Mechanisms of bone degradation in infection: a review of current hypotheses

Bone infection in clinical practice results in loss of structural integrity, leading to complications such as fracture and implant loosening. The biology of this process has received relatively little attention. In experimental models it seems clear that both polymorphonuclear leukocytes, whose effect predominates in the early stages, and mononuclear phagocytes are capable of bone degradation. An indirect effect by stimulation of physiologic mechanisms of resorption has not been ruled out, but the evidence points to direct degradation by inflammatory cell enzymes.