What are the risk factors for developing bursitis?

Risk Factors for Developing Bursitis

Bursitis develops primarily from chronic microtrauma and repetitive pressure on bursal tissues, with additional risk from acute trauma, inflammatory conditions, infection, and specific patient characteristics including obesity, poor physical conditioning, and certain occupational or recreational activities.

Primary Risk Factors

Mechanical and Traumatic Causes

• Chronic microtrauma from repetitive pressure is the most common cause of superficial bursitis, particularly affecting the prepatellar bursa (from kneeling) and olecranon bursa (from leaning on elbows) 1
• Acute trauma and hemorrhage into the bursa can precipitate bursitis 1, 2
• Prior joint or soft tissue injury increases risk of developing bursitis 3
• Occupational or recreational activities involving repetitive motion or sustained pressure on specific anatomical sites significantly elevate risk 3, 4

Inflammatory and Metabolic Conditions

• Inflammatory disorders such as gout and rheumatoid arthritis are established causes of bursitis 1, 2
• Metabolic diseases can trigger bursal inflammation 5
• The presence of multiple symptomatic bursae should raise suspicion for underlying systemic rheumatic disease 6
• Autoimmune connective tissue diseases may manifest with multifocal bursitis 5

Infectious Causes

• Septic bursitis, most commonly caused by Staphylococcus aureus, represents an important infectious risk factor 1
• Iatrogenic infection can occur following bursal aspiration, making this procedure generally not recommended for chronic microtraumatic bursitis 1

Patient-Specific Risk Factors

Demographic and Constitutional Factors

• Female sex is associated with increased risk of musculoskeletal conditions including bursitis 3
• Increasing age, particularly over 40 years, elevates risk 3
• Obesity increases mechanical stress on weight-bearing bursae 3

Physical and Anatomic Factors

• Poor physical fitness and inadequate conditioning predispose to overuse injuries including bursitis 3
• Greater forearm muscle strength and joint laxity may paradoxically increase risk in certain contexts 3
• Anatomic variations such as Haglund's deformity specifically predispose to retrocalcaneal bursitis 3

Medical Comorbidities

• Diabetes, malnutrition, and poor wound healing increase infection risk in bursitis 3
• Chronic corticosteroid therapy or other immunosuppressive treatment elevates infection risk 3
• Poor kidney function is associated with increased risk of crystal-induced bursitis 3

Lifestyle and Behavioral Risk Factors

• Excess alcohol intake contributes to metabolic conditions that can cause bursitis 3
• Diet rich in meat, seafood, and high-fructose foods increases risk of gout-related bursitis 3
• Diuretic use is associated with hyperuricemia and crystal-induced bursitis 3
• Inadequate activity modification and continued pressure on affected areas perpetuate chronic bursitis 6, 4

Location-Specific Risk Factors

• For heel bursitis (Haglund's deformity), women aged 20-30 years are at highest risk, with symptoms aggravated by shoe pressure 3
• Prepatellar bursitis risk is elevated in occupations requiring frequent kneeling 1
• Olecranon bursitis occurs more commonly in those who habitually lean on their elbows 1
• Trochanteric bursitis risk increases with hip pathology and altered biomechanics 6

Important Clinical Considerations

• Complete immobilization should be avoided as it can lead to muscular atrophy and deconditioning, which are themselves risk factors for recurrent bursitis 6
• Previous bursitis at the same site increases risk of recurrence, particularly if underlying mechanical factors are not addressed 1
• The distinction between septic and aseptic bursitis is critical, as infection risk is elevated in patients with diabetes, immunosuppression, and overlying skin breakdown 3, 1