Bone Pain

What is bone pain?

Bone pain is a tenderness or pain in one or more of your bones. Bone pain can be sharp, dull, stabbing, or throbbing. It can occur in just one spot or in several areas throughout the body. And you may feel it when you’re moving or at rest.

There are many different causes of bone pain, with the most common being an injury. That can cause anything from a bone bruise to a fracture.

But the pain can also be a sign of an underlying medical condition, like osteoporosis, sickle cell anemia, or even bone or blood cancer. If you have bone pain or tender bones, you should see your doctor.

Causes

1. Bone bruise

Symptoms

• Bone pain
• Tender bones
• Swelling
• Bruising of skin
• Stiffness
• Difficulty moving the area

A bone bruise, also known as a bone contusion, is an injury to the surface of the bone. A bump, bang, or other trauma causes blood vessels to break within the bone, similar to what happens when you bruise your skin.

Bone bruises happen from a sports injury, car accident, twisting motion, or a fall. The legs are the most common bones that get bruised. Certain medical conditions, like arthritis, can also cause bone bruises. The protective cartilage in between bones wears down, causing the bones to rub against each other.

A bone bruise is diagnosed with imaging, in particular an MRI. Although bone bruises do not show up on an X-ray, the doctor may order one to check if there is a fracture.

Treatment includes resting and icing the area, wrapping the area with a compression bandage, and keeping it elevated if there is any swelling. Over-the-counter anti-inflammatory medications like ibuprofen (Advil) may also be used to relieve pain.

2. Bone fracture

Symptoms

• Bone pain
• Tender bones
• Swelling
• Bruising of skin
• Deformity of bone
• Difficulty moving the area
• Difficulty walking

A broken bone (called a fracture) can be extremely painful. There are many different types of bone fractures.

• Open fractures: The bone is broken and it has broken through skin.
• Closed fractures: The bone is broken but remains under the skin.
• Displaced fractures: The bone is broken and has moved out of place.
• Non-displaced fractures: The bone is broken but remains in place.
• Hairline fracture, also known as a stress fracture, is a small crack in the bone.

Most fractures are caused by a high-impact injury like an accident or fall. Medical conditions like osteoporosis, cancer, and arthritis can increase the risk of fractures. Hairline fractures, though, are usually due to repetitive movements and often occur in athletes who spend a lot of time running or jumping.

A fracture is diagnosed with imaging tests like an X-ray. Sometimes X-rays do not always detect a fracture so a CT scan or MRI may also be used.

Treatment depends on the type of fracture. In relatively simple fractures that occur under the skin and the bone hasn’t moved much, a splint or cast is used to immobilize the bone (keep it from moving) and help it heal properly.

Surgery may be required, especially in cases of open fractures, displaced fractures, or when the bone has broken into multiple pieces. Sometimes surgery is also recommended if the bone does not heal properly with a cast.

Surgery typically involves repairing the bone, putting it back into place, and securing its position with metal plates, rods, or screws.

You will likely be told to rest and avoid using the area with the broken bone (or to keep weight off of it). You may be given prescription pain medications for a brief time and then told to take over-the-counter pain relievers.

3. Osteoporosis

Symptoms

• Bone pain
• Loss of height
• Hunched over posture

Osteoporosis is when bones become brittle, fragile, and likely to fracture. The word osteoporosis means “porous bone.” It happens when your bone breaks down at a faster pace than it rebuilds, causing bone loss.

It occurs with age, and women who have reached menopause are at risk since estrogen plays an important role in keeping bones healthy and strong. Low levels of vitamin D and calcium also make it worse.

Osteoporosis occurs most often in people of non-hispanic White and Asian descent but can affect people of all ethnicities. Other risk factors include excessive alcohol consumption, smoking, long-term steroid use, and family history of hip fractures. Certain medical conditions such as celiac disease, kidney disease, and autoimmune diseases like inflammatory bowel disease, rheumatoid arthritis, and lupus, increase the risk of osteoporosis.

The process of osteoporosis itself is not painful. The pain occurs when bones have become so brittle that they fracture. The most common areas for fractures to occur from osteoporosis are the spine (known as vertebral compression fractures), hips, and wrist.

Osteoporosis is diagnosed with a special type of X-ray called a DEXA scan that determines bone strength.

Treatment includes taking calcium and vitamin D supplements and exercising. Eating foods rich in calcium and vitamin D, such as fatty fish (salmon and tuna), egg yolks, and fortified milk, yogurts, and cereals, is also recommended.

Medications like bisphosphonates (such as alendronate, risedronate, and zoledronic acid) may also be prescribed. These medications decrease the breakdown of bones. Other medications, such as teriparatide and abaloparatide, stimulate bone growth.

4. Osteomalacia

Symptoms

• Bone pain, which may be all over, dull, and achy
• Weakness
• Difficulty walking or a waddling gait
• Muscles cramps or spasms
• Numbness and tingling
• In children, skeletal deformities such as a soft skull (in infants), bowed legs, knock knees, and scoliosis.

Osteomalacia causes bones to become soft and weak. It is caused by other diseases that affect your ability to absorb essential nutrients like vitamin D, calcium, and phosphorus. These include kidney disease, pancreatic insufficiency, or gastric bypass surgery. It can also be caused by liver disease, certain antiseizure medications, and genetic diseases. When osteomalacia occurs in children, it is known as rickets.

Bone pain from osteomalacia most often occurs in the hips, lower back, and lower legs. It usually starts off as dull and subtle but becomes more painful over time. It can cause muscle weakness, leading to difficulty walking and, sometimes, a waddling gait.

The definitive way to diagnose osteomalacia is via bone biopsy. This is typically done by inserting a needle in the pelvis and removing a small piece of bone. A non-surgical option for diagnosing involves a combination of blood tests, X-rays, and DEXA scans.

Treatment includes taking vitamin D and calcium and increasing these nutrients in your diet. Treatment also depends on the underlying disease that’s causing osteomalacia.

5. Bone cancer

Symptoms

• Bone pain
• Tender bones
• Swelling of the affected area
• Weakness
• Fatigue
• Numbness
• Tingling
• Night sweats
• Weight loss

Bone cancer occurs when there are abnormal cells growing out of control in the bone. It can be either primary (when the cancer started in the bone) or metastatic (when the cancer started in another part of the body, like the lung or breast, and then spread to the bone).

The pain may first be dull and achy and become sharp and severe as the cancer progresses and damages more of the bone.

Bone cancer is diagnosed with imaging tests like an X-ray, CT scan, MRI, bone scan, and PET scan. Bone scans and PET scans require radioactive tracer material. You may need a bone biopsy of the affected bone to get an accurate diagnosis. The bone may be removed via a needle going into the bone, or by surgically cutting off a small piece of bone.

Treatment of bone cancer depends on the type of cancer and whether it’s primary or metastatic. You may need surgery to repair the bone if the cancer has caused a fracture or to remove the cancerous part of the bone. Treatment may also include chemotherapy and radiation.

6. Sickle cell anemia

Symptoms

• Bone pain
• Swelling
• Fatigue
• Fevers
• Shortness of breath
• Delayed puberty
• Reduced growth
• Visual issues

Sickle cell anemia causes red blood cells to be irregularly shaped (they are shaped like sickles or crescent moons). Because they are misshapen, nutrients in the blood cannot get to the bone and the bone may become damaged. It is more common in Black people, according to the Centers for Disease Control and Prevention.

People with sickle cell anemia often have bone pain in multiple bones. It can occur in either sudden, severe bouts or be chronic pain.

The only cure is a stem cell transplant, but it’s such a risky procedure that many people can’t have it. It’s mostly done in children, not adults. In a stem cell transplant, a person is given chemotherapy and sometimes radiation to destroy all of their stem cells, which are then replaced by healthy stem cells. Risks include organ damage, infections, graft vs. host disease, and possibly death.

Other treatments try to reduce symptoms and improve quality of life. Many people require periodic blood transfusions to replace their misshapen red blood cells with healthy cells.

7. Bone infection

Symptoms

• Bone pain
• Tender bones
• Fever
• Swelling
• Redness
• Warmth over affected area
• Difficulty moving
• Difficulty bearing weight

An infection in the bone is known as osteomyelitis. The bone can become infected from bacteria that gets in through broken skin (though you may not be able to see a cut or opening near the bone pain). Or it can spread to the bone from an infection in another part of the body. Medical conditions like diabetes, poor circulation, and a suppressed immune system increase the risk of bone infection.

A bone infection is diagnosed with blood tests and imaging studies like an MRI or CT scan. Sometimes you may need a bone biopsy, which is when a piece of bone is removed and looked at under a microscope to determine the exact type of bacteria that is causing the infection.

You will likely be given antibiotics and may need surgery to remove the infected bone and clean out any surrounding tissue that may also be infected. Surgery may also be needed if antibiotics don’t help or if the infection has destroyed the bone.

8. Leukemia

Symptoms

• Fatigue
• Weakness
• Night sweats
• Dizziness
• Lightheadedness
• Shortness of breath
• Weight loss
• Bone pain
• Weakness
• Easy bleeding or bruising

Leukemia is a type of cancer that causes your body to make too many white blood cells. It begins in the bone marrow, found at the center of your bones. White blood cells are made in the bone, so when there are too many of them, the bone becomes overcrowded and painful.

There are different types of leukemia, which affect different types of white blood cells. Some progress quickly (acute leukemias), while others grow slowly (chronic).

Bone pain from leukemia most commonly occurs in the legs and arms.

Leukemia is diagnosed with blood tests and a bone marrow biopsy, in which a piece of bone is removed and looked at under a microscope.

Treatment may include chemotherapy, radiation, or a bone marrow transplant, depending on the type of leukemia.

Acute lymphoblastic leukemia is the most common leukemia in children and with proper treatment, the 5-year survival rate is over 90%, according to the National Cancer Institute.

Chronic lymphocytic leukemia is the most common leukemia in adults, and survival rates vary widely based on a range of factors.

9. Paget disease

Symptoms

• Deformity
• Bone pain
• Numbness
• Tingling
• Hearing loss
• Headache

In Paget disease, there is a problem with the way the body rebuilds old bone into new bone (called remodeling). Paget disease usually affects older people and most often occurs in the bones of the skull, spine, hips, and legs. Pain can occur if the bone becomes abnormally shaped or fractured.

Paget disease is diagnosed with X-rays. Certain blood tests may detect abnormal levels of a specific protein called alkaline phosphatase.

Paget disease is treated with prescription medications aimed at decreasing the breakdown of bone. These include:

• Bisphosphonates such as zoledronic acid (which is given as an intravenous infusion) and alendronate or risedronate (which are pills).
• Calcitonin may be used if a person cannot tolerate or take bisphosphonates.

Surgery may also be needed if the bone is very deformed or broken.

Other possible causes

A number of conditions may also be associated with bone pain including:

• Cushing syndrome
• Kidney disease
• Liver disease
• Lyme disease
• Celiac disease
• Hyperparathyroidism
• Certain medications can be harmful to the bone, including steroids like prednisone, thyroid medications, seizure medications, and medications used to treat acid reflux.

When to call the doctor

You should call the doctor if:

• Bone pain started right after an injury.
• Bone pain occurs in multiple parts of the body.
• You have weight loss.
• You have night sweats.
• You have numbness or tingling.
• You have hearing loss.
• You have headaches.
• You are losing height.

Should I go to the ER for bone pain?

You should go to the ER for bone pain if you are experiencing any of the following:

• The pain started right after an injury.
• Pain is severe.
• The bone looks deformed.
• You have fevers.
• You have redness.
• You have swelling.
• You have trouble breathing.
• You have chest pain.
• You are dizzy or lightheaded.
• You have fainted.
• You cannot walk normally because of the pain.

Treatments

At-home care

You can take the following steps to help treat your bone pain at home:

• Resting
• Applying ice to the area
• Wrapping the area with a compression bandage
• Elevating the area
• Over-the-counter anti-inflammatory medications
• Vitamins

Other treatment options

Your doctor may recommend one or more of the following to help treat your bone pain, depending on the exact cause:

• Surgery
• Prescription medications
• Chemotherapy
• Radiation
• Antibiotics
• Physical therapy
• Occupational therapy