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Effect of NSAIDs on Bone Healing Rates: A Meta-analysis
Benjamin M Wheatley1, Kyle E Nappo, Daniel L Christensen
1From the Division of Orthopaedic Surgery (Dr. Wheatley, Dr. Nappo, Dr. Christensen, and Dr. Potter), Uniformed Services University, Walter Reed Department of Surgery, the Darnall Medical Library (Ms. Holman), Walter Reed National Military Medical Center, and the Department of Research Programs (Dr. Brooks), Walter Reed National Military Medical Center, Bethesda, MD.
Introduction:
NSAIDs inhibit osteogenesis and may result in delayed union or nonunion. The purpose of this meta-analysis was to determine whether their use leads to delayed union or nonunion.
Methods:
We systematically reviewed the literature reporting the effect of NSAIDs on bone healing. We included studies of pediatric and adult patients NSAID exposure and healing bone. The outcomes of interest were delayed union, nonunion, or pseudarthrosis with at least six months of follow-up. A maximum likelihood random-effects model was used to conduct meta-analysis and meta-regression.
Results:
NSAID exposure increased delayed union or nonunion (odds ratio [OR], 2.07; confidence interval [CI], 1.19 to 3.61). No effect was noted in pediatrics (OR, 0.58; CI, 0.27 to 1.21) or low dose/short duration of exposure (OR, 1.68; CI, 0.63 to 4.46).
Conclusion:
Analysis of the literature indicates a negative effect of NSAIDs on bone healing. In pediatric patients, NSAIDs did not have a significant effect. The effect may be dose or time dependent because low-dose/short-duration exposure did not affect union rates.
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