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Updated: May 11, 2026

Minimally Invasive Treatment for Thoracolumbar Burst Fracture Using Sagittal Alignment Screws and A Trauma Reduction Device

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Published on: November 8, 2024

NSAIDs and fracture healing.

Piet Geusens¹, Pieter J Emans, Joost J A de Jong

¹Department of Rheumatology, Maastricht University Medical Center, Maastricht, The Netherlands. piet.geusens@scarlet.be

Current Opinion in Rheumatology

|May 18, 2013

Summary

Nonsteroidal anti-inflammatory drugs (NSAIDs) that inhibit cyclo-oxygenase (COX)-2 may impair fracture healing. Physicians should consider short-term use only and avoid COX-2 inhibitors in patients at risk for delayed bone healing.

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Area of Science:

Orthopedics
Pharmacology
Biomedical Science

Background:

Nonselective NSAIDs and selective COX-2 inhibitors raise concerns for patients with fractures or undergoing orthopedic surgery.
Clinical evidence on COX-2 inhibition's effect on human fracture healing remains variable and inconclusive.

Purpose of the Study:

To review published data on NSAIDs and fracture healing.
To provide guidance on avoiding NSAIDs in specific patient populations.

Main Methods:

Review of existing scientific literature on NSAIDs, COX-2 inhibition, and fracture healing.
Analysis of animal studies and limited human clinical data.

Main Results:

Prostaglandins, produced via COX enzymes, are crucial mediators of inflammation essential for fracture healing.
Animal studies indicate that NSAIDs inhibiting COX-2 can impede fracture healing by affecting endochondral ossification.
The impact of COX-2 inhibitors in animal models is dose-, duration-, and timing-dependent and reversible.

Conclusions:

Limited robust clinical data in humans necessitate caution with COX-2 inhibitors.
Short-term administration of COX-2 inhibitors or alternative analgesics is advised for pain management during fracture healing.
COX-2 inhibitors pose a potential risk for delayed fracture healing and should be avoided in at-risk patients.