Nonsteroidal anti-inflammatory drugs for pain relief in case of injuries: Is there a risk of bone metabolism disorders and nonunion of bone fractures?

Abstract

According to experimental studies, nonsteroidal anti-inflammatory drugs (NSAIDs) can affect the healing of bone tissue after fractures. The significance of this effect of NSAIDs for real clinical practice is the subject of discussion. We analyzed publications on the problem of nonunion or development of fractures against the background of taking NSAIDs presented in the PubMed and MEDLINE system. From 1976 to 2021, 75 papers on this topic were published, of which 19 were observational, cohort and randomized controlled trials, as well as case-control studies, 4 meta-analyses. According to meta-analyses, which included from 6 to 16 studies, there was an association between taking NSAIDs and nonunion of bones after fractures or postoperative trauma: the odds ratio ranged from 2.07 (95% CI: 1.19–3.61) to 5.27 (95% CI: 2.34–11.88). A number of large studies confirm an increased risk of nonunion of fractures and the development of “marching” fractures in patients treated with NSAIDs. The risk of nonunion was increased when using NSAIDs for more than 2 weeks and in high doses. With short-term use of NSAIDs (less than 2 weeks) and the use of these drugs in pediatric practice, the frequency of bone tissue repair disorders did not increase.