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If you have any medical questions or concerns, please talk to your healthcare provider. The articles on Health Guide are underpinned by peer-reviewed research and information drawn from medical societies and governmental agencies. However, they are not a substitute for professional medical advice, diagnosis, or treatment.
Bone pain is any pain that originates in your bones. It’s considered a subset of symptoms called musculoskeletal pain—pain coming from your skeleton, muscles, joints, and ligaments.
However, pain coming from your bones usually feels different than pain coming from those other areas. People affected by bone pain typically describe it as deep, dull, and penetrating. Bone pain is much more uncommon than other sources of bodily pain and can be more serious. Examples of diseases and disorders that cause bone pain include fractures, infection, and in rare cases cancer.
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In contrast, muscle pain is typically described as less intense than bone pain and feels like an ache in a particular muscle group. Muscle strains, spasms, and cramps are all common causes of muscle pain. In rare cases, muscle pain can be caused by autoimmune conditions, such as polymyalgia rheumatica.
Joint pain is another source of common pain. It’s often described as stiff, aching, and can be worse when the affected joint is moved. The older folks among us will know joint pain well—it’s the type of pain found in osteoarthritis, rheumatoid arthritis, and gout. Out of all sources of chronic pain, joint pain is one of the most prevalent. It’s estimated that 15 million Americans are dealing with severe joint pain due to arthritis (CDC, 2018).
Tendon or ligament pain is the final major category of musculoskeletal pain. It’s usually sharp and gets worse when the affected tendon or ligament is stretched. If you’ve ever had tennis elbow, golfer’s elbow, jumper’s knee, or any ligament tear, you know what this would feel like.
What causes bone pain?
Bone pain can be caused by a variety of medical conditions, some more serious than others.
Most commonly, bone pain is caused by an injury that results in a bone fracture. This could be from trauma, like a fall or a car accident. Other times it could be due to overuse and repetitive stress causing wear and tear on the bone, such as a stress fracture.
Another major reason could be due to weakness in the bone itself. This, paired with a minor injury, can cause a fracture that leads to bone pain. If your bones are weak enough, something as small as a cough can cause a fracture in your spine, which can lead to back pain.
The most common reason for bone weakness is osteoporosis. Osteoporosis, like the name implies, occurs when your bones become porous and weak due to the loss of bone mineral density and bone quality, which increases your risk of fractures. This condition commonly affects older people because bone density naturally drops as we age.
Osteomyelitis: what causes bone marrow inflammation?
Osteomyelitis, or an infection of the bone, is a well-known cause of bone pain. An infection can reach the bone through surrounding tissue or by traveling through the bloodstream. Along with pain, you might also experience fevers, chills, redness, and swelling.
Compared with other infections, osteomyelitis is fairly uncommon, though it happens more often in children and the elderly. Risk factors for osteomyelitis include recent surgeries, injection drug abuse, circulation problems such as uncontrolled diabetes and sickle cell anemia, and poor immunity.
Loss of blood flow
Ischemia, or the loss of blood supply, to a bone, can cause excruciating bone pain. This type of pain is common in sickle cell anemia.
This refers to the sickle shape of the red blood cells clogging up blood vessels that are piping oxygen and nutrients to the bone. As the bone is starved of oxygen, it starts to die, resulting in bone pain. Over time, this weakens the bone and can lead to the permanent collapse of the affected bone.
The most serious cause of bone pain is cancer. When cancer is present in your bone, it expands and destroys what’s around it. This can cause a lot of pain.
Bone pain from cancer usually starts as an ache in the area that’s affected. It might come and go, worsening when more stress is put on a particular limb. Then, it will become more persistent and be present throughout the night, making it more difficult to sleep.
As more and more bone is destroyed, the structure of the bone will weaken as well. This can lead to fractures, causing severe pain. Often, unexplained weight loss, loss of appetite, and night sweats can accompany these symptoms.
Bone pain from cancer can come from cancer that originates in the bone (bone cancer), of which the most common type is called osteosarcoma, as well as cancer that spreads to the bone from other areas. This is called metastatic cancer and is usually a result of advanced disease.
Cancers that commonly spread to the bone include:
- Breast cancer
- Lung cancer
- Thyroid cancer
- Kidney cancer
- Prostate cancer
Diagnosing bone pain
The first step is to figure out whether or not your pain is actually coming from your bones. The best way to do this is through a thorough history and physical exam. Then, your healthcare provider will be able to tailor diagnostic testing to your clinical picture.
Blood and urine tests can help detect mineral and vitamin deficiencies, as well as cancer markers, infection markers, or anemia that might accompany a disease that’s associated with bone pain.
Imaging tests can also be very helpful in figuring out what’s causing your bone pain. X-rays, CT scans, and MRI scans can be used to find areas of injury, infection, or cancer in your bones. Your healthcare provider might also order a bone scan, also called bone scintigraphy, which can detect certain types of infections, fractures, inflammation, and cancer that might not be as easily detected on other scans.
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How to treat bone pain
Bone pain treatment varies based on the cause of bone pain, which will need to be treated in order to relieve the pain. For instance, a fracture will need to be stabilized, and the broken bone will need to be immobilized to allow it to heal.
Bone weakness from osteoporosis can be treated with medications that increase bone mineralization, such as bisphosphonates, accompanied by calcium and vitamin D supplements. Bone pain from infections will need to be treated with antibiotics.
In serious cases, infected parts of the bone may need to be removed. And in cancer, treatments to shrink the bone tumor will often be needed to treat the pain.
As the root cause is being addressed, pain medications can be helpful in controlling the symptoms. Anti-inflammatory pain relievers like acetaminophen (brand name Tylenol) and ibuprofen (brand name Advil) can help alleviate the pain. If the pain is severe, opioid and corticosteroid medications may need to be used, especially in cancer patients.
Can you prevent bone pain?
Maintaining good general health and good bone health are both important to prevent bone pain.
First, make sure you’re eating a well-balanced diet rich in vitamin D and calcium. For women, the National Osteoporosis Foundation recommends 1,000 mg of calcium intake daily for those 50 and younger and 1,200 mg for women over 50.
For men, the recommendation is 1,000 mg of calcium daily if you’re 70 and younger and 1,200 mg if you’re over 70. For vitamin D, the recommended daily intake at least 400-800 international units (IU) a day if you’re 50 and younger and at least 800-1,000 IU daily if you’re over 50 (BHOF, 2018).
Second, exercise is important to maintain good bone health. Weight-bearing exercise programs have been shown to improve bone density. A good start is getting at least 30 minutes of exercise most days of the week.
Third, make sure to maintain good lifestyle habits. This means avoiding smoking, which has been linked with fracture risk. Excessive drinking is also a detriment to bone health. And finally, abusing intravenous drugs can increase the risk of bone infections, along with a whole host of other health problems (Kanis, 2005).
Finally, keep up to date with the recommendations of your healthcare provider. Annual health screenings for cancer can help catch colon, breast, cervical, lung, and other cancers before they have the chance to grow, spread, and affect your bones.
Always let your healthcare provider know about any worrying symptoms you’re experiencing so that they can keep you healthy.
- Centers for Disease Control and Prevention. (2018, September 19). Joint Pain and Arthritis. Retrieved from https://www.cdc.gov/arthritis/pain/index.htm
- Kanis, J. A., Johansson, H., Johnell, O., Oden, A., Laet, C. D., Eisman, J. A., … Tenenhouse, A. (2005). Alcohol intake as a risk factor for fracture. Osteoporosis International, 16(7), 737–742. doi: 10.1007/s00198-004-1734-y. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/15455194
- Bone Health & Osteoporosis Foundation (BHOF). (2018, February 26). Calcium and Vitamin D. Retrieved from https://www.bonehealthandosteoporosis.org/patients/treatment/calciumvitamin-d/
- Ward, K. D., & Klesges, R. C. (2001). A meta-analysis of the effects of cigarette smoking on bone mineral density. Calcified Tissue International, 68(5), 259–270. doi: 10.1007/bf02390832. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/11683532
Dr. Mike is a licensed physician and the Director, Medical Content & Education at Ro.