Osteomyelitis may not be a household term, but this bone infection is more common than many people realize, affecting thousands of people each year. Imagine a silent invader that can turn a simple cut or injury into a life-altering condition, especially for those with diabetes or weakened immune systems. Understanding osteomyelitis is crucial not only for you but also for your patients. Dr. Amanda Novack, infectious disease specialist at Baptist Health, will help uncover more about this condition so that you can learn when a cut or broken bone requires common treatment or something more serious.
IN THIS BLOG:
1. What is osteomyelitis?
Osteomyelitis is an infection of bone tissue that can arise from trauma, surgery, compromised blood flow (particularly in diabetes), or infections that spread through the bloodstream.
2. Who is at higher risk for developing osteomyelitis?
Individuals at higher risk include older adults, men, children, and particularly those with diabetes (both type 1 and type 2), weakened immune systems, peripheral neuropathy, and vascular diseases. Additionally, trauma, such as motorcycle accidents or penetrating injuries, can significantly increase the risk.
3. How is osteomyelitis diagnosed?
Diagnosis typically begins with imaging tests like X-rays, CT scans, or MRIs, along with blood tests for cultures and inflammatory markers. In many cases, cultures are taken directly from the bone to identify the specific bacteria involved.
4. What are the recommended prevention strategies for osteomyelitis?
Preventive measures include good foot care for diabetic patients, such as daily foot inspections, wearing socks and well-fitting shoes, and managing blood sugar levels to minimize complications that could lead to infections.
5. What treatment options are available?
Treatment usually involves a combination of surgical intervention to remove infected bone and prolonged antibiotic therapy, often administered intravenously. If not treated, osteomyelitis can lead to serious complications, including the spread of infection and permanent deformities.
A Quick Overview
Osteomyelitis is an infection of bone tissue that can result from trauma or surgery, lack of blood flow in diabetes-related complications, or infections that spread via the blood.
“There are different ways to categorize osteomyelitis, but I think of it in terms of ‘hematogenous’ and ‘contiguous,’” Dr. Novack says. The infection can either spread from the bloodstream to the bone (hematogenous) or from the skin and soft tissue into the bone from the outside (contiguous).
Several species of Staphylococcus infections are some of the most common causes, but most bacteria that can cause a bloodstream infection can also cause a bone infection.
Diabetes and Weakened Immune Systems Increase the Risk
Osteomyelitis is more common in older people, and men are at higher risk than women. It is also more common in children, premature infants, and immunocompromised babies who may not have a fully developed immune system.
“By far the most common type of patient I see with osteomyelitis are those with diabetes mellitus (both type 1 and type 2),” Dr. Novack says. Diabetes can cause nerve and blood vessel damage that weakens the bones, especially in the feet. High blood sugars weaken the immune system and “feed” the bacteria.
Along with diabetes, other risk factors include any sort of peripheral neuropathy and vascular diseases. People who use injected drugs and those who have weakened immune systems are also at high risk of osteomyelitis.
“Trauma, like a motorcycle wreck or a penetrating injury, can significantly increase risk of bone infection,” Dr. Novack adds.
Diagnosis
Diagnosing osteomyelitis often starts with an X-ray, CT scan, or MRI. Blood tests, such as blood cultures and inflammatory markers, can also help.
“Most of the time, we get cultures from the actual bone to determine what kind of bacteria are involved and what the best antibiotics will be for treatment,” Dr. Novack says.
Some diagnoses can be difficult depending on where the osteomyelitis may present. Your patient may complain of back pain, for example, and due to the myriad of causes for back pain, it may take a while to discover that the pain is from infection.
“Running a fever of greater than 100.4°F is never normal and should be evaluated for infection,” Dr. Novack suggests.
Prevention and Management
Good foot care is extremely important for patients with diabetes. Diabetic neuropathy can make it difficult for our patients with diabetes to feel cuts, scrapes, or other common foot injuries. Untreated, these abrasions may get infected and turn into something more serious.
“I recommend my patients with diabetes inspect their feet every single day,” Dr. Novack says. “They should be wearing socks and well-fitting shoes as much as possible. Even a small injury from stepping on a rock, for instance, can lead to a wound that eventually invades the bone.”
Keeping blood sugar under control can also decrease the risk of neuropathy and blood vessel problems that contribute to these injuries.
Treatment Methods
Osteomyelitis is often treated with a combination of surgery and antibiotics. In more severe cases, the infection could spread to the bone, which must be extracted to completely cure the infection.
“Even after surgery, it can take several weeks of antibiotics (often intravenous antibiotics) to cure osteomyelitis,” Dr. Novack says.
If left untreated, osteomyelitis can spread from the infected bone to the rest of the body. Even less serious cases can cause permanent deformity and debility. Clear communication of expectations and follow up to ensure your patients are following their treatment plan are critical to limiting the spread of infection.
Speaking in Familiar Terms
Many patients may have low health literacy levels, making it difficult for them to find, understand, and use the medical knowledge you provide. However, patients with a limited science and medical background can still understand bone infections if you use familiar terms.
“I think it’s especially important for them to understand that there is no antibiotic that can penetrate the bone with inadequate blood supply or necrotic tissue,” Dr. Novack says. “So, I will often use terms like ‘dead bone’ or ‘destroyed tissue’ to help explain the need for surgical intervention when necessary.”
There are great online resources that include a mix of technical information and high-level content for patients. For professionals, UpToDate has good algorithms for diagnosing and treating osteomyelitis. The Infectious Diseases Society of America (IDSA) regularly updates relevant practice guidelines, including guidelines on diabetic foot infections, vertebral osteomyelitis in adults, and hematogenous osteomyelitis in pediatrics.
For patients and families, there are several great videos on YouTube that illustrate the pathophysiology in an easy-to-understand way. Mayo Clinic and Cleveland Clinic also have very accessible patient education materials.
Though fairly common, osteomyelitis may often go unnoticed until it has progressed to a critical stage. Raising awareness about bone infections is vital for early intervention and effective treatment. By understanding the risk factors, diagnostic methods, and treatments, you can help patients protect their bone health and prevent complications. Whether you’re a healthcare professional or someone eager to stay informed about your health, being proactive about awareness and education can make all the difference in combatting osteomyelitis.
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