What are the key clinical features that suggest a diagnosis of osteomyelitis in a patient presenting with bone pain?

Key clinical features suggesting osteomyelitis in a patient presenting with bone pain include:

• Localized bone pain that is often severe and persistent, worsening over time.
• Swelling, tenderness, and warmth over the affected bone area, indicating local inflammation.
• Systemic signs such as fever and malaise, reflecting an infectious process.
• Reduced function or movement of the adjacent joint or limb due to pain and inflammation.
• In some cases, the presence of a draining sinus or overlying skin changes if the infection has progressed.
• In vertebral osteomyelitis, back pain with possible neurological symptoms if there is spinal involvement.

These features align with UK clinical guidelines emphasizing localized pain, swelling, and systemic infection signs as key diagnostic clues ¹. Recent literature further highlights that osteomyelitis may present variably depending on the site, such as mandibular osteomyelitis presenting with jaw pain and swelling (Kumar et al., 2025). Additionally, vertebral osteomyelitis often presents with insidious onset back pain and systemic symptoms (Gasbarrini et al., 2005). Thus, a combination of localized bone pain, signs of inflammation, systemic illness, and site-specific symptoms should raise suspicion for osteomyelitis.