Fracture healing and NSAIDs

Christopher Lam

The article by Taylor et al provided very limited data comparing use of analgesics and rates of nonunion.¹ It is pretty drastic to conclude that “patients should not be denied NSAIDs [nonsteroidal anti-inflammatory drugs] for short-term pain relief.”¹ In terms of fracture healing there is evidence in rodent studies that NSAIDs can slow healing.^2–4 A review article by Boursinos et al advised caution in using NSAIDs in patients with fractures.⁵ As inflammation is the first step in the healing process, and given the range of choice of analgesics, there is no particular reason to recommend NSAIDs after a fracture.

Footnotes

Competing interests

None declared

References

1.↵
1. Taylor IC,
2. Lindblad AJ,
3. Kolber MR
. Fracture healing and NSAIDs. Can Fam Physician 2014;60:817. (Eng), e429 (Fr).
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2.↵
1. Li J,
2. Waugh LJ,
3. Hui SL,
4. Burr DB,
5. Warden SJ
. Low-intensity pulsed ultrasound and nonsteroidal anti-inflammatory drugs have opposing effects during stress fracture repair. J Ortho Res 2007;25(12):1559-67.
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3.
1. Murnaghan M,
2. Li G,
3. Marsh DR
. Nonsteroidal anti-inflammatory drug-induced fracture nonunion: an inhibition of angiogenesis? J Bone Joint Surg Am 2006;88(Suppl 3):140-7.
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4.↵
1. Brown KM,
2. Saunders MM,
3. Kirsch T,
4. Donahue HJ,
5. Reid JS
. Effect of COX-2-specific inhibition on fracture-healing in the rat femur. J Bone Joint Surg Am 2004;86-A(1):116-23.
OpenUrl Abstract/FREE Full Text
5.↵
1. Boursinos LA,
2. Karachalios T,
3. Poultsides L,
4. Malizos KN
. Do steroids, conventional nonsteroidal anti-inflammatory drugs and selective Cox-2 inhibitors adversely affect fracture healing? J Musculoskelet Neuronal Interact 2009;9(1):44-52.
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