Table of ContentsView AllTable of ContentsSymptomsCausesDiagnosisTreatmentPrognosis

Table of ContentsView All

View All

Table of Contents

Symptoms

Causes

Diagnosis

Treatment

Prognosis

Whiletuberculosis(TB)usually affects the lungs, it can attack any part of the body, including the bones. When TB occurs outside the lungs, it is called extrapulmonary tuberculosis.

Bone tuberculosis, orosteoarticulartuberculosis, is a type of extrapulmonary TB. Most often, bone TB affects the spine, but it can also spread to other bones and joints.

This article discusses bone tuberculosis, its symptoms, causes, how it’s diagnosed, and treatment options.

ADAM GAULT/SPL / Getty Images

A healthcare provider discussing the spine with an older man.

Incidence of Extrapulmonary TBExtrapulmonary tuberculosis (TB affecting areas of the body other than the lungs) accounts for about 20% of all TB cases.

Incidence of Extrapulmonary TB

Extrapulmonary tuberculosis (TB affecting areas of the body other than the lungs) accounts for about 20% of all TB cases.

Bone Tuberculosis Symptoms

Bone tuberculosis typically affects joints in the spine. Only 2% to 3% of cases occur in other joints—most often the hips and knees.

Symptoms of joint and bone tuberculosis typically include:

Up to one-third of people with bone tuberculosis will also have classicsymptoms of TB, such as:

Once the bacterium is in the lungs, it can grow and spread to other areas of the body through the bloodstream. However, tuberculosis that settles in places other than the lungs is not typically infectious.

What Is Tuberculosis?

The first step in diagnosing bone tuberculosis is to test for the presence of bacterium in the body. This can be done with a skin test and blood tests.

TheMantoux tuberculin skin testinvolves injecting a small amount of tuberculin underneath the skin (typically on the forearm). After 48 to 72 hours, the area is examined. If the skin presents with a raised, hard bump a healthcare provider measures the bump in millimeters (mm). A provider considers the size of the bump and the individual’s risk factors when determining whether the person had a positive reaction.

Blood tests can also be performed to identify an immune response to TB bacteria in the blood. Bone tuberculosis, specifically, is diagnosed throughbiopsiesand cultures of pus samples and tissue from the affected bone or joint.

Imaging tests, such asX-raysand magnetic resonance imaging (MRI), are also used to determine the extent of damage to the affected bone and/or joint.

Latent TuberculosisPeople can be infected with the bacterium that causes tuberculosis without being sick or contagious. This condition is called latent tuberculosis.Approximately 25% of the world’s population has latent TB, with 5% to 10% becoming sick at some point.People with human immunodeficiency virus (HIV) or other immune system diseases are more likely to develop active symptoms.Screening for latent TB is recommended for anyone at greater risk of exposure.

Latent Tuberculosis

People can be infected with the bacterium that causes tuberculosis without being sick or contagious. This condition is called latent tuberculosis.Approximately 25% of the world’s population has latent TB, with 5% to 10% becoming sick at some point.People with human immunodeficiency virus (HIV) or other immune system diseases are more likely to develop active symptoms.Screening for latent TB is recommended for anyone at greater risk of exposure.

People can be infected with the bacterium that causes tuberculosis without being sick or contagious. This condition is called latent tuberculosis.Approximately 25% of the world’s population has latent TB, with 5% to 10% becoming sick at some point.People with human immunodeficiency virus (HIV) or other immune system diseases are more likely to develop active symptoms.

Screening for latent TB is recommended for anyone at greater risk of exposure.

Treatment of bone tuberculosisincludes medication to treat the infection and sometimes surgery, depending on the amount of damage that has occurred to the bones or joints.

Medications

Tuberculosis is treated withantibiotics, but the specific drugs used depend on the particular type of bacteria present—some strains of bacteria that cause TB are resistant to certain antibiotics. Drug susceptibility testing is performed to determine the correct course of treatment.

Medication treatment of bone TB follows a specific frequency and dosage schedule that typically lasts six to 12 months, depending on the drugs used.

Drugs used in a nine- or 12-month RIPE treatment plan (named after the initials of the medications) include:

Other Treatments

Bone damage and infection from TB can require surgery in addition to medication. Procedures can include:

Restoring Function After Surgery

According to the World Health Organization (WHO), in 2020, approximately 10 million people became sick from tuberculosis worldwide. Of this population, 1.5 million people died from the disease.

Summary

Tuberculosis is an infectious disease that usually affects the lungs. However, it can also spread to other parts of the body, including the bones. This condition, called extrapulmonary tuberculosis, can lead to pain, decreased range of motion, loss of muscle mass, and joint deformities.

Bone tuberculosis is treated with medication and sometimes surgery, depending on the extent of bone damage.

14 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Centers for Disease Control and Prevention.About tuberculosis.Chen X, Jia X, Lei H, et al.Screening and identification of serum biomarkers of osteoarticular tuberculosis based on mass spectrometry.J Clin Lab Anal. 2020;34(7):e23297. doi:10.1002/jcla.23297Cataño J, Sanchez-Bautista J.Osteoarticular tuberculosis.Am J Trop Med Hyg. 2022;106(6):1575-1576. doi:10.4269/ajtmh.21-1258Agashe VM, Johari AN, Shah M, et al.Diagnosis of osteoarticular tuberculosis: perceptions, protocols, practices, and priorities in the endemic and non-endemic areas of the world—a waiot view.Microorganisms. 2020;8(9):1312. doi:10.3390/microorganisms8091312Centers for Disease Control and Prevention.Tuberculosis: Causes and how it spreads.Centers for Disease Control and Prevention.Tuberculin skin testing fact sheet.American Family Physician.Latent tuberculosis.World Health Organization.Tuberculosis.US Preventive Services Task Force, Mangione CM, Barry MJ, et al.Screening for Latent Tuberculosis Infection in Adults: US Preventive Services Task Force Recommendation Statement.JAMA. 2023;329(17):1487-1494. doi:10.1001/jama.2023.4899Centers for Disease Control and Prevention.Clinical overview of drug-resistant tuberculosis disease.Nahid P, Dorman SE, Alipanah N, et al.New guidelines for the treatment of drug-susceptible tuberculosis from the american thoracic society, centers for disease control and prevention, and the infectious diseases society of america. Now comes the hard part.Am J Respir Crit Care Med. 2016;194(7):791-793.Centers for Disease Control and Prevention.Treatment for TB disease.Zhao J, Lian XF, Hou TS, et al.Anterior debridement and bone grafting of spinal tuberculosis with one-stage instrumentation anteriorly or posteriorly.Int Orthop. 2007;31(6):859-863. doi:10.1007/s00264-006-0253-1Moule MG, Cirillo JD.Mycobacterium tuberculosis dissemination plays a critical role in pathogenesis.Front Cell Infect Microbiol. 2020;10:65. doi:10.3389/fcimb.2020.00065

14 Sources

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Centers for Disease Control and Prevention.About tuberculosis.Chen X, Jia X, Lei H, et al.Screening and identification of serum biomarkers of osteoarticular tuberculosis based on mass spectrometry.J Clin Lab Anal. 2020;34(7):e23297. doi:10.1002/jcla.23297Cataño J, Sanchez-Bautista J.Osteoarticular tuberculosis.Am J Trop Med Hyg. 2022;106(6):1575-1576. doi:10.4269/ajtmh.21-1258Agashe VM, Johari AN, Shah M, et al.Diagnosis of osteoarticular tuberculosis: perceptions, protocols, practices, and priorities in the endemic and non-endemic areas of the world—a waiot view.Microorganisms. 2020;8(9):1312. doi:10.3390/microorganisms8091312Centers for Disease Control and Prevention.Tuberculosis: Causes and how it spreads.Centers for Disease Control and Prevention.Tuberculin skin testing fact sheet.American Family Physician.Latent tuberculosis.World Health Organization.Tuberculosis.US Preventive Services Task Force, Mangione CM, Barry MJ, et al.Screening for Latent Tuberculosis Infection in Adults: US Preventive Services Task Force Recommendation Statement.JAMA. 2023;329(17):1487-1494. doi:10.1001/jama.2023.4899Centers for Disease Control and Prevention.Clinical overview of drug-resistant tuberculosis disease.Nahid P, Dorman SE, Alipanah N, et al.New guidelines for the treatment of drug-susceptible tuberculosis from the american thoracic society, centers for disease control and prevention, and the infectious diseases society of america. Now comes the hard part.Am J Respir Crit Care Med. 2016;194(7):791-793.Centers for Disease Control and Prevention.Treatment for TB disease.Zhao J, Lian XF, Hou TS, et al.Anterior debridement and bone grafting of spinal tuberculosis with one-stage instrumentation anteriorly or posteriorly.Int Orthop. 2007;31(6):859-863. doi:10.1007/s00264-006-0253-1Moule MG, Cirillo JD.Mycobacterium tuberculosis dissemination plays a critical role in pathogenesis.Front Cell Infect Microbiol. 2020;10:65. doi:10.3389/fcimb.2020.00065

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

Centers for Disease Control and Prevention.About tuberculosis.Chen X, Jia X, Lei H, et al.Screening and identification of serum biomarkers of osteoarticular tuberculosis based on mass spectrometry.J Clin Lab Anal. 2020;34(7):e23297. doi:10.1002/jcla.23297Cataño J, Sanchez-Bautista J.Osteoarticular tuberculosis.Am J Trop Med Hyg. 2022;106(6):1575-1576. doi:10.4269/ajtmh.21-1258Agashe VM, Johari AN, Shah M, et al.Diagnosis of osteoarticular tuberculosis: perceptions, protocols, practices, and priorities in the endemic and non-endemic areas of the world—a waiot view.Microorganisms. 2020;8(9):1312. doi:10.3390/microorganisms8091312Centers for Disease Control and Prevention.Tuberculosis: Causes and how it spreads.Centers for Disease Control and Prevention.Tuberculin skin testing fact sheet.American Family Physician.Latent tuberculosis.World Health Organization.Tuberculosis.US Preventive Services Task Force, Mangione CM, Barry MJ, et al.Screening for Latent Tuberculosis Infection in Adults: US Preventive Services Task Force Recommendation Statement.JAMA. 2023;329(17):1487-1494. doi:10.1001/jama.2023.4899Centers for Disease Control and Prevention.Clinical overview of drug-resistant tuberculosis disease.Nahid P, Dorman SE, Alipanah N, et al.New guidelines for the treatment of drug-susceptible tuberculosis from the american thoracic society, centers for disease control and prevention, and the infectious diseases society of america. Now comes the hard part.Am J Respir Crit Care Med. 2016;194(7):791-793.Centers for Disease Control and Prevention.Treatment for TB disease.Zhao J, Lian XF, Hou TS, et al.Anterior debridement and bone grafting of spinal tuberculosis with one-stage instrumentation anteriorly or posteriorly.Int Orthop. 2007;31(6):859-863. doi:10.1007/s00264-006-0253-1Moule MG, Cirillo JD.Mycobacterium tuberculosis dissemination plays a critical role in pathogenesis.Front Cell Infect Microbiol. 2020;10:65. doi:10.3389/fcimb.2020.00065

Centers for Disease Control and Prevention.About tuberculosis.

Chen X, Jia X, Lei H, et al.Screening and identification of serum biomarkers of osteoarticular tuberculosis based on mass spectrometry.J Clin Lab Anal. 2020;34(7):e23297. doi:10.1002/jcla.23297

Cataño J, Sanchez-Bautista J.Osteoarticular tuberculosis.Am J Trop Med Hyg. 2022;106(6):1575-1576. doi:10.4269/ajtmh.21-1258

Agashe VM, Johari AN, Shah M, et al.Diagnosis of osteoarticular tuberculosis: perceptions, protocols, practices, and priorities in the endemic and non-endemic areas of the world—a waiot view.Microorganisms. 2020;8(9):1312. doi:10.3390/microorganisms8091312

Centers for Disease Control and Prevention.Tuberculosis: Causes and how it spreads.

Centers for Disease Control and Prevention.Tuberculin skin testing fact sheet.

American Family Physician.Latent tuberculosis.

World Health Organization.Tuberculosis.

US Preventive Services Task Force, Mangione CM, Barry MJ, et al.Screening for Latent Tuberculosis Infection in Adults: US Preventive Services Task Force Recommendation Statement.JAMA. 2023;329(17):1487-1494. doi:10.1001/jama.2023.4899

Centers for Disease Control and Prevention.Clinical overview of drug-resistant tuberculosis disease.

Nahid P, Dorman SE, Alipanah N, et al.New guidelines for the treatment of drug-susceptible tuberculosis from the american thoracic society, centers for disease control and prevention, and the infectious diseases society of america. Now comes the hard part.Am J Respir Crit Care Med. 2016;194(7):791-793.

Centers for Disease Control and Prevention.Treatment for TB disease.

Zhao J, Lian XF, Hou TS, et al.Anterior debridement and bone grafting of spinal tuberculosis with one-stage instrumentation anteriorly or posteriorly.Int Orthop. 2007;31(6):859-863. doi:10.1007/s00264-006-0253-1

Moule MG, Cirillo JD.Mycobacterium tuberculosis dissemination plays a critical role in pathogenesis.Front Cell Infect Microbiol. 2020;10:65. doi:10.3389/fcimb.2020.00065

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