Bone marrow edema - signs, causes and treatment

Edema on the bone marrow

Bone marrow edema is a relatively common finding that people are diagnosed with after magnetic resonance imaging. There may be pain in the diseased areas (e.g. the knee) or it may be a coincidental discovery. The various causes of such edema determine the therapy method, which is often a temporary phenomenon that can be treated conservatively. It is important to differentiate from dangerous (early) osteonecrosis.

Definition: Findings of bone marrow edema

If the diagnosis is bone marrow edema (KMÖ) or bone marrow edema syndrome (KMÖS), there is an increased water accumulation (edema) in the bone or in the bone marrow. Strictly speaking, the term comes from the field of imaging diagnostics and describes an edema-equivalent signal change that can be displayed in magnetic resonance imaging (MRI). X-rays can be used to identify edema in the bone marrow at a later stage.

The disease usually occurs between the thirtieth and fiftieth year of life, whereby men are affected much more often than women

Differential diagnosis of osteonecrosis

There is still disagreement among experts as to whether the bone marrow edema is a separate clinical picture or a reversible pre-stage of osteonecrosis (bone infarction with subsequent necrosis).

However, it is important to have a clear diagnosis in which bone marrow edema is differentiated from early osteonecrosis. This is not always easy, but usually rapidly progressing bone necrosis usually has serious consequences. This should not be overlooked or underestimated.

Bone marrow edema: symptoms

The relatively common MRI finding of a bone marrow edema is mainly due to unclear acute joint pain, for which the affected people seek specialist advice. The pain usually subsides somewhat over time, which can take months. But symptoms or pain do not always occur.

The exact location of the bone marrow edema is decisive for the type and severity of the symptoms. The hip, knee and upper ankle (ankle bone) are particularly often affected, so that those affected accordingly report hip pain, knee pain or foot pain. As a rule, it is stress-related pain in the affected areas.

Since people with bone marrow edema move less and avoid certain stresses, there is also the occurrence of joint stiffness, protective and incorrect posture, and restricted movement.


Different factors come into question for the development of bone marrow edema. Above all, this includes circulatory disorders and overloading of the bones. This can be a consequence of bone books (microfactures) or other injuries to the musculoskeletal system.

It can also occur as a concomitant disease in other bone and joint diseases. The latter is known as reactive bone marrow edema and mainly occurs together with osteoarthritis, rheumatism, osteomyelitis or bone tumors.

Treatment of bone marrow edema

Depending on the cause and type of disease, different therapy methods are used. Treatment of the underlying disease plays an essential role.

For symptomatic treatment, treatment is often conservative for a few weeks, and movement therapy and relief of the affected joints and bones (physiotherapy) are carried out.

If acute severe pain occurs, pain and anti-inflammatory agents can be administered temporarily. So far, there is no scientific evidence for a supplemental intake of calcium and vitamin D to strengthen the bones in general.

Cause-specific therapy methods, such as infusion therapy with iloprost or bisphosphonates have not yet been officially approved, but are certainly used in practice.

Bone marrow drilling is also a standard surgical procedure for bone marrow edema and early osteonecrosis, in order to relieve pressure and reduce bone healing, among other things, to reduce pain. (tf, cs)

Author and source information

This text corresponds to the requirements of the medical literature, medical guidelines and current studies and has been checked by medical doctors.


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Video: Should we use Bone Marrow Edema or Bone Marrow Lesion? (January 2022).