Bone Marrow Edema: All You Need to Know

16 October, 2020
Bone marrow edema is an inflammatory process in the bones. It often causes pain during exercise, especially for prolonged periods of time. Want to know more about it? Read on!

Bone marrow edema is an inflammatory process that usually occurs within the trabecular bone. In other words, it occurs in the internal spongy component of the bones. It’s causes range from trauma to degenerative diseases. It also sometimes occurs among those who begin to practice strenuous physical activity after living a sedentary life.

The scientific journal Dolor, Investigación, Clínica y Terapéutica explains that this pathology is frequent in the clinical practice of rheumatology. This is because there’s a greater use and availability of magnetic resonances as a diagnostic test. Consequently, it’s become easier to identify this type of problem.

So, with all that in mind, what are its characteristics?

What is bone marrow edema?

Simply put, we can say that bones consist of two issues that are easy to differentiate. One of them is the cortical bone, which is made of a hard and compact material that surrounds the outer shell of the skeleton. The other is the trabecular bone, a more spongy tissue composing the internal skeletal matter.

In the trabecular bone, there’s a large number of blood vessels since the bones must also be nourished. According to an article published at the FASTA University of Argentina, an accumulation of fluids within the trabecular bone causes bone inflammation. This often occurs because the blood vessels break and bleeding occurs inside the bone. The origin can also be in the accumulation of inflammatory fluid after an injury. In any case, it could be said that bone marrow edema is a kind of bruising inside the bone.

However, it’s important to understand that this condition can also occur in the cortical bone, even though it’s not as common. Likewise, it’s important to note that its characteristics vary according to its reversibility.

Thus, experts classify it into two large groups:

  1. Transient Bone Edema Syndrome (TBES): This is a reversible inflammatory process that decreases with treatment and time.
  2. Osteonecrosis: This causes the death of bone-forming cells (osteocytes). For this reason, experts consider it an irreversible condition.
A digital image of bone marrow edema.

Bone edema is an inflammatory process characterized by the accumulation of fluids within the bone.

Visit: Calcium and Vitamin D-Rich Foods to Care for Your Bone Health

Why does bone marrow edema occur?

As you may expect, most bone marrow edema is the result of injuries, falls, high physical burden, or sports overload. Even so,  Reumatología del Hospital General de Elche warns us that, in many cases, the causes are not completely clear.

Although its main trigger is usually a serious injury, micro-injuries that continue over time can also cause bone marrow edema. For example, during a 10-kilometer race, a person hits the ground about 8,000 times. Consequently, this takes its toll on the internal bone structure as well as on the muscles and ligaments.

However, exercise is not the only trigger. Diseases like osteoarthritis, avascular necrosis (lack of blood supply), osteoporosis, or complex regional pain syndrome also promote the appearance of this inflammation. In short, anything that weakens the bone predisposes it to breakage.

The symptoms of bone marrow edema

The clinical manifestations of bone marrow edema may vary in each person depending on the severity with which it occurs. According to information published in the journal Clinical Rheumatology, its main symptoms include the following:

  • A localized pain in the affected bone structure.
  • Discomfort when putting the injured bone to work. The pain increases when exercising.
  • When treatment of the injury does not take place promptly, the pain extends even while the patient is resting.
  • In the most serious cases, people may experience discomfort in daily activities such as walking.

Due to their nature, it’s easy to guess that bone marrow edema appears more frequently in the knees, the metatarsals of the foot, or the calcaneus. Even so, the symptoms vary according to the bone structure in question.

Diagnosis

This type of lesion is not visible in traditional radiography, so an MRI is necessary. Also, studies show that new techniques such as Dual-Energy Computed Tomography (DET), which reconstructs images from the decomposition of materials, can be very useful tools when it comes to detecting bone edema.

What’s the treatment of bone marrow edema?

According to traumatology professionals, the treatment of bone edema involves several phases:

  • Rest is a determining factor for optimal recovery. To relieve acute symptoms, the use of crutches is important. It’s also important to decrease stress and burden on the bone for a minimum of four weeks.
  • Various drugs can also be helpful. For example, analgesics to control pain, bisphosphonates, vitamins, and other compounds to increase bone density or iloprost for vasodilation.
  • After the initial medical stages, it is appropriate to approach recovery with physical therapy treatment. This may include magnet therapy, thermotherapy, muscle relaxation, water exercise, and other techniques.

In the most serious cases, a visit to the operating room may be necessary. It’s possible to practice a spinal cord decompression using multiple perforations to empty the liquid from the bone.

Physiotherapy of the knee.
The treatment for bone edema consists of several phases. At first, rest is key. However, later on, experts recommend physical therapy techniques.

Discover: How to Reduce Bone Pain during Pregnancy

Preventive measures

As the popular saying goes, “prevention is the best medicine”. We shouldn’t place more burden on our bodies than is necessary. Also, in the face of extreme physical activity, the presence of a trainer who controls our exercise is essential.

At the same time, if you experience discomfort after walking, running, or any other activity, you need to go to the doctor. Whether it’s bone marrow edema, a fracture, or a sprain, you need to get an early diagnosis to intervene in time and prevent complications.

  • Edema óseo, clinicaMEDS. Recogido a 23 de septiembre en https://www.meds.cl/edema-oseo/#:~:text=El%20Edema%20%C3%93seo%20es%20un,y%20puede%20tener%20diversos%20pron%C3%B3
  • López, B. M., & de la Serna, A. R. (2017). Edema óseo: clasificación, clínica y diagnóstico. Dolor: Investigación, clínica & terapéutica32(3), 93-98.
  • López de la Vega, S. (2018). Edema ósea en rodilla: descripción de una lesión oculta.
  • Revista de Reumatología, Hospital General de Elche. Recogido a 23 de septiembre en https://svreumatologia.com/wp-content/uploads/2013/10/Cap-43-Edema-oseo-y-osteonecrosis.pdf
  • Fernández-Cantón, G. (2009). Del edema de médula ósea a la osteonecrosis. Nuevos conceptos. Reumatología Clínica5(5), 223-227.
  • Castell Herrera, A. (2020). Nuevos avances en tomografía computarizada mediante energía dual. Estudio de edema óseo.
  • Asepeyo salud, edema óseo. Recogido a 23 de septiembre en https://salud.asepeyo.es/profesionales/traumatologia/edema-oseo-como-detectarlo-y-actuar/#:~:text=Tratamiento%20del%20edema%20%C3%B3seo&text=Se%20pueden%20utilizar%20diferentes%20f%C3%A1rmacos,para%20aumentar%20la%20densidad%20%C3%B3sea.