218.
Pineda C, Vargas A, Rodriguez AV. Imaging of osteomyelitis: current concepts. Infect Dis Clin North Am. 2006;20(4):789-825.
Prasad KC, Prasad SC, Mouli N, Agarwal S. Osteomyelitis in the head and neck. Acta Otolaryngol. 2007;127(2):194-205.
Ratnayake K, Davis AJ, Brown L, Young TP. Pediatric acute osteomyelitis in the postvaccine, methicillin-resistant Staphylococcus aureus era. Am J Emerg Med. 2015;33(10):1420-4.
Sia IG, Berbari EF. Infection and musculoskeletal conditions: Osteomyelitis. Best Pract Res Clin Rheumatol. 2006;20(6):1065-81.
Singh Lubana S, Alfishawy M, Singh N, Brennessel DJ. First Reported Case of Methicillin-Resistant Staphylococcus aureus Vertebral Osteomyelitis with Multiple Spinal and Paraspinal Abscesses Associated with Acupuncture. Case Rep Med. 2015;2015:524241.
Senneville E. Nguyen S. Current pharmacotherapy options of osteomyelitis: convergences, divergences and lessons to be drawn. Expert Opin Pharmacother. 2013;14(6):723-34.
Shank CF, Feibel JB. Osteomyelitis in the diabetic foot: diagnosis and management. Foot Ankle Clin. 2006;11(4):775-89.
Spellberg B, Lipsky BA. Systemic antiobiotic therapy for chronic osteomyelitis in adults. Clin Infect Dis. 2012;54(3):393-407.
Tanninen T. Saarelainen S. Mikkola J, Vainio M. Osteomyelitis in pregnancy. Duodecim. 2013;129(15):1586-9.
Tiemann AH, Hofmann GO. Principles of the therapy of bone infections in adult extremities: Are there any new developments? Strategies Trauma Limb Reconstr. 2009 Oct;4(2):57-64.
Vouillarmet J, Morelec I, Thivolet C. Assessing diabetic foot osteomyelitis remission with white blood cell SPECT/CT imaging. Diabet Med. 2014;31(9):1093-9.