[Systematic review: is the use of NSAIDs effective and safe in the elderly?]

To analyze the efficacy and safety of nonsteroidal anti-inflammatory drugs (NSAID) in the elderly.

We performed a systematic review using a sensitive search strategy. All studies published in MEDLINE (since 1961), EMBASE (since 1961) and Cochrane Library (up to December 2007) were selected. We defined the population (elderly as subjects aged 60 years or above with musculoskeletal diseases), the intervention (use of NSAID), and the results related to efficacy (pain, function and quality of life) and safety (gastrointestinal, cardiovascular or renal toxicity). Randomized clinical trials (RCT), (Jadad 4 or 5) and high quality cohort studies were included.

A total of 101 studies were analyzed in detail, and 16 were included. More than 50,000 patients aged 60 years or above were analyzed from 1 week, up to 4 years. Different NSAID were included as well as different outcomes. Four meta-analyses, 9 RCT, 2 cohort studies, and one cross-sectional study were included. NSAID are effective for the treatment of musculoskeletal pain, stiffness or joint function. However, NSAID are associated with an increased risk of any serious adverse events, especially serious gastrointestinal adverse events (death, hospitalization, bleeding, ulcers, obstruction). This risk decreased with the use of proton pump inhibitors.

Based on the evidence, NSAID in the elderly are effective for the treatment of different musculoskeletal diseases, although the risk of serious adverse events (mainly gastrointestinal) is also clearly increased.