Introduction:

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), vertebral (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 become 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 (symptoms last a few months) or chronic (symptoms can last years), and the type of disease determines the treatment. Osteomyelitis is a serious condition that requires prompt medical treatment.

Signs and Symptoms:

The symptoms of osteomyelitis include:

• Pain, swelling, warmth, and redness at the site of the affected bone
• Persistent back pain that is not relieved by rest, heat, or painkillers
• Abscesses with pus in tissue surrounding the painful bone
• Fever, in some cases
• Fatigue
• 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 fracture or other injury, or as the result 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 fractured bones that break 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 (vertebral osteomyelitis)

What to Expect at Your Provider's Office:

After you describe your symptoms, your health care provider will feel your skin above the affected bone, to check for tenderness. You will get a blood test to check for infection.

Your health care provider may do a bone biopsy, either through surgery or needle aspiration. In needle aspiration, your doctor inserts a needle through the skin and into the bone, and removes 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 a conventional 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 produce more detailed information than conventional x-rays. PET scans, in particular, are highly accurate for evaluating chronic osteomyelitis.

Treatment Options:

Chronic osteomyelitis is treated with surgery and antibiotics. Acute and vertebral osteomyelitis may be treated with antibiotics alone, depending on the condition. Your health care provider may also put you in a cast or splint to immobilize the affected bones and joints.

Drug Therapies

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. Courses of antibiotics lasting several weeks should clear up infections identified early. With chronic osteomyelitis, you may need to take antibiotics for years or even the rest of your life.

Surgical Procedures

In some cases you may need surgery. Surgical procedures for osteomyelitis include:

• Draining the infected area, to get rid of pus or fluid
• Removing bone and tissue (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 previously

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 do not treat osteomyelitis solely with alternative therapies. Make sure to tell all of your health care providers about any alternative therapies or supplements you may be using.

Nutrition

While there are no nutritional supplements that specifically treat osteomyelitis, these supplements may help you strengthen your immune system and may be good for your overall health:

• Vitamin C (250 - 500 mg two times a day, or up to 6 g per day in divided doses if tolerated and for the short-term only, up to one week). Lower dose if diarrhea develops.
• Zinc (30 - 50 mg per day, then reduce to 25 mg per day)
• Vitamin E (400 - 800 IU per day)
• Vitamin A (10,000 - 15,000 IU per day). Do not use if you are, or may become, pregnant.
• Selenium -- High doses of vitamin C can interfere with selenium absorption in the body. Too much selenium, however, can be dangerous. Talk to our doctor before taking selenium to make sure you understand the proper dose.
• Probiotics -- Acidophilus and bifidobacteria (1 - 3 capsules per day, or 1 - 5 million organisms per day). 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.

Herbs

Herbs are generally a safe 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 any treatment. You may use herbs as dried extracts (capsules, powders, 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 - 10 minutes for leaf or flowers, and 10 - 20 minutes for roots. Drink two to four cups per day.

While there are no herbs that specifically treat osteomyelitis, these herbs may help you strengthen your immune system and reduce infection:

• Garlic (Allium sativum, 600 - 1,200 mg in two or three divided doses per day, standardized to 1.3% allicin) -- has antibacterial properties. Do not take garlic if you take blood-thinning medication.
• Echinacea (Echinacea spp., doses vary from 300 - 900 mg per day) -- may help strengthen your immune system. Since echinacea can interact with other medications, take it only under your doctor's supervision.
• Goldenseal (Hydrastis canadensis, doses vary from 500 - 1,000 mg three times per day) -- has antibacterial properties.
• Siberian ginseng or eleuthero (Eleutherococcus senticosus, 400 mg per day) -- 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, 4 - 7 g per day) -- may help strengthen the immune system.
• Barberry (Berberis vulgaris, one cup of tea per day) -- has antibacterial properties. Steep 1 - 2 tsps. berries or 2 g of bark in one cup boiling water, strain, and cool.

Herbs are traditionally known as blood cleansers. Although there are no scientific studies to say for sure, these herbs may help strengthen the immune system. If you are interested in trying alteratives, ask your 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). Drink two to three cups a day. Note the following cautions: Do not use licorice if you have high blood pressure or congestive heart failure. Avoid burdock and yarrow if you take blood-thinning medication. 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 with the healing of abscesses, have an experienced botanical medicine prescriber make a paste from the powders of goldenseal root and slippery elm (Ulmus fulva). Ask your medical doctor the best way to use this therapy without aggravating the infected area, and then apply as needed.

Homeopathy

You can use homeopathy as a supportive therapy, but never alone to treat osteomyelitis. Although very 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 -- 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

Acupuncture may help stimulate your immune system, reducing inflammation, pain, swelling, and fever.

Massage

Avoid massage because it could spread the infection.

Following Up:

Expect your health care provider to monitor you carefully during your treatment.

Alternative Names:

Bone infection