Osteomyelitis and Diabetes: What is the Relation?

Last updated on September 28th, 2022

Osteomyelitis is an inflammation of bone tissue. This generally results due to an infection. Bone infection might happen due to many reasons. The condition may affect both children and adults. Infections can reach a bone by moving via blood or multiplying from adjacent tissue. Infections might also start in the bone itself. This is the case if injury exposes the bone to germs.

Smokers and individuals having chronic diseases are at a higher risk of osteomyelitis. Diabetic people may develop osteomyelitis in their feet if they experience foot ulcers. Osteomyelitis is now successfully curable. Many individuals need surgery to remove the dead bone areas. After surgery, there is a need for strong intravenous antibiotics.

Symptoms of Osteomyelitis

Signs of osteomyelitis involve:

• Fever
• Pain in the infected regions
• Inflammation and redness over the infected regions
• Fatigue

Osteomyelitis may cause no signs or the signs may be hard to differentiate from other problems. This can be true for infants, older adults and people with compromised immunity.

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Who is at risk?

Only 2 out of every 10,000 individuals may get osteomyelitis. This health problem affects adults and children. Various conditions deteriorate immunity. And they increase an individual’s risk for osteomyelitis. These conditions can include:

• Sickle cell disease
• Alcoholism
• Diabetes (many cases of osteomyelitis arise from diabetes)
• Rheumatoid arthritis
• Hemodialysis
• Recent injury
• Intravenous medications use
• HIV or AIDS
• Chronic use of steroids
• Poor blood supply

Bone surgery (hip and knee replacements) also enhance the possibility of bone infection.

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When to Visit a Doctor

Visit a doctor if:

• bone pain worsens with fever
• a person is at risk of infection because of a medical condition
• the person has undergone any recent surgery or injury
• a person observes signs of an infection.

Causes of Osteomyelitis 

Many cases of osteomyelitis occur due to staphylococcus bacteria. These are types of bacteria commonly present in the skin or nose of healthy people. Germs may enter a bone in several ways such as:

• The bloodstream. Germs in other body parts may travel via the bloodstream to a weakened spot in a bone. For example, in the lungs from pneumonia or in the bladder from a UTI.
• Injuries. Numerous puncture wounds carry germs deep inside the body. If infection occurs, germs spread into a nearby bone. Also, germs can enter the body in case of broken bones. Part of it sticks out through the skin.
• Surgery. Direct infection with germs may happen during surgeries to replace joints or repair fractures.

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Risk Factors of Osteomyelitis 

Bones are usually resistant to infection. However, this protection reduces as a person gets older. Other factors that may increase the susceptibility of the bones to osteomyelitis can be:

• Recent injury or orthopaedic surgery
• A serious bone fracture or a deep puncture wound. This gives bacteria a route to enter the bone or adjacent tissue. A deep puncture wound (animal bite or a nail piercing) may also trigger infection.
• Surgery replacing worn joints or repairing broken bones also opens the entry of germs into a bone. Another risk factor of infection is implanted orthopaedic hardware.

Circulation disorders

Damage can occur in the blood vessels. The body may then face difficulty in distributing the infection-fighting cells. These cells protect the enlargement of a small infection. A small cut may progress to a deep ulcer. And this can expose deep tissue and bone to infection.

Illnesses that impair blood circulation can be:

• Uncontrolled diabetes
• Sickle cell disease
• Peripheral artery disease, associated with smoking
• Problems demanding intravenous lines or catheters

Several conditions demand the use of medical tubing. These relate the external world to the internal body organs. Yet, this tubing may also act as a way of entry of germs into the body. This might increase the infection risk leading to osteomyelitis.

Examples of tubings can be:

• Urinary catheters
• Dialysis machine tubing
• Long-term i.v. tubing, at times known as central lines

Conditions that impair immunity

The osteomyelitis risk increases if any medical condition or medicine affects a person’s immunity. Factors that may suppress a person’s immunity include:

• Poorly controlled diabetes
• Cancer treatment
• The necessity of using corticosteroids or tumour necrosis factor inhibitors

Illicit drugs

People who inject illegal drugs have a higher risk of developing osteomyelitis. As they might use nonsterile needles. They are less likely to sterilize their skin before injections.

Complications of Osteomyelitis 

Osteomyelitis complications can be:

• Bone death (osteonecrosis). Bone infection obstructs blood circulation within the bone. This may lead to bone death. Dead bone areas must be surgically removed. This results ineffectiveness of the antibiotics.
• Impaired growth. Osteomyelitis affects the normal bone and joint health in kids. This occurs if the condition affects the softer areas (growth plates). This happens at either end of the long bones of the arms and legs.
• Septic arthritis. Infection within bones might spread into an adjacent joint.
• Skin cancer. If osteomyelitis causes an open sore that is draining pus, the risk of squamous cell cancer increases.

Prevention of Osteomyelitis 

Discussion with the doctor is important in case of an increased risk of infection. He or she discusses different ways of preventing infections from occurring. Lowering the infection risk also helps in reducing the risk of developing osteomyelitis. Usually, exercise precautions to avoid scrapes, cuts, and bites. This gives an easy access for the germs into the body. In case of minor injury, clean the area instantly. And, use a clean bandage. Check wounds more often for infection signs.

Diagnosis of Osteomyelitis 

Doctor feels the region around the affected bone for:

• tenderness
• inflammation
• warmth.

In case of a foot ulcer, doctor uses a dull probe. This determines the closeness of the underlying bone. The doctor might also order a combination of tests and procedures. This helps in diagnosing osteomyelitis and determining which germ is triggering infection. Tests might include:

Blood tests

Blood tests reveal any spikes in the levels of WBCs. Also, other factors show that the body is fighting an infection. If osteomyelitis occurs due to an infection in the blood, tests might reveal which germs are the cause. No blood test can inform the doctor whether a person has osteomyelitis. Yet, blood tests may help a doctor decide the need of tests and procedures.

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Imaging tests

X-rays

X-rays reveal any damage to the bone. Yet, the damage might not be visible until osteomyelitis is present. Thorough imaging tests are necessary in case of recent osteomyelitis.

Magnetic resonance imaging (MRI)

MRI scans use radio waves and a strong magnetic field. And it produces detailed images of bones and the soft tissues surrounding them.

Computerized tomography (CT)

A CT scan combines X-ray images taken from several angles. And, produces thorough cross-sectional views of an individual’s interior structures. CT scans are generally done only if somebody can’t have an MRI.

Bone biopsy

A bone biopsy reveals the type of germ infecting the bone. Knowing the germ type permits a doctor to select an antibiotic. Antibiotics that function well for that kind of infection. An open biopsy needs surgery and anaesthesia to access the bone. In certain circumstances, a surgeon inserts a long needle via skin and into the bone. This helps in the biopsy. This process needs local anaesthetics to numb the area of needle insertion. X-ray or other imaging scans can guide in this.

Treatment of Osteomyelitis

The most common osteomyelitis treatments are surgery followed by I.V. antibiotics. Surgery removes infected or dead parts of the bone.

Surgery

Based upon the infection severity, osteomyelitis surgery involves the following:

• Drain the infected region. Opening up the areas around the infected bone drains pus or accumulated fluid. Fluid accumulates due to an infection.
• Remove infected bone and tissue. In debridement, the surgeon removes the diseased bone. Then, take a small edge of healthy bone. This makes sure the removal of all the infected regions. Also, remove the surrounding tissue showing infection signs.
• Bring back the blood flow to the bone. The surgeon might fill any empty space left by the debridement. This can be done using a part of the bone or other tissue. This can be skin or muscle, from other body parts.
• At times, place temporary fillers in the pocket. This can occur until a person is healthy enough for a bone graft or tissue graft. The graft assists in repairing the damaged blood vessels and producing new bone.
• Get rid of any foreign objects. Remove the foreign objects including surgical plates or screws placed during a previous surgery.
• Amputate the limb. As a last resort, amputation of the affected limb is done. This prevents the infection from spreading further.

Medications

Bone biopsy reveals the type of germ causing an infection. This helps the doctor select an antibiotic that works against that infection. Administer the antibiotics via a vein in the arm for 6 weeks. An added course of oral antibiotics can help in more serious infections. If a person smokes, quitting smoking helps in speeding up the healing. Also, it is vital to take steps to manage any chronic conditions. This may include keeping tight glucose control in case of diabetes.

FAQs:

References:

1. https://www.mayoclinic.org/diseases-conditions/osteomyelitis/symptoms-causes/syc-20375913
2. https://www.hopkinsmedicine.org/health/conditions-and-diseases/osteomyelitis

Last Updated on September 28, 2022 by Dr. Damanjit Duggal