Over the last decades, there has been a significant increase in the diagnosis of „bone marrow edema“ (BME). BME is primarily a radiological-descriptive term. It can be caused by a variety of physiological and pathophysiological processes. This narrative review aims to present a standardized diagnostic algorithm and summarize the existing evidence on adjunctive therapies.
The diagnostic algorithm is based on a sequential diagnostic approach, which includes MRI, X-ray/CT, basic laboratory tests, a detailed endocrinological laboratory workup, and DXA. This sequential process addresses traumatic, inflammatory, septic, mechanical/degenerative, ischemic/neurogenic, neoplastic, and metabolic causes of BME. Only when no specific cause has been identified, the BME should be classified as a bone marrow edema syndrome (BMES).
The cornerstone of BME therapy is identifying and treating the underlying pathology. Only by addressing the cause long-term recovery can be achieved. In addition to treating the primary disease—or in cases of isolated BMES—adjunctive conservative therapies (e.g., NSAIDs ± immobilization ± partial weight-bearing, shockwave therapy, pulsed electromagnetic fields) or pharmacological treatments (e.g., bisphosphonates or iloprost) may be considered. All pharmacological treatments are off-label and therefore require an informed consent. According to the authors, surgical treatment is not part of BME Management.
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