Bones Are Painful: What Causes Bone Pain

What bone pain feels like

Bone pain is usually described as deep, dull, penetrating or boring. Unlike muscle pain, it is often present at rest and may not change much with movement. It can wake you at night. The bone may be tender to press. Joint pain, by contrast, is felt at the joint and worsens with moving that joint, and muscle pain is more cramp-like or sore and eases with rest.

Causes of painful bones

Injury and overuse

• Fractures: sudden pain, swelling, bruising and loss of function after trauma.
• Stress fractures: tiny cracks from repetitive load, common in runners, dancers and military recruits. Pain builds with activity, then becomes constant, with a tender spot on the shin, foot or hip.
• Shin splints: a diffuse ache along the inner shin from overuse.
• Bone bruise: after a blow or twisting injury, seen on MRI.

Bone softening and thinning

• Osteomalacia (soft bones from vitamin D deficiency): a widespread dull ache, especially in the lower back, pelvis, hips, legs and ribs, with muscle weakness and a waddling gait. In children it causes rickets. Vitamin D deficiency is common in people with little sun exposure, dark skin living at high latitudes, malabsorption, kidney or liver disease.
• Osteoporosis: thin bones cause no pain until a fracture happens, often a sudden sharp pain in the back from a vertebral compression fracture, or a wrist or hip fracture after a minor fall.

Children and teenagers

• Growing pains: an aching in both legs (thighs, calves, behind the knees) in the evening or night, gone by morning, in children aged roughly 3 to 12. They never cause limping, swelling or daytime pain.
• Osgood-Schlatter disease and Sever's disease: growth plate irritation below the knee or at the heel in active children.

Infection

Osteomyelitis is infection of the bone. It may follow a blood infection (common in children, often in the long bones), an open fracture, surgery or a diabetic foot ulcer. It causes constant pain, tenderness, warmth, swelling and fever.

Other bone diseases

• Paget's disease of bone: disordered bone remodeling in older adults, causing aching, enlarged or bowed bones, often the pelvis, spine, skull or legs. Blood alkaline phosphatase (ALP) is high.
• Avascular necrosis: bone death from loss of blood supply, often the hip, linked to steroids and alcohol.
• Hyperparathyroidism: high calcium and bone loss, with aches, kidney stones and tiredness.
• Fibrous dysplasia and benign bone tumors.

Blood disorders

• Sickle cell disease: sudden severe bone pain crises from blocked blood flow.
• Leukemia: in children, bone pain, a limp, bruising, pallor and fever.
• Multiple myeloma: a cancer of plasma cells in adults over 60, causing back or rib pain, fractures, tiredness, kidney problems and high calcium.

Cancer in bone

• Primary bone cancer (osteosarcoma, Ewing sarcoma) mainly affects children and young adults, typically around the knee or in the pelvis, with night pain and later swelling.
• Bone metastases are far more common than primary bone cancer. Breast, prostate, lung, kidney and thyroid cancers spread to the spine, pelvis, ribs and long bones.

Medicines and other causes

Some medicines cause bone aches: aromatase inhibitors for breast cancer, filgrastim (white cell boosters), and bisphosphonates in the first days of treatment. Viral infections such as flu and dengue cause aching "in the bones" that is actually muscle and whole-body inflammation.

Clues to the cause

When to worry about bone pain

Red flags that need prompt medical review include pain that is constant and progressive, pain that wakes you at night, a lump or swelling over the bone, fever, unexplained weight loss, night sweats, a history of cancer, and fractures after minimal force.

How doctors diagnose bone pain

The doctor will ask where the pain is, when it started, what makes it worse, and about injuries, activity, diet, sun exposure, medicines and other symptoms. They will press over the bones, check joints and muscle strength, and look for swelling or deformity.

Tests may include:

• Blood tests: full blood count, calcium, phosphate, alkaline phosphatase, vitamin D, parathyroid hormone, kidney function, inflammatory markers, PSA in men, and protein electrophoresis for myeloma
• X-ray: fractures, bone thinning, tumors, Paget's disease
• MRI: early stress fractures, infection, bone marrow problems
• Bone scan or PET-CT: spread of cancer, multiple sites of disease
• DEXA scan: bone density for osteoporosis
• Biopsy: when a tumor or unusual infection is suspected

Treatment and home care

Treatment depends on the cause:

• Overuse injuries: relative rest for 4 to 8 weeks, gradual return to activity, supportive footwear.
• Vitamin D deficiency: vitamin D and calcium replacement as advised by your doctor. Bone aches improve over weeks to months.
• Osteoporosis: bisphosphonates or other bone-strengthening medicines, calcium and vitamin D, weight-bearing exercise, fall prevention.
• Infection: prolonged antibiotics and sometimes surgery.
• Cancer-related pain: radiotherapy, bone-strengthening drugs, pain medicines and treatment of the cancer.

For pain relief, acetaminophen (paracetamol) or an NSAID such as ibuprofen can help; follow the label dose and avoid NSAIDs if you have kidney disease, stomach ulcers or take blood thinners. Warm packs help growing pains.

Frequently asked questions

Why are my bones painful?

The most common reasons are injury, overuse and stress fractures, and vitamin D deficiency, which softens bones and causes widespread aching. Osteoporotic fractures, infection, Paget's disease and, less often, cancer are other causes. Persistent or night-time bone pain should be checked by a doctor.

What does bone pain at night mean?

Night pain that wakes you is a red flag because it can be a sign of a bone tumor, infection or cancer that has spread to bone. It can also occur with stress fractures and growing pains. Pain that is constant and worsening at night needs an X-ray and blood tests.

Can vitamin D deficiency cause aching bones?

Yes. Low vitamin D causes osteomalacia, where bones are poorly mineralized and become soft. This produces a deep aching in the lower back, hips, pelvis, legs and ribs, often with muscle weakness. A blood test confirms it, and replacement therapy usually improves symptoms over months.

How can I tell bone pain from muscle pain?

Bone pain is usually deep, dull and constant, may be present at rest and can wake you at night. Muscle pain is more cramping or sore, often follows activity and eases with rest and stretching. Joint pain is felt at the joint and worsens with moving it.

Can anxiety cause bone pain?

Anxiety does not damage bones, but it increases muscle tension and pain sensitivity, which can feel like aching all over. Bone pain that is localized, constant, worse at night or associated with swelling or weight loss should not be blamed on anxiety without proper tests.