What Causes Bone Pain in the Legs?

Bone pain in the legs can have several causes, including infection, a bone bruise or fracture, or even bone cancer. The diagnosis will depend on your symptoms and the type of pain (sharp, stabbing, or dull). Imaging and blood tests can help a healthcare provider to determine a diagnosis.

Treatment for bone pain will depend on the cause. It may be as simple as rest and over-the-counter pain medication for a minor injury to cancer care after a bone marrow biopsy. Some people may need immediate intervention, for example, to deal with complications of sickle cell disease.

This article discusses the causes of bone pain and how you can know if the pain is a sign of a serious health concern. It explains how various conditions that cause bone pain are treated.

bone pain causes

Verywell / Alexandra Gordon

Osteoporosis

Osteoporosis is a disease in which your bones become thinner and weaken, typically with age, although it can affect young people. About 54 million people, both male and female, live with osteoporosis in the United States. Risk factors include:

  • Underlying health issues
  • Medication
  • Genetics
  • Hormonal changes
  • Diet, smoking, and other lifestyle factors

Osteoporosis is a common cause of bone pain. Bone density scans are used to evaluate a diagnosis, with X-rays often used to confirm a fracture. Treatment will depend on the problem, but prevention is key with the disease. It includes:

  • Maintaining a healthy weight
  • Regular weight-bearing exercise, like walking
  • Vitamin D and calcium in your diet
  • No smoking

Osteoporosis is a common cause of bone fractures, while bone bruises often are caused by osteoarthritis. As cartilage between bones wears away or degenerates, the bones begin to rub against each other—a trauma that can eventually develop into a bruise.

Bone Bruise

A bone bruise most commonly occurs when a bone hits a hard surface, as in a fall from a great height. It is often associated with another injury, like an anterior cruciate ligament (ACL) tear.

A bruise causes:

  • Bone pain with tenderness to the touch
  • Swelling
  • Discoloration

The diagnosis of bone pain usually involves visual confirmation of the injury during a physical exam, along with a detailed medical history and an X-ray or other imaging tests. Treatment includes:

  • Rest: In order to allow for optimal healing, resting the affected bone is extremely important.
  • Ice: Applying a cold compress, bag of ice, or bag of frozen peas over the bruised bone can reduce swelling, stiffness, and pain.
  • Support: If the bruised bone is near a joint (for example, your knee), wearing a knee brace can provide support and stability.

To ease your bone pain, your healthcare provider may recommend Tylenol (acetaminophen) or a non-steroidal anti-inflammatory drug (NSAID) like Advil (ibuprofen).

Preventing a Bone Bruise

To prevent bone bruises, wear protective gear during contact sports, like shin guards and knee or elbow pads. Always wear a bicycle helmet when riding, and use seatbelts while riding in a vehicle.

Fracture

A fracture refers to a broken bone, which may occur as a result of trauma, bone weakening from osteoporosis, or repetitive stresses on the bone.

Besides a sharp, stabbing pain that worsens with movement or when pressure is applied, swelling and bruising around the fracture may occur. In some cases, the area involving the fracture will appear deformed.

Diagnosis is typically straightforward. The fracture may be visible, or the injury is identified with imaging. Treatment will depend on the location and severity of the fracture. A finger may require basic splinting for a few weeks, while a severe femur (leg) fracture needs immediate surgery.

Pain management and physical therapy also may be part of your fracture treatment plan, in order to strengthen and improve the flexibility and mobility of surrounding muscles. Physical therapy is also useful for improving bone strength and health in people who have osteoporosis or osteomalacia.

Vertebral compression fractures—also called spinal fractures—cause back pain and are most common in individuals with osteoporosis. These fractures may result from simple tasks like performing a household chore, sneezing, or coughing.

Infection

An infection of the bone—called osteomyelitis—causes dull bone pain, along with swelling, warmth, redness, and tenderness around the affected area. A fever may also be present.

Osteomyelitis may occur as a result of bacteria within the bloodstream seeding the bone or from an infection that spreads to the bone from an adjacent soft tissue or joint. Antibiotics are used to treat many types of bone infections after a diagnosis that relies on blood tests and imaging.

However, some people experience chronic osteomyelitis that's not caused by bacteria. This bone pain primarily affects children and is treated with other medications.

Antibiotics, given through the vein (intravenous), are necessary to treat a bone infection. In some cases, surgical techniques are used to remove dead bone and tissue.

Osteonecrosis

Osteonecrosis occurs when a bone's blood supply is compromised, resulting in death of bone and bone marrow cells and subsequent bone collapse. In addition to pain, limited use of the affected area is common. For instance, with osteonecrosis of the hip, a person may limp and require the use of a cane or walker.

Besides serious injury or trauma, the most common risk factors for developing osteonecrosis include:

Treatment may vary depending on the location and severity of the osteonecrosis. It can include anti-inflammatory medication and surgical options.

Osteomalacia

Osteomalacia refers to decreased bone mineralization and subsequent bone softening. This bone condition most commonly occurs as a result of vitamin D deficiency. While not always present, the dull, aching bone pain of osteomalacia tends to be worse with activity and bearing weight.

In addition to generalized bone pain and tenderness, a person with osteomalacia may experience:

  • Muscle weakness
  • Muscle spasms and cramps
  • Fractures
  • Difficulty walking and a waddling gait
  • Fractures due to excessive bone weakening

Treatment depends on the underlying cause but may require vitamin D supplements since vitamin D deficiency is the most common cause. Improvement in bone pain can be significant, occurring within weeks.

Paget's Disease

Paget's disease is a chronic bone condition that affects older adults. In this disease, the bone remodeling process (in which old bone is removed and new bone is formed) goes awry. This leads to the formation of excess bone that is brittle or abnormally shaped.

Bone pain is the most common symptom. However, many people with Paget's disease have no symptoms. The condition is often found by X-ray for another purpose. It most often affects the spine, pelvis, femur (thigh), humerus (upper arm), and skull bones. 

An alkaline phosphatase blood level test (which would be elevated due to the high rate of bone turnover going on) and liver function tests are used to diagnose Paget's. A bisphosphonate medication is used to treat Paget's disease, as well as bone damage caused by cancer or osteoporosis. In some cases, surgery may be needed to treat Paget's.

Vaso-Occlusive Crisis From Sickle Cell Anemia

Sickle cell anemia is an inherited disease caused by a mutation in the gene that codes for hemoglobin, a protein that delivers oxygen within your red blood cells to your organs and tissues. The abnormal hemoglobin in people with sickle cell anemia (called hemoglobin S) leads to crescent-shaped red blood cells that are sticky and stiff.

Unfortunately, these sticky, stiff cells get stuck to the walls of small blood vessels, eventually blocking blood flow and oxygen delivery—a phenomenon called a vaso-occlusive crisis (VOC).

Bone pain from a VOC can be intense and felt in the legs, arms, and back.

Triggers are variable and often unknown, but may include:

  • Dehydration
  • Weather or air conditions like cold, windy, or low humidity
  • Travel to high-altitude places
  • Stress
  • Infection

Sickle cell anemia requires life-long treatment. In addition to pain medications, patients often take antibiotics to prevent and treat infections and Hydrea (hydroxyurea) to help reduce the number of vaso-occlusive crises.

Because sickle cell anemia is a genetic disease, vaso-occlusive crises may begin in babies as young as 6 months old and last throughout life.

Primary Bone Cancer

Bone pain is the most common symptom of bone cancer. The pain usually comes and goes at first and then becomes constant. Besides a deep or dull aching pain that is worse at night and during activity, swelling around the bone, weight loss, and fatigue may occur with bone cancer 410.

Primary bone cancers, ranging from most to least common, include:

For a suspected bone cancer diagnosis, several blood tests will be ordered by an oncologist. Other tests include imaging and a biopsy, commonly used to diagnose cancer. It involves removing a small piece of the affected bone and sending it off to a laboratory for examination under a microscope.

Both osteosarcoma and Ewing's sarcoma are more common in children and adolescents. Chondrosarcoma is most common in adults older than 40 years. 

Metastatic Bone Cancer

Metastatic bone cancer refers to cancer that begins in another organ (most commonly, the breast, lung, thyroid, kidney, and prostate) and spreads (metastasizes) to the bone. Cancer that spreads to the bone weakens it, causing pain and making the bone more prone to breaking.

An oncologist will order blood tests, especially if the cancer is metastatic and the primary cancer site is unknown. While certainly not an exhaustive list, some of these blood tests that may be ordered include:

Multiple Myeloma

Multiple myeloma is a cancer of plasma cells, a type of immune system cell that normally produces antibodies. These cells grow abnormally and uncontrollably within the bone marrow and eventually cause a multitude of symptoms including:

  • Bone pain (felt most commonly in the back or chest and triggered by movement)
  • Fractures
  • Anemia (low iron) or hypercalcemia (high calcium levels)
  • Infection
  • Kidney problems

Neurologic problems also affect people with multiple myeloma. To diagnose the condition, your healthcare provider will order a blood and urine protein electrophoresis. These tests look for the abnormal protein produced by plasma cells called a monoclonal (M) protein.

Your healthcare provider also will order imaging and evaluate a bone marrow aspiration and biopsy. Treatment may include chemotherapy, steroid medications, and/or stem cell transplants.

Leukemia

With leukemia, abnormal blood cells grow uncontrollably within a person's bone marrow. This excess growth of cancer cells leads to overcrowding within the bone marrow, which causes bone and joint pain.

The aching bone pain is usually felt in the long bones of the arms and legs as well as the ribs. It is most common in acute lymphoblastic leukemia, but may also occur in acute myeloid leukemia or myelodysplastic syndrome.

Blood tests, along with bone marrow aspiration and biopsy, are used to diagnose bone pain caused by leukemia.

Bone Pain and Cancer Treatments

Once cancer has been diagnosed, treatment will depend on the type of cancer, its location, and how advanced its growth and spread have become. It also will depend on if the cancer is a primary bone cancer or not. Radiation is a key therapy for treating primary and metastatic bone cancer. Other cancer treatments include:

When to Call a Healthcare Provider

It's important to seek medical attention for any type of bone pain, especially (and more urgently) if your pain is severe, persistent, worsening over time, or associated with:

Your healthcare provider will evaluate the pain, your mobility, and related factors. They will likely order imaging tests to diagnose your bone pain, and rule out other causes of joint pain or muscle pain. Beyond X-rays and bone scans, these tests may include:

Questions From a Healthcare Provider

Expect to answer these questions about your bone pain:

  • Where is your pain located?
  • When did your bone pain first become noticeable?
  • Have you experienced any recent trauma or injury?
  • Is your pain constant or does it come and go?
  • Does anything make your pain worse or better?
  • Does your pain wake you up at night?
  • Are you experiencing other symptoms (e.g., fever, weight loss, or muscle weakness)?

Summary

Bone pain in your legs can have many causes. They may be obvious, as is the case when you injure yourself and know the cause of a bone bruise or fracture. The cause also may become clear during routine tests, like a bone density scan that reveals osteoporosis or an X-ray that shows Paget's disease even where no pain occurred.

In other cases, though, the bone pain in your legs may be more difficult to diagnose. It also may involve a serious illness such as cancer or complications of sickle cell disease.

Contact your healthcare provider for diagnosis and treatment of your bone pain. And seek immediate care for a sudden injury or if symptoms are severe.

16 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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By Carol Eustice
Carol Eustice is a writer covering arthritis and chronic illness, who herself has been diagnosed with both rheumatoid arthritis and osteoarthritis.