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Osteomyelitis

Also listed as: Bone infection

• Signs and Symptoms
• What Causes It?
• What to Expect at Your Provider's Office
• Treatment Options
• Following Up
• Supporting Research

Osteomyelitis is a bone infection. It usually affects the long bones (leg and arm) but can occur in practically any bone in the body. Bacteria almost always cause the infection, but fungi can occasionally have the same effect. 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.

The disease takes several forms, depending on the way the infection traveled to the bone and the type of bone infected. 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:

• Intense pain and a sensation of heat at the site of the affected bone
• Areas of tenderness, redness, and swelling
• Persistent back pain that is not relieved by rest, heat, or painkillers
• Abscesses containing 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?

Several different types of bacteria or fungi can infect bones, often 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 occur following injury (such as fractured bones that break the skin) or surgery
• Those that occur due to poor circulation (caused by diabetes, for example), which keeps the body from ridding itself 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. Blood tests are done to check for osteomyelitis and the type of bacterium or fungus responsible.

Your health care provider may do a bone biopsy, either through surgery or needle aspiration, where a needle is inserted through the skin and into the bone, and a small piece of the bone is removed for testing.

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), two types of imaging tests that produce more detailed information than conventional x-rays.

Treatment Options

Chronic osteomyelitis is treated with surgery and antibiotics. Acute and vertebral osteomyelitis may be treated with antibiotics alone, depending on the condition. In addition to prescribing medications, your health care provider may recommend bed rest, particularly if the infection affects your back. 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 fungi that caused your osteomyelitis. Courses of antibiotics lasting several weeks should clear up infections identified early. Antimicrobials are recommended for chronic osteomyelitis and forms of the condition caused by fractures or infections in sites adjacent to the bone.

Intravenous medications may be given initially when the cause of the infection is not clear. You may then be switched to oral medications.

In cases of osteomyelitis that result from foot ulcers or diabetes, medical treatment should include antimicrobial agents.

Surgical Procedures

Surgery may be necessary when osteomyelitis is identified late or in cases of chronic osteomyelitis, osteomyelitis caused by fractures and infections in soft tissue next to the bone, and that originating in foot ulcers. Surgery may include draining the area of the infection, removing diseased bone, and removing any foreign objects (such as screws or pins used previously to set a bone). Antimicrobial or antibiotic therapy should follow all cases of surgery.

Infected prostheses should be surgically removed, following several weeks of antibiotic treatment, to allow a new prosthesis to be implanted at the same time.

Complementary and Alternative Therapies

Osteomyelitis should be treated with prescription antibiotics. Alternative therapies can be used along with medical treatment to strengthen your immune system and help you recover, but do not treat osteomyelitis solely with alternative therapies. Make sure all of your health care providers are informed about any alternative therapies or supplements you may be using.

Nutrition

For overall immune support and help with healing, use the following.

• Vitamin C (250 - 500 mg two times a day, or up to 6 g per day in divided doses if tolerated and for 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 (200 mcg per day). High doses of vitamin C can interfere with selenium absorption in the body. Too much selenium, however, can be dangerous. Talk with your doctor to establish the proper dose.
• Acidophilus and bifidobacteria (1 - 3 capsules per day, or 1 - 5 million organisms per day), to prevent antibiotic-induced diarrhea and yeast infections

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 on getting your problem diagnosed before you start any treatment. Herbs may be used 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, teas should be made with 1 tsp. 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.

To treat infection and strengthen the immune system:

• Garlic ( Allium sativum , 600 - 1200 mg in two or three divided doses per day, standardized to 1.3 percent alliin). Do not take garlic if you take blood-thinning medication.
• Echinacea ( Echinacea spp ., doses vary from 300 - 900 mg per day). Because 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)
• Siberian ginseng ( Eleutherococcus senticosus , 400 mg per day). 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 )
• Barberry (Berberis vulgaris, one cup of tea per day). Steep 1 - 2 tsps. berries or 2 g of bark in one cup boiling water, strain, and cool.

Herbs called alteratives are traditionally known as blood cleansers. Use 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.

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). Consult with your medical doctor regarding sterile technique and the best way to use this therapy without aggravating the area, and then apply as needed.

Homeopathy

Homeopathy can be used as a supportive therapy, but should never be used 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 -- their 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 individuals who are run-down or exhausted

Acupuncture

May help stimulate immune response, reducing inflammation, pain, swelling, and fever.

Massage

Massage should be avoided because it could spread the infection.

Following Up

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

Supporting Research

Berkow R, ed. Merck Manual of Diagnosis and Therapy. 16th ed. Rahway, NJ: Merck Research Laboratories; 1992.

Carr AC, Frei B. Toward a new recommended dietary allowance for vitamin C based on antioxidant and health effects in humans. Am J Clin Nutr. 1999;69(6):1086-1107.

Concia E, Prandini N, Massari L, Ghisellini F, et al. Osteomyelitis: clinical update for practical guidelines. Nucl Med Commun . 2006 Aug;27(8):645-60.

Dambro MR, ed. Griffith's 5 Minute Clinical Consult. New York, NY: Lippincott, Williams & Wilkins; 1998.

JAMA Patient Page. How much vitamin C do you need? JAMA. 1999;281(15):1460.

Johnston CS. Recommendations for vitamin C intake. JAMA. 1999;282(22):2118-2119.

Larson DE, ed. Mayo Clinic Family Health Book. 2nd ed. New York, NY: William Morrow and Company; 1996.

Levine M, Rumsey SC, Daruwala R, Park JB, Wang Y. Criteria and recommendations for vitamin C intake. JAMA. 1999;281(15):1415-1453.

• Review Date: 10/3/2006
• Reviewed By: Steven D. Ehrlich, N.M.D., private practice specializing in complementary and alternative medicine, Phoenix, AZ. Review provided by VeriMed Healthcare Network.

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