Overview
Osteomyelitis is swelling or inflammation of bone tissue. When the symptoms of osteomyelitis remain untreated or persist for more than six months, it is termed chronic osteomyelitis. Osteomyelitis can target any bone in the body. However, it typically affects the long bones of arms or legs in children and the spine bones (vertebrae) and hips (pelvis) in adults. It is caused by organisms, such as bacteria or fungi, entering the weakened bone tissue due to an infection, puncture wound, or surgical procedure. The main treatment plan involves an antibiotic course, but surgical procedures may also be performed for chronic osteomyelitis or severe infection. This blog explores the symptoms, causes, and what are the available treatment options for osteomyelitis.
What causes chronic osteomyelitis?
Osteomyelitis is caused by infections that spread to your bones. Viral and bacterial infections can both cause it, but those from staphylococcus bacteria are the most common. The infections can enter the bone through a variety of ways, including
- Bloodstream: Germs from other body parts of infection sites can travel through the bloodstream and enter a weak spot in the bone, for example, a UTI from the bladder or pneumonia from the lungs.
- Injuries: injured, broken, or fractured bones can become infected during treatment or if they stick out from the skin. Puncture wounds can also carry germs directly into the bloodstream or muscle.
- Surgery: bones can become infected during surgeries, joint replacements, and fracture repairs.
Who is at the highest risk for developing osteomyelitis?
Immunocompromised individuals, children under 18, and adults over 50 are at the highest risk of developing osteomyelitis. A 2023 study involving 168 children found that 86% of the patients who came in for an X-ray had chronic osteomyelitis.
Certain conditions, habits, and behaviors that can weaken the immune system and increase the risk for osteomyelitis include
- Diabetes
- Rheumatoid arthritis
- Sickle cell anemia
- AIDS / HIV
- Circulation disorders
- Alcoholism
- Long-term steroid use
- Intravenous drug use
- Recent surgery, mainly involving joint replacement, bone fractures, or implant procedures
- Recent puncture injuries
- Individuals who need hemodialysis
- Cancer treatment
“Clinical symptoms of osteomyelitis can be difficult to recognize due to their non-specific nature. Chronic pain, wound drainage, poor wound healing, fever, and pain are general indicators of it.”, shares Dr. Richard Honaker
What is the treatment for Osteomyelitis?
Treatment for osteomyelitis includes prescription medication for managing the infection and surgery if the bone tissue is permanently damaged. The treatment for chronic osteomyelitis is similar in adults and children. Common treatment options include
Prescription Medication
Your doctor will prescribe different medications depending on the source of the infection.
For bacterial infections, antibiotics such as penicillins and ciprofloxacin are prescribed for several weeks to clear out the infection. Intravenous antibiotics are prescribed at the start before switching to oral pills. In the case of MRSA (methicillin-resistant S aureus), vancomycin or clindamycin are prescribed. Antivirals and antifungals will be prescribed if the infection is viral or fungal.
IV therapy lasts 2-6 weeks for chronic osteomyelitis, while an additional oral course of antibiotics may be required for 4-8 weeks, depending on the patient.
Over the counter Medication
Pain relievers (analgesics) such as acetaminophen are taken over the counter for pain. Non-steroidal anti-inflammatory drugs (NSAIDs) such as naproxen are given to help reduce the inflammation related to the infection. It is advised not to take any medication without consulting your doctor first to avoid unwanted side effects and allergic reactions.
Surgery
Surgery is needed when the bone infection becomes severe enough that antibiotic therapy is not enough to control the infection. Depending on the state of infection, the following procedures may be performed for chronic osteomyelitis.
- Draining the pus or fluid from the infected bone
- Remove debris, dead tissue, and diseased bone to salvage or save what’s left of the healthy bone. This can leave empty pockets behind where bone or tissue grafts are used to restore blood flow to the healthy bone.
- For chronic osteomyelitis, amputation or surgical removal of the bone is often the only option to stop the infection from spreading.
Can you die from osteomyelitis?
Osteomyelitis is a serious illness that can cause severe disability and sometimes death. Chances of recovery are higher if the infection is detected and treated within five days. 1 in 5 people with osteomyelitis die if the treatment is not started immediately, with males being at a higher risk of developing chronic osteomyelitis.
However, given that the symptoms do not present themselves or mimic other conditions, osteomyelitis may be diagnosed too late. Even after recovery, there is a high chance of relapse, as the causative bacteria or fungi can lay dormant in the body and return when the patient is immunocompromised. Seek immediate medical help if you are experiencing symptoms of osteomyelitis again if you previously had the condition.
How long does it take for osteomyelitis to heal?
Osteomyelitis can heal within 4 to 6 weeks with proper treatment and monitoring. If the infection is severe, it can take up to 12 weeks or more before you start to feel better. If the infection is detected when it begins, it can be cured within 3-5 days. Recovery from chronic osteomyelitis may last longer due to surgical procedures or amputations.
Maintaining good wound hygiene and avoiding alcohol and smoking can help speed up the recovery process.
When should I see a doctor?
Osteomyelitis is a serious bone infection that can lead to permanent bone damage. Contact a healthcare provider immediately if you notice signs of infection, such as warmth, pus, discharge, fever, pain, discoloration, or swelling around a bone, especially after a medical procedure. Addressing the signs early can be the difference between making a full recovery and not.
FAQs about chronic osteomyelitis
There is not much difference between osteomyelitis in children and adults, except it can affect different body parts with age. Long bones are mainly affected in children, and joints, hips, and spinal bones in adults.
Osteomyelitis can happen at any age, but it is most common in children, especially those under 5 years. Boys are more prone to it than girls. However, kids with weak immune systems or chronic conditions are at a higher risk of developing osteomyelitis.
Chronic osteomyelitis can severely affect the quality of life of individuals suffering from it. The symptoms can last for years, even with amputations and surgeries. The chances of the infection returning are also greater, especially in those with circulation disorders, diabetes, or other immunocompromised conditions.
Yes, bone tissue can regenerate after a few weeks of osteomyelitis, even if the dead tissue was surgically removed. The outlook is better with acute than chronic osteomyelitis.
