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Nutritional support may reduce infection risks and improve outcomes in bone infectionsNutritional support may lower risks for serious bone infections

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Key Takeaway
Consider nutritional support as a core management strategy to reduce infection and wound complications in bone infections.

This narrative review synthesizes the role of nutritional support, including macronutrients, micronutrients, and immunomodulatory nutrients, in the management of patients with bone infections such as osteomyelitis and periprosthetic joint infection. The review highlights that patients with inadequate nutritional status face a 2-4-fold higher risk of postoperative infection, wound dehiscence, and sepsis. Furthermore, the review notes a 2-year osteomyelitis risk of RR = 2.55 in certain contexts.

The authors suggest specific nutritional targets for patients to maintain nitrogen balance and support bone repair, recommending protein intake of 1.5-2.0 g/kg/d and energy intake of 25-35 kcal/kg/d. These findings suggest that nutritional intervention may mitigate the risks associated with bone infections.

A significant limitation noted by the authors is the lack of high-quality RCTs for bone infections, with most current recommendations derived from observational studies (evidence levels C-D). Despite these limitations, the authors argue that nutritional support should be elevated to core status, recommending routine screening and a structured management pathway for patients with these conditions.

How this fits prior evidence

This narrative review addresses a gap in the management of bone infections by emphasizing nutritional support. While prior coverage noted that antibiotic holiday durations do not differ in treatment failure rates for periprosthetic joint infection, this review focuses on the role of macronutrients and micronutrients in reducing risks such as sepsis and wound dehiscence. It also notes that while probiotics show anti-Candida activity in preclinical models, clinical evidence for their use in bone infections remains limited.

When a patient suffers from a bone infection, like osteomyelitis or an infection near a joint replacement, the stakes are incredibly high. These infections can lead to serious complications, including wound failure and sepsis. Research shows that patients with poor nutritional status face a 2 to 4 fold higher risk of these dangerous complications. Additionally, those with poor nutrition face a much higher risk of developing osteomyelitis again within two years.

To fight these risks, experts suggest that nutritional support should be a core part of patient care. This includes providing specific amounts of protein and energy to help the body maintain a nitrogen balance and repair bone tissue. Specifically, the data suggests a goal of 1.5 to 2.0 grams of protein per kilogram of body weight daily, along with 25 to 35 calories per kilogram of body weight.

While these findings are promising, it is important to know that much of the current evidence comes from observational studies rather than high-quality clinical trials. Because the current evidence is not yet perfect, doctors are still working to establish the best routine for screening and managing these patients. Talk to your healthcare provider about how nutrition fits into your specific treatment plan.

What this means for you:
Proper protein and calorie intake can help reduce the risk of severe complications in patients with bone infections.

Common questions

How does nutrition affect the risk of complications from bone infections?

Patients with poor nutritional status face a 2 to 4 fold higher risk of serious complications like wound failure, sepsis, and postoperative infections. Proper nutritional support is being recommended as a core part of care to help manage these risks and improve patient outcomes.

What specific nutritional goals are recommended for these patients?

To help with bone repair and maintaining a nitrogen balance, the data suggests a goal of 1.5 to 2.0 grams of protein per kilogram of body weight daily. Patients also need between 25 and 35 calories per kilogram of body weight daily to support their recovery.

How strong is the evidence for using nutrition to treat bone infections?

The current evidence is still developing. Most of the current recommendations come from observational studies rather than high-quality clinical trials. Because of this, the evidence is not yet perfect, and doctors are still refining the best ways to screen and treat patients.

Study Details

Study typeSystematic review
EvidenceLevel 1
PublishedOct 2026
View Original Abstract ↓
Bone infections, including osteomyelitis and periprosthetic joint infection (PJI), are characterized by prolonged treatment, high recurrence, and functional impairment. Persistent inflammation induces hypercatabolism, negative nitrogen balance, and micronutrient depletion, impairing immune defense and bone repair. Systematic nutritional assessment remains insufficient. This review elucidates metabolic mechanisms under infectious stress, evaluates macronutrients, micronutrients, and immunomodulatory nutrients in infection control and bone regeneration, and proposes a clinical nutritional management framework. A structured literature search was conducted in PubMed, Web of Science, and CNKI from January 2020 to April 2026 to inform this narrative review. Studies on metabolic profiles, nutritional interventions, or nutritional status–outcome associations in osteomyelitis or PJI were included. Data were synthesized across five dimensions: molecular mechanisms, macronutrient therapy, micronutrient functions, immunonutrition, and implementation pathways, with evidence graded by OCEBM levels. TNF-α and IL-6 drive muscle degradation via ubiquitin-proteasome activation and mTORC1 suppression, causing negative nitrogen balance; zinc, selenium, and 25-hydroxyvitamin D are depleted. Nutritional risk markers (albumin ≤ 3.5 g/dl and/or lymphocytes ≤ 1.5 × 103/μl) are associated with 2-−4-fold higher risks of postoperative infection, wound dehiscence, and sepsis, and increased 2-year osteomyelitis risk (RR = 2.55). Protein (1.5–2.0 g/kg/d) and energy (25–35 kcal/kg/d) correct nitrogen balance and support immunity and bone repair. Vitamin D induces cathelicidin via VDR, exerting mineralization and anti-infection effects; zinc/selenium alleviate oxidative damage; omega-3 PUFAs provide anti-inflammatory effects. Probiotics show gut-bone axis potential with limited evidence. High-quality RCTs for bone infections are lacking; most recommendations derive from observational studies (evidence levels C–D). Nutritional support should be elevated to core status. We recommend routine albumin, prealbumin, and lymphocyte screening, and a “screening → assessment → stratified intervention → dynamic monitoring” pathway. Enteral nutrition is preferred perioperatively, with 1.5–2.0 g/kg/d protein and 25–35 kcal/kg/d energy, plus individualized correction of vitamin D, zinc, and selenium deficiencies. Multicenter RCTs are needed to validate immunonutrient efficacy and advance precision nutrition via metabolomics and gut-bone axis mechanisms.
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