Bone marrow is the sponge like substance inside your bones responsible for making blood cells, including red blood cells, white blood cells and platelets. Bone marrow oedema is a general term used to describe a painful build up of fluid within the bone marrow, usually seen during an MRI—a magnetic resonance imaging scan. It is usually a symptom of some underlying disease, so treatments are focused on treating the cause of the oedema. Bone marrow oedema syndrome, sometimes called BME, is a rare and painful transient condition that affects the bones of the lower extremities and for which treatment is limited.
Conditions such as avascular necrosis, osteoarthritis and rheumatoid arthritis can give rise to bone marrow oedema as can cases of acute trauma or injury to the bone. Bone marrow oedema syndrome is a self-limiting condition characterised by the sudden onset of terrible bone pain usually in the lower extremities and most often in the hip joint. It usually resolves itself within six to 12 months.
Bone Marrow Edema Syndrome
Bone marrow oedema syndrome, also known as localised transient osteoporosis, is seen mostly in middle-aged men. Some women experience it during the third trimester of pregnancy. Bone marrow oedema is seen on MRI with a reduced density of the bone, or bone mineral density. According to Osteoporosis International, current available treatments are "limited and ineffective."
Treatment is usually rest and physiotherapy. In difficult cases, a type of surgery called core decompression is used. In core decompression, a surgeon drills a hole into the affected part of the bone to allow increased blood flow, the formation of new blood vessels and healing to take place.
Sometimes drugs called bisphosphonates are given with vitamin D supplements to help with calcium balance and to increase bone density. A study reported on the website Ortho Super Site and in Osteoporosis International found that treatment with a certain intravenous bisphosphonate was effective at increasing the density of the bone and reducing pain.
An article in the Indian Journal of Therapeutics and another in Biomed Central both cite the use of iloprost, a generic vasoactive drug—meaning it exerts its actions on the vascular system. The vasoactive drug is usually used for pulmonary hypertension. Both institutions routinely use it in the treatment of bone marrow oedema syndrome because it opens blood vessels, encouraging normal blood flow, and treats the vascular abnormalities associated with the condition. The Indian Journal of therapeutics goes so far as to say that reduced load-bearing was not required in most cases in which the drug was used.
Treatment of Conditions Bone Marrow Edema Syndrome
Avascular necrosis is a painful condition that usually affects the hip joint. It is characterised by death of the bone marrow tissues caused by a temporary or permanent reduction in blood flow to the bone marrow. Treatment of the associated bone marrow oedema includes treating the avascular necrosis, which usually involves core compression surgery, bone grafting and sometimes a complete hip replacement. Osteoarthritis and rheumatoid arthritis are painful conditions of the joints that may be treated with pain killers, medication that reduce inflammation, injections into the affected joints or joint replacement. Rheumatoid arthritis is also sometimes treated with steroids and special drugs called disease-modifying anti-rheumatics, which slow down the progression of the disease.
- Indian Journal of Orthapedics: Outcome of painful bone marrow oedema of the femoral head following treatment with parenteral iloprost
- Biomed Central: Natural course of intra-articular shifting bone marrow oedema syndrome of the knee
- Annals of Internal medicine: Association of Bone Marrow Changes with Worsening of Knee Osteoarthritis
- Osteoperosis International: Effective and rapid treatment of localised LTO
- Ortho Super Site: Hip Fracture in a Patient Affected by Transient Osteoporosis of the Femoral Head During the Last Trimester of Pregnancy