How Serious Is Bone Marrow Edema?

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Bone marrow edema is a potentially serious condition where fluid builds up inside your bone marrow (the spongy mass in the center of bones that produces blood cells). There are many possible causes of bone marrow edema, ranging from arthritis and bone injury to more serious or debilitating conditions like osteoporosis, bone infections, bone tumors, and bone cancer.

This article describes common causes of bone marrow edema. It also explains when it is time to see a healthcare provider as well as the possible signs and symptoms of bone cancer

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Bone Marrow Edema Causes

As with all forms of edema, bone marrow edema involves the swelling of tissues due to the build-up of fluids. There are many possible causes for this.

Arthritis

Both inflammatory and non-inflammatory arthritis can cause bone marrow edema. With non-inflammatory arthritis, the degeneration of bone can cause changes that place direct pressure on the underlying marrow.

Types of arthritis that can cause bone marrow edema include:

Injury

Bone marrow edema can occur due to an injury of a bone or connective tissues like ligaments and tendons. The injury may be acute (sudden, severe) or chronic (persistent or recurrent). This includes overuse injuries caused by repetitive stress to bones and joints.

Injuries like this cause inflammation, a normal protective response that causes the widening of blood vessels and swelling of surrounding tissues.

Injuries that can cause bone marrow edema include:

Osteoporosis

Osteoporosis is a condition that causes bones to become porous and brittle. Osteoporosis is increasingly common as a person ages, particularly in postmenopausal women. The instability caused by osteoporosis makes bones vulnerable to fracture.

Bone marrow edema can occur with severe osteoporosis, particularly in the knees and hips. It tends to come and go rather than being persistent.

Bone Infection

Osteomyelitis is an infection of the bone. It is relatively uncommon but can cause damage to the blood vessels servicing the bone. If the blood supply is significantly reduced, bone tissues can start to die (referred to as osteonecrosis).

Bone marrow edema is characteristic of osteomyelitis, especially in the hip.

Osteomyelitis is most commonly caused by bacteria, the chief of which include Staphylococcus aureus. Less commonly, fungal infections can invade bones and cause osteomyelitis.

Bone Tumors

Benign (non-cancerous) bone tumors can cause edema by placing direct stress on the bone marrow as they grow in size and invade tissues. Some bone tumors grow faster than others.

There are many different types of benign bone tumors, including:

  • Chondroblastoma: A type found in children that cause significant pain
  • Chondromyxoid fibroma: A rare type that starts in the bone marrow
  • Enchondroma: A type situated inside the bone marrow space
  • Giant cell tumor. A rare but aggressive type of bone tumor
  • Non-ossifying fibroma: The most common bone tumor in children
  • Osteoblastoma; A type that is more common in males
  • Osteochondroma: A type that grows outside of the bone
  • Osteoid osteoma: A type usually found in the long bones of the body
  • Unicameral bone cyst: A type found near the ends of long bones

Cancer

Cancers associated with bone marrow edema not only include those that start in the bone but also those that spread (metastasize) from a cancerous tumor in other parts of the body to the bone or bone marrow.

These include:

Almost all cancers can spread to the bone, but the cancers that most often do include breast cancer, lung cancer, prostate cancer, kidney cancer, melanoma, ovarian cancer, and thyroid cancer.

Complications

In most cases, bone marrow edema is secondary to another condition such as cancer, osteomyelitis, arthritis, or an injury. The most common complication is severe and sometimes debilitating pain. Although the symptoms will typically resolve on their own (or when the underlying condition is treated), the pain can take a serious toll on a person's well-being until it does.

Less commonly, bone marrow edema can occur on its own for no known reason, a condition referred to as bone marrow edema syndrome (BMES). BMES is a self-limited condition that mostly affects middle-aged males and younger females who experience sudden or gradual pain and swelling in the lower extremities (mainly the hip, knee, ankle, or foot).

The pain may be present while resting but tends to get worse with activity or at night. The symptoms may be unilateral (occurring on one side of the body) or bilateral (affecting the same body part on both sides of the body).

BMES is diagnosed when edema is spotted on a magnetic resonance imaging (MRI) scan and no other explanation is found. An MRI is preferred because it is better at imaging soft tissues than X-rays or computed tomography (CT) scans.

When to See a Healthcare Provider

If you experience sudden or persistent bone pain in the absence of a known cause, it is in your interest to see a healthcare provider. This is especially true if the pain is severe and interfering with your mobility. Other symptoms to watch out for are warm and swollen joints (joint effusion).

Arguably, the biggest concern with bone marrow edema is whether it is caused by cancer. Although pain is common with bone cancer and bone metastases, it is not diagnostic of cancer.

If you have bone cancer, you are likely to experience a cascade of symptoms that warrant an immediate visit with your healthcare provider.

These include:

  • Persistent bone pain that worsens at night
  • A broken bone, often after a relatively minor trauma
  • Numbness or weakness in the legs
  • Swelling and redness over a bone
  • A noticeable bone lump
  • Loss of bladder control (urinary incontinence)
  • Loss of bowel control (fecal incontinence)

Bone cancer may require chemotherapy, radiation, immunotherapy, and surgery.

Summary

Bone marrow edema is a buildup of fluid inside your bones. It can happen because of an injury such as a fracture. Or, it may be related to a health condition like osteoarthritis, a bone infection, a bone tumor, or cancer. Less commonly, it can occur on its own for no known reason, a condition referred to as bone marrow edema syndrome (BMES).

9 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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By Carol Eustice
Carol Eustice is a writer who covers arthritis and chronic illness. She is the author of "The Everything Health Guide to Arthritis."