What Is Bone Marrow Edema? Symptoms, Causes, and Treatment Options
Updated: 3 days ago
Medically reviewed by Dr. Baraa Alnahhal, MD · Last reviewed: October 2026
Quick Answer: What is bone marrow edema?
Bone marrow edema is swelling caused by fluid building up inside the bone marrow, the spongy tissue inside bones. The most common symptom is bone pain, though some people have none and it is often found by accident on MRI. It is treated with rest, NSAIDs and physical therapy and usually resolves, though symptoms can take 4 to 12 months. [1]
Key takeaways
Bone marrow edema (BME) happens when fluid builds up in the soft tissue inside your bones (bone marrow). Bone marrow is spongy tissue that contains blood stem cells. Edema is swelling due to fluid. Another name for it is bone marrow lesions. [1]
There are two types: secondary BME (caused by another condition — which may be symptomatic or symptom-free) and spontaneous or primary BME (unknown cause, with specific pain), also called bone marrow edema syndrome. [1]
The main symptom is pain around or in your bone, along with swollen joints (joint effusion) and warm joints. Some people have no symptoms at all. [1]
Providers diagnose BME with blood tests, MRI, ultrasound, DEXA scans, and sometimes a bone marrow biopsy — CT scans and X-rays do not show it. Treatment includes rest (often several months), NSAIDs, and physical therapy, plus steroid injections or surgery for serious forms. Symptoms often go away in four to 12 months. [1]
What the research says
Primary bone marrow edema usually resolves with conservative care over months. A rheumatology review describes primary BME as a diagnosis of exclusion that usually causes lower limb pain, commonly in the hip, knee, ankle, or foot, with symptoms gradually resolving over a number of months. Treatment is usually conservative (analgesics and staying off the affected limb), evidence for medical treatment is limited, and surgical decompression is usually a last resort (Patel, Rheumatology, 2014). [4]
The evidence for specific treatments is still thin. A systematic review of 36 articles (880 patients) on bone marrow edema syndrome and transient osteoporosis found that bisphosphonates, iloprost, core decompression, and extracorporeal shockwave therapy each came out ahead at different time points while conservative care (NSAIDs, analgesics, restricted weight bearing) did not, and called for large multicenter randomized trials (Paraskevopoulos et al., Osteoporos Int, 2023). [7]
Intravenous iloprost helped in studies of bone marrow edema syndrome of the upper thigh bone. A meta-analysis of 11 studies covering 190 proximal femora found that 3 to 6 months after iloprost alone, pain scores improved by a mean of 3.3 cm on a visual analog scale and Harris Hip Score rose by about 24 points; only 9.3% of cases showed no clinical or radiological improvement. These results are specific to the proximal femur, not every site or cause of BME (Zippelius et al., J Pers Med, 2022). [8]
What Is Bone Marrow Edema?
Bone marrow edema (BME) happens when fluid builds up in the soft tissue inside your bones. This soft tissue is your bone marrow — the spongy tissue that contains blood stem cells. Edema is swelling caused by fluid. Another name for bone marrow edema is bone marrow lesions. [1]
Bone marrow edema may occur due to certain health conditions, such as osteoarthritis or osteoporosis, or from injury or infection. [1]
BME is one of the most common findings during an MRI investigating another condition. It may be very painful, but it usually goes away over time. Treatments focus on managing your symptoms. [1]
Types of Bone Marrow Edema
There are two types of bone marrow edema:
Type | What it means | Symptoms |
Secondary BME | You have another condition that causes the BME [1] | Can be symptomatic or asymptomatic (no symptoms) — which is why it is often found on an MRI while examining another condition [1] |
Spontaneous or primary BME | Providers don't know the cause, but you have specific pain [1] | Painful; also called bone marrow edema syndrome [1] |
What Is Bone Marrow Edema Syndrome?
Bone marrow edema syndrome (BMES) is a rare type of BME with an unknown cause. While BMES is related to bone marrow edema, it is a separate condition, and your provider will use different techniques to diagnose and manage it. [1]
Who Might Get Bone Marrow Edema?
People of any age, race, or sex might have bone marrow edema. You are at greater risk if you have arthritis, bone cancer, bone infections (osteomyelitis), or osteoporosis. [1]
What Causes Bone Marrow Edema?
Several types of health conditions may lead to bone marrow edema. [1]
Category | Conditions that may cause BME |
Cancer | Acute myeloid leukemia (AML), bone metastasis, chondrosarcoma, Ewing sarcoma, osteosarcoma, and radiation therapy for cancer [1] |
Degenerative conditions | Osteoarthritis, tendinopathy [1] |
Infections | Bone infections (osteomyelitis), septic arthritis [1] |
Ischemic conditions (not enough blood or oxygen) | Avascular necrosis (osteonecrosis), Charcot foot [1] |
Metabolic conditions | Cushing syndrome, hyperparathyroidism, mastocytosis, mineral and bone disorders due to chronic kidney disease, osteomalacia, osteoporosis (especially of the hip and knee), vitamin D deficiency [1] |
Musculoskeletal inflammation | Ankylosing spondylitis (AS), enthesitis (inflammation where tendons and ligaments attach to bones), psoriatic arthritis, rheumatoid arthritis, sacroiliitis [1] |
Trauma | ACL tears, complex regional pain syndrome (CRPS), compression fractures, hip dislocation causing osteonecrosis, other bone or joint injuries (especially ankle, hip, knee, or spine), stress fractures (especially ankle, foot, hip, or knee) [1] |
Symptoms of Bone Marrow Edema
The main symptom of bone marrow edema is pain around or in your bone. Other symptoms may include joint effusion (swollen joints) and warm joints. Some people with BME may not have any symptoms at all. [1]
How Is Bone Marrow Edema Diagnosed?
Your healthcare provider will do a physical examination and ask about your symptoms and medical history. Providers often diagnose bone marrow edema when someone has a related health condition. [1]
If they suspect BME, your provider may suggest these tests: [1]
Test | What it involves |
Physical exam | Examines the affected area; reviews your symptoms and medical history [1] |
Blood tests | Looks for signs of inflammation [1] |
MRI | Images the bone marrow to reveal fluid buildup |
Ultrasound | Evaluates the affected area with sound waves |
DEXA (DXA) scan | Checks for osteoporosis [1] |
Bone marrow biopsy | Samples the marrow tissue directly |
Important to know: CT scans and X-rays do not show bone marrow edema. [1]
How Is Bone Marrow Edema Treated?
Bone marrow edema usually goes away on its own over time. Your provider will probably recommend that you rest, often for several months. [1]
To manage your symptoms, your provider may also suggest nonsteroidal anti-inflammatory drugs (NSAIDs) and physical therapy. [1]
If you have a more serious form of bone marrow edema, your provider may recommend steroid injections or surgery. [1]
If you need surgery, your surgeon may suggest core decompression surgery. During this surgery, they drill small holes into your bone. These holes help lessen pressure and reduce pain. [1]
To encourage the growth of healthy bone marrow, your surgeon may recommend a bone marrow transplant with stem cells — especially if a cancerous condition has been identified as the cause — or fill the holes with bone grafts. [1]
Treatment | When it's used | How it helps |
Rest | First-line, for most cases | Gives the bone time to heal; often required for several months |
NSAIDs | Symptom management [1] | Reduces inflammation and pain |
Physical therapy | Symptom management [1] | Restores strength and function around the affected bone |
Steroid injections | More serious forms [1] | Reduces inflammation directly at the site |
Core decompression surgery | More serious forms [1] | Small drilled holes lessen pressure and reduce pain [1] |
Stem cell transplant / bone grafts | Cancerous causes or to encourage healthy marrow growth [1] | Fills surgical holes and supports new, healthy bone marrow [1] |
How Soon Will You See Results?
Results will depend on the cause of the bone marrow edema, the severity of your condition, and the treatment you use. Symptoms often go away in four to 12 months. But sometimes bone marrow edema can last for two years or more. [1]
Outlook: What Can You Expect?
The good news is that BME usually goes away over time. [1] The waiting period can be frustrating, especially when the pain is significant, but the prognosis is generally favorable.
Prevention: Can You Reduce Your Risk?
You cannot reduce your risk of bone marrow edema. But seeing your provider as soon as you have symptoms helps you begin treatment promptly. [1]
Living With Bone Marrow Edema
Be sure to rest the bones affected by BME and follow your healthcare provider's instructions. [1]
See your provider if your symptoms return or worsen. Also, see your provider with any concerns about side effects from your treatments, or if you don't notice any results after some time — they will be able to recommend other treatments that may help. [1]
Conclusion
Bone marrow edema sounds alarming — fluid inside your bone — but in most cases it is a temporary, treatable finding that resolves on its own. Whether it stems from arthritis, an ACL tear, a stress fracture, or a metabolic condition, the treatment path usually begins with rest, NSAIDs, and physical therapy, reserving injections and surgery for more serious cases. Because CT scans and X-rays can't detect it, an MRI is your provider's key tool, and patience is the key ingredient in your recovery: symptoms often take four to 12 months to fade. If you have persistent bone pain, don't wait it out — an early evaluation gets your treatment started sooner.
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Frequently Asked Questions
What is bone marrow edema?
Bone marrow edema is swelling caused by fluid that builds up inside your bone marrow — the spongy tissue inside your bones that contains blood stem cells. Another name for it is bone marrow lesions. [1]
Is bone marrow edema serious?
Bone marrow edema may be very painful, but it usually goes away over time. Treatments focus on managing symptoms. However, serious forms may require steroid injections or surgery. [1]
What causes bone marrow edema?
Bone marrow edema is caused by underlying health conditions such as osteoarthritis or osteoporosis, injury, or infection. Specific causes range from ACL tears and stress fractures to rheumatoid arthritis, bone infections, and certain cancers. [1]
What are the symptoms of bone marrow edema?
The main symptom is pain around or in your bone. Other symptoms include swollen joints (joint effusion) and warm joints. Some people have no symptoms at all. [1]
What is the difference between secondary and primary bone marrow edema?
Secondary BME is caused by another condition and can be symptomatic or symptom-free. Spontaneous (primary) BME has no known cause but involves specific pain and is also called bone marrow edema syndrome. [1]
What is bone marrow edema syndrome?
BMES is a rare type of BME with an unknown cause, most common in men between the ages of 30 and 60. It may be related to high cholesterol and low vitamin D, and most often affects the lower part of the body. [1]
Who is at higher risk of bone marrow edema?
People of any age, race, or sex can develop BME, but your risk is greater if you have arthritis, bone cancer, bone infections (osteomyelitis), or osteoporosis. [1]
Can bone marrow edema be caused by cancer?
Yes. Cancers that may cause BME include acute myeloid leukemia (AML), bone metastasis, chondrosarcoma, Ewing sarcoma, and osteosarcoma. Radiation therapy for cancer can also cause it. [1]
Which joint injuries commonly cause bone marrow edema?
ACL tears, hip dislocations, compression fractures, stress fractures (especially of the ankle, foot, hip, or knee), and other bone or joint injuries, especially of the ankle, hip, knee, or spine. [1]
Which metabolic conditions cause bone marrow edema?
Cushing syndrome, hyperparathyroidism, mastocytosis, mineral and bone disorders due to chronic kidney disease, osteomalacia, osteoporosis (especially of the hip and knee), and vitamin D deficiency. [1]
How is bone marrow edema diagnosed?
With a physical exam plus blood tests (to look for inflammation), MRI, ultrasound, DEXA scans (for osteoporosis), and sometimes a bone marrow biopsy. CT scans and X-rays do not show bone marrow edema. [1]
Why do CT scans and X-rays not show bone marrow edema?
Standard X-rays and CT scans mainly show dense bone structure rather than fluid within the soft marrow, so they usually miss it. MRI, which shows soft tissue well, is the key diagnostic tool.
How is bone marrow edema treated?
Most cases are treated with rest (often for several months), NSAIDs, and physical therapy. More serious forms may require steroid injections or surgery such as core decompression. [1]
What is core decompression surgery?
A procedure where the surgeon drills small holes into the bone to lessen pressure and reduce pain. [1] The holes may then be filled with bone grafts or stem cells to encourage healthy marrow growth.
How long does bone marrow edema take to heal?
Symptoms often go away in four to 12 months, depending on the cause, severity, and treatment. Sometimes it can last two years or more. [1]
Can you prevent bone marrow edema?
You cannot reduce your risk of bone marrow edema. But seeing your provider as soon as you have symptoms helps you begin treatment promptly. [1]
What should I do while recovering from bone marrow edema?
Rest the bones affected by BME and follow your healthcare provider's instructions. [1]
When should I see my provider again?
See your provider if your symptoms return or worsen, if you have concerns about treatment side effects, or if you don't notice any results after some time. [1]
Related Reading
What Is a Bone Bruise (Bone Contusion)? Symptoms, Causes, and Treatment Options
Osteoporosis: Causes, Symptoms, Diagnosis and Treatment Explained
Avascular Necrosis (Osteonecrosis): Symptoms, Causes, Diagnosis & Treatment — Complete Guide
Rheumatoid Arthritis — Symptoms, Causes, Diagnosis, Treatment & Complete Guide
Tendinopathy: Symptoms, Causes, Diagnosis and Treatment — What You Need to Know
Understanding NSAIDs: A Comprehensive Guide to Nonsteroidal Anti-Inflammatory Drugs
References
Cleveland Clinic. Bone Marrow Edema. Cleveland Clinic. Last reviewed January 3, 2023. https://my.clevelandclinic.org/health/diseases/24622-bone-marrow-edema
Baumbach SF, Pfahler V, Bechtold-Dalla Pozza S, et al. How We Manage Bone Marrow Edema—An Interdisciplinary Approach. J Clin Med. 2020;9(2):551. PMID 32085459. https://doi.org/10.3390/jcm9020551
Davis DD, Kane SM. Bone Marrow Edema Syndrome. StatPearls [Internet]. Treasure Island, FL: StatPearls Publishing; updated June 5, 2023. PMID: 32644602. https://www.ncbi.nlm.nih.gov/books/NBK559176/
Patel S. Primary bone marrow oedema syndromes. Rheumatology (Oxford). 2014;53(5):785-792. PMID 24080251. https://doi.org/10.1093/rheumatology/ket324
Szaro P, Geijer M, Solidakis N. Traumatic and non-traumatic bone marrow edema in ankle MRI: a pictorial essay. Insights Imaging. 2020;11:97. PMID 32804284. https://doi.org/10.1186/s13244-020-00900-8
Sobti A, James J, Sobti S, et al. Bone Marrow Edema Syndrome, Revisiting a Forgotten Entity. Open J Orthop. 2020;10(2):21-24. https://doi.org/10.4236/ojo.2020.102004
Paraskevopoulos K, Keskinis A, Vasios IS, et al. Comparison of various treatment modalities for the management of bone marrow edema syndrome/transient osteoporosis in men and non-pregnant women: a systematic review. Osteoporos Int. 2023;34(2):269-290. PMID 36370218. https://doi.org/10.1007/s00198-022-06584-8
Zippelius T, Strube P, Rohe S, et al. The Use of Iloprost in the Treatment of Bone Marrow Edema Syndrome of the Proximal Femur: A Review and Meta-Analysis. J Pers Med. 2022;12(11):1757. PMID 36573724. https://doi.org/10.3390/jpm12111757
Medical disclaimer
This article is for general informational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of a qualified healthcare provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read in this article.
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