Risk factors for osteomyelitis: a systematic review and meta-analysis

Area of Science:

• Orthopedics
• Infectious Diseases
• Epidemiology

Background:

• Osteomyelitis (OM) is a severe bone infection frequently linked to diabetic foot ulcers, trauma, or surgery.
• Its complex nature and recurrence necessitate identifying reliable risk factors for timely diagnosis and treatment.
• This study systematically reviews and analyzes independent risk factors for OM.

Purpose of the Study:

• To conduct a systematic review and meta-analysis to identify independent risk factors for osteomyelitis (OM).
• To provide evidence for early diagnosis and targeted interventions for OM.
• To reduce the incidence of amputations and healthcare burden associated with OM.

Main Methods:

• A comprehensive literature search was performed across multiple databases up to January 2025.
• Data extraction and quality assessment (Newcastle-Ottawa Scale) were conducted independently.
• Statistical analyses included univariate and multivariate methods, with heterogeneity and publication bias assessed.

Main Results:

• 27 studies (11,941 participants) were included, analyzing risk factors across demographic, medical, clinical, laboratory, and bacterial categories.
• Significant medical history risk factors included foot ulcers (OR=2.520), long operation duration (OR=1.740), and large incision length (OR=6.530).
• Clinical features (inflamed ulcer, fever, ulcer size), laboratory findings (elevated HbA1c, hypoalbuminemia, anemia), and polymicrobial infections were also identified as independent OM risk factors.

Conclusions:

• This meta-analysis is the first to combine univariate and multivariate evidence on OM risk factors.
• It highlights clinically preventable risk factors applicable across OM subtypes.
• Findings enable early, targeted interventions to mitigate OM-related amputations and healthcare costs.