What is Bone Marrow Edema Syndrome?
Bone marrow edema syndrome is a condition identified when no other cause can be found. It’s characterized by pain and an increase in fluid within the bone marrow. However, it often gets misdiagnosed, as the symptoms can vary greatly and not be specific. Because the symptoms are so diverse, this condition has been called many different names, including “transient osteoporosis,” “regional migratory osteoporosis,” and “algodystrophy”.
What Causes Bone Marrow Edema Syndrome?
Bone marrow edema syndrome refers to a condition where you experience pain and fluid buildup in your bone marrow, and the cause isn’t entirely known. However, some evidence suggests that it might be linked to certain metabolic issues, including a shortage of vitamin D in your body.
Interestingly, this syndrome was first categorized in pregnant women during their third trimester. Some research articles have pointed out other health conditions, such as liver disease (cirrhosis) and a particular type of elevated fat levels in the blood (type IV hyperlipoproteinemia), that could potentially increase the chances of getting bone marrow edema syndrome.
Risk Factors and Frequency for Bone Marrow Edema Syndrome
Bone marrow edema syndrome is a condition that usually affects the lower parts of the body (in 98% of cases). It is less common to see it in the upper limbs. This condition often impacts middle-aged men, those aged 30 to 60, and young women, those aged 20 to 40. More men than women get this condition, with a ratio of 3 men to 1 woman. Interestingly, bone marrow edema syndrome tends to move around the body and affects both sides in 41% of people.
Signs and Symptoms of Bone Marrow Edema Syndrome
People who have bone marrow edema syndrome often complain about severe pain that makes it difficult to perform day-to-day tasks. They may experience pain and swelling both when at rest and during activities. This pain and swelling can either develop suddenly or appear gradually over time. It’s common for patients to have tenderness and noticeable swelling in the affected area. However, the spaces between the joints usually remain unaffected, as joint pain and fluid accumulation in the joint are not common symptoms.
This syndrome typically goes through three stages:
- The first month is marked by initial pain and challenges in carrying out regular activities.
- The following one to two months are characterized by peak levels of pain.
- Last, over the subsequent few months, the symptoms start to lessen after the period of maximum pain. However, note that the onset and disappearance of symptoms can vary a lot from person to person.
Testing for Bone Marrow Edema Syndrome
If you’re experiencing symptoms such as pain and swelling, your doctor may request different types of imaging tests to get a clearer picture of what’s going on inside your body. This could include X-rays, computed tomography (CT) scans, and magnetic resonance imaging (MRI).
X-rays might show signs of bone thinning within a couple of months after you’ve started feeling symptoms. CT scans can help your doctor look at the affected area in more detail, to see if there are any signs of other conditions such as cancer or infection. It can also check for any local loss of bone density.
However, out of these three types of imaging, MRI scans are usually the most effective at assessing bone marrow edema syndrome – a condition where the bone marrow becomes inflamed and swollen. This is because the MRI can detect signs of swelling in as little as two days after symptoms start. During the MRI, there will be a decreased signal seen on T1 weighted images and an increased signal seen on T2 and STIR images.
Alongside imaging tests, your doctor may do blood tests. In most cases, the bloodwork won’t show anything unusual, however, if it shows lower levels of vitamin D, your doctor may need to conduct a bone mineral density test. This test measures how much calcium and other types of minerals are in an area of your bone. If necessary, they may recommend treatment to address the low vitamin D level.
Treatment Options for Bone Marrow Edema Syndrome
Bone marrow edema syndrome is a condition that usually gets better on its own. So the main goal of treatment is to help control symptoms you’re experiencing. This often involves resting the affected area to help with pain. Drugs named nonsteroidal anti-inflammatory drugs (NSAIDs) as well as physical therapy are frequently used avenues of treatment to alleviate discomfort.
There is also evidence that a calcium channel blocker medication known as nifedipine and a method called sympathetic nerve blockade could potentially provide substantial pain relief for this condition.
Iloprost, a medication that is similar to a naturally occurring body compound called prostacyclin, has shown to improve both functionality and pain in patients with bone marrow edema syndrome. However, this medication is not suitable for patients who are using blood-thinning medications or who are pregnant.
Taking supplements of vitamin D and a kind of medication called bisphosphonates might be another useful option. This method aims to boost both the rebuilding and renewing activity and blood supply of the bone. Certain types of bisphosphonates such as Ibandronate not only enhance bone repair but also show relieving effect on pain.
What else can Bone Marrow Edema Syndrome be?
Bone marrow edema syndrome is a condition that’s identified when other diseases are ruled out. As a result, doctors need to think about a wide range of possible health issues when making a diagnosis. Some of these potential conditions could include:
- Physical injuries
- Cancer
- Infections
- Osteonecrosis (death of bone tissue)
- Complex regional pain syndrome (a form of chronic pain)
- Stress fractures (small cracks in the bone)
These are just some of the diagnoses that could be considered when a patient has pain and increased amounts of water in their bone marrow.
What to expect with Bone Marrow Edema Syndrome
Bone marrow edema syndrome is a condition that naturally improves over time. The pain usually reaches its peak one to two months after the symptoms first start, and then generally fades away within three to nine months. The good news is that the symptoms usually clear up completely without leaving any lasting problems.
Possible Complications When Diagnosed with Bone Marrow Edema Syndrome
Bone marrow edema often causes severe pain that can interfere with daily activities and limit a person’s ability to function properly. While this condition typically gets better over time, the intense pain can significantly affect a person’s mental and emotional health.
Effects of Bone Marrow Edema:
- Intense and debilitating pain
- Limited daily functioning and activities
- Negative impact on mental and emotional health
Preventing Bone Marrow Edema Syndrome
Bone marrow edema syndrome is a rare condition the cause of which is still not entirely understood despite many theories. Given its rarity and variability in symptoms, doctors often find it challenging to diagnose quickly and usually rule out all other possibilities first. Once diagnosed, the primary focus of treatment is managing symptoms.
Patients often find pain relief through physical therapy and ‘offloading’ techniques, which involve reducing weight or pressure on the affected area. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, can also help by reducing the inflammation associated with the condition. Over time, symptoms tend to disappear.
It’s important for patients to understand that they might need to use various coping mechanisms or seek help to handle the physical discomfort and emotional stress during their recovery process.
