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Title: NSAIDs and fracture healing
Authors: GEUSENS, Piet 
Emans, Pieter J.
de Jong, Joost J. A.
Issue Date: 2013
Source: CURRENT OPINION IN RHEUMATOLOGY, 25 (4), p. 524-531
Abstract: Purpose of review Published data raise concerns about the use of nonselective NSAIDs and selective cyclo-oxygenase (COX)-2 inhibitors as anti-inflammatory or analgesic drugs in patients after a recent fracture or who are undergoing (uncemented) arthroplasty or osteotomy. However, clinical reports on the effect of COX-2 inhibition on fracture healing in humans have been variable and inconclusive. This review gives an overview of the published data and an advice when to avoid NSAIDs. Recent findings Prostaglandins play an important role as mediators of inflammation and COX are required for their production. Inflammation is an essential step in the fracture healing process in which prostaglandin production by COX-2 is involved. Data from animal studies suggest that NSAIDs, which inhibit COX-2, can impair fracture healing due to the inhibition of the endochondral ossification pathway. Animal data suggest that the effects of COX-2 inhibitors are dependent on the timing, duration, and dose, and that these effects are reversible. Summary These animal data, together with the view of limited scientifically robust clinical evidence in humans, indicate that physicians consider only short-term administration of COX-2 inhibitors or other drugs in the pain management of patients who are in the phase of fracture or other bone defect healing. COX-2-inhibitors should be considered a potential risk factor for fracture healing, and therefore to be avoided in patients at risk for delayed fracture healing.
Notes: [Geusens, Piet; de Jong, Joost J. A.; van den Bergh, Joop] Maastricht Univ, Dept Rheumatol, Med Ctr, NL-6202 AZ Maastricht, Netherlands. [Geusens, Piet; Emans, Pieter J.] Maastricht Univ, Res Sch CAPHRI, NL-6202 AZ Maastricht, Netherlands. [Geusens, Piet; van den Bergh, Joop] Hasselt Univ, Biomed Res Ctr, Hasselt, Belgium. [Emans, Pieter J.] Maastricht Univ, Dept Orthoped, Med Ctr, NL-6202 AZ Maastricht, Netherlands. [de Jong, Joost J. A.; van den Bergh, Joop] Maastricht Univ, Res Sch NUTRIM, Med Ctr, NL-6202 AZ Maastricht, Netherlands. [van den Bergh, Joop] Viecuri Med Ctr Venlo, Dept Internal Med, Venlo, Netherlands.
Keywords: Rheumatology;cyclo-oxygenase inhibitors; cyclo-oxygenases-1; cyclo-oxygenases-2; fracture healing; inflammation; prostaglandins
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ISSN: 1040-8711
e-ISSN: 1531-6963
DOI: 10.1097/BOR.0b013e32836200b8
ISI #: 000330359900017
Category: A1
Type: Journal Contribution
Validations: ecoom 2015
Appears in Collections:Research publications

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