The present invention relates to the medical use of polysulfated polysaccharides and compositions thereof for the treatment of disease or disorders associated with bone marrow pathologies in the musculoskeletal system of a mammal. In particular, the invention relates to use of polysulfated polysaccharides, such as pentosan polysulfate, in treatment of bone marrow edema lesions or spinal Modic Endplate Changes as assessed by magnetic resonance imaging (MRI).