What can cause bone oedema?

Causes of Bone Oedema

Bone oedema (bone marrow edema) can be caused by trauma, osteonecrosis, chronic non-bacterial osteitis, osteomyelitis, osteoarthritis, compression fractures, malignant bone tumors, and hematological malignancies. 1, 2

Inflammatory and Infectious Causes

• Chronic non-bacterial osteitis (CNO) presents with bone marrow oedema as an early and activity-related disease feature, particularly in typical skeletal sites including the anterior chest wall, spine, and mandible 1
• Osteomyelitis (both infectious and non-infectious) causes bone marrow oedema with increased signal on T2 and STIR MRI sequences 1
• Charcot arthropathy in diabetic patients demonstrates bone marrow oedema that can be difficult to distinguish from superimposed osteomyelitis 1

Traumatic and Mechanical Causes

• Acute trauma and bone fractures produce bone marrow oedema that typically resolves within 1-3 months 1, 2
• Vertebral compression fractures show vertebral body oedema on fluid-sensitive MRI sequences (STIR or fat-saturated T2-weighted imaging) 1
• Osteoarthritis can induce bone marrow oedema depending on the disease subtype, though it is not always present 2

Vascular and Ischemic Causes

• Osteonecrosis (avascular necrosis) causes bone marrow oedema around the focus of necrosis, with increased risk for femoral head collapse when associated with increased joint effusion and extensive bone marrow oedema 1
• Bone marrow edema syndrome (BMES) is characterized by increased interstitial fluid within bone marrow in the absence of a definable cause, most commonly affecting the talus (56% of cases) and other bones of the foot and ankle 3, 4

Neoplastic Causes

• Malignant bone tumors can present with bone marrow oedema, particularly when there is cortical destruction or rapid growth 1
• Hematological malignancies including multiple myeloma, leukemia, and lymphoma demonstrate bone marrow oedema on MRI, which may be the only finding in some cases 5

Important Clinical Pitfalls

Bone marrow oedema lacks specificity because it occurs in multiple conditions and can even be seen in healthy individuals 1. The key to diagnosis is correlating the pattern of bone marrow oedema with:

• Anatomical location: CNO favors anterior chest wall, spine, and mandible 1
• Clinical context: Presence of skin ulceration suggests osteomyelitis; history of corticosteroid use, alcohol, or trauma suggests osteonecrosis 1
• Associated imaging findings: Structural changes (sclerosis, erosions, hyperostosis) help differentiate chronic conditions 1

MRI with T2-weighted and STIR sequences is the only imaging modality that clearly demonstrates bone marrow oedema 1, 2, though dual-energy CT can also quantify its presence 1.