Understanding Bone Marrow Edema, Its Causes, Diagnosis and Treatment

What is Bone Marrow Edema?

Bone marrow is the spongy tissue that is found inside your bones.(1, 2) Bone marrow is crucial for the production of certain constituents of your blood, such as the white and red blood cells.(2, 3, 5) When tiny, microscopic fractures affect the internal bone structure, it can lead to bleeding as well as inflammation within the bone marrow.(8) This can cause fluid to build up within the bone marrow. This fluid buildup is referred to as bone marrow edema.(6, 7)

Bone marrow edema generally happens as a response of the body to a fracture or another injury.(8) Bone marrow edema can also be a resultant of bone-related conditions, such as osteoarthritis.(8)

This buildup of fluid or swelling in the bone marrow can cause pain that usually feels like a soft tissue bruise. This is why it is also commonly referred to as bone marrow bruise or just a bone bruise. At times, though, bone marrow edema can occur without any noticeable symptoms, while at other times, it may even affect the functioning of the bone or the joint. The symptoms of bone marrow edema generally depend on what is the underlying cause behind the edema and the severity of the edema.

Understanding bone marrow edema is important to understand whether it can be treated. Typically bone marrow edema tends to resolve itself with some physical therapy and plenty of rest.

What are the Causes of Bone Marrow Edema?

As mentioned above, one of the most common causes of getting a bone marrow edema is when trauma is caused to that area. Trauma can be caused by an acute injury or even by repetitive overuse of the tissue over a period of time that wears it down.

Some other causes of bone marrow edema can include:

Bone Marrow Edema Caused by Injury to a Ligament

Damage caused to the surface of the cartilage of the joint due to conditions, such as arthritis can also cause bone marrow edema. Arthritis is a common cause of edema of the bone marrow in both inflammatory and non-inflammatory types of the condition. The cellular infiltrates present within the bone is what compromises the bone cell function.

Stress Fractures Resulting in Bone Marrow Edema

These occur when there is repetitive stress on the bones due to either physical activity or due to a physical condition. Activities such as competitive dancing, weightlifting, and even running can cause stress fractures to develop can in turn cause Bone Marrow Edema.

Joint Inflammation

Inflammation of joint, also known as synovitis, can also cause Bone Marrow Edema.

Osteonecrosis

Osteonecrosis is a condition that leads to an interruption of the blood supply to a specific bone, leading to weakness in the bone, which can cause fracture is also one of the causes of Bone Marrow Edema.(8)

Bone Marrow Edema Caused by Cancer(8):

Metastatic tumors can also be a cause of edema of the bone marrow.(8) This is because such tumors increase the water production in a bone.(8) Radiation treatment for healing tumors or cancer can also cause a bone marrow edema to develop.

Bone Infection:

Bone infection also increases the water production in bone.(8) The bone marrow edema that develops due to an infection tends to generally disappear once the infection is treated.

How is the Diagnosis of Bone Marrow Edema Made?

Bone marrow edemas are usually diagnosed with an ultrasound or with an MRI (Magnetic Resonance Imaging) technology.(9) This allows doctors to produce a detailed image of the soft tissues of the body, including bones. MRI makes use of radio waves and magnetic fields. The MRI images can help spot any abnormality in the bone tissue, which indicates the accumulation of fluid. Before the advent of MRI, doctors were not able to spot these types of injuries.

Bone marrow edemas do not show up on X-rays or on CT scans.

Usually, bone marrow edemas get diagnosed when the patient comes in complaining about pain within or surrounding the bone or when the patient is suffering from another condition.

Treatment of Bone Marrow Edema

To begin with, the treatment of bone marrow edema depends on the underlying cause of the condition. One of the most effective treatments for bone marrow edema that is a result of trauma or injury is to give that area plenty of rest and relief from any strain. For minor cases of bone marrow edema, most orthopedic doctor or surgeons recommend limiting the activity of that bone or joint till the time the bruise on the bone heals.

Other treatment options for minor cases of bone marrow edema include medication and steroid injections.

In most of the cases of bone marrow edema, it has been found that the fluid buildup will resolve itself over a period of time with rest, pain medication, and therapy if required. Medication used in treating bone marrow edema typically includes NSAIDs (non-steroidal anti-inflammatory drugs).

In more serious cases of bone marrow edema, your doctor will suggest surgery. One of the common surgical procedures for treating bone marrow lesions is core decompression.(8) In this procedure, holes are drilled into the affected bone and the surgeon then inserts bone marrow stem cells or bone graft material for filling up the cavity. This will stimulate the bone marrow to start growing normally again.

It takes 4 to 12 months for a typical bone marrow lesion to heal after an injury. However, in around 10 to 15 percent of patients, the problem may continue to persist even after one or two years of the initial injury. In the rarest cases, the conditions of the bone marrow edema can be persistent indefinitely.

This is why it is so important that you do not ignore injuries that may seem to be small, but have actually affected your bone. Consulting your doctor if the pain persists is the best recommendation you can follow to have the edema in the bone marrow diagnosed and treated in a timely manner to avoid future complications.

Conclusion

It is very important to have the bone marrow edema/lesion detected on time. This is especially true if you are managing symptoms of arthritis, cancer, infection or even a stress fracture. Bone marrow edemas are only an indication of where the pain starts from and how strong your bones are. However, without treatment, the condition can continue to get worse, which will affect your treatment plan eventually.

If you are diagnosed with bone marrow edema, then you must make sure to ask what is the potential cause and the recommended treatment for your condition. Your doctor will be the best person to advise on how much time it will take for the bone marrow edema to heal, what therapy you require, and if needed, what pain medication will be the best for getting relief in your condition. Do not delay in going to the doctor as it may worsen the pain over a period of time.

References:  

  1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4554886/
  2. https://www.ncbi.nlm.nih.gov/pubmed/28898758
  3. https://www.ncbi.nlm.nih.gov/books/NBK2263/
  4. https://www.ncbi.nlm.nih.gov/books/NBK26919/
  5. https://www.ncbi.nlm.nih.gov/pubmed/3065314
  6. https://www.ncbi.nlm.nih.gov/pubmed/25607388
  7. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4662576/
  8. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4662576/
  9. https://www.ncbi.nlm.nih.gov/pubmed/16315067

Felson, D.T., McLaughlin, S., Goggins, J., LaValley, M.P., Gale, M.E., Totterman, S., Li, W., Hill, C. and Gale, D., 2003. Bone marrow edema and its relation to progression of knee osteoarthritis. Annals of internal medicine, 139(5_Part_1), pp.330-336.

Wilson, A.J., Murphy, W.A., Hardy, D.C. and Totty, W.G., 1988. Transient osteoporosis: transient bone marrow edema?. Radiology, 167(3), pp.757-760.

Hayes, C.W., Conway, W.F. and Daniel, W.W., 1993. MR imaging of bone marrow edema pattern: transient osteoporosis, transient bone marrow edema syndrome, or osteonecrosis. Radiographics, 13(5), pp.1001-1011.

Korompilias, A.V., Karantanas, A.H., Lykissas, M.G. and Beris, A.E., 2009. Bone marrow edema syndrome. Skeletal radiology, 38(5), pp.425-436.

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