Nonsteroidal Anti-Inflammatory Drugs Do Not Affect the Bone Metabolic Response to Exercise

Nonsteroidal anti-inflammatory drugs (NSAID) are associated with increased stress fracture risk, potentially due to inhibiting the adaptive bone formation responses to exercise. This study investigated if a single, maximal dose of three different NSAID alters bone formation biomarker response to strenuous exercise.

In a randomized, counterbalanced order, 12 participants (10 male, 2 female), performed four bouts of plyometric jumps, each separated by at least 1 wk. Two hours before exercise, participants consumed either placebo or NSAID: ibuprofen (800 mg), celecoxib (200 mg), flurbiprofen (100 mg). Blood was collected before (PRE), and at 0, 15, 60, 120, and 240 min postexercise. Parathyroid hormone, ionized calcium, procollagen type 1 N-terminal propeptide, bone alkaline phosphatase, osteocalcin, C-terminal telopeptide of type 1 collagen, tartrate-resistant acid phosphatase, and sclerostin were measured. Prostaglandin E2 metabolite and creatinine were measured in urine. Data were analyzed using repeated-measures ANOVA and area under the curve analysis. Data are mean ± SD.

There was an exercise effect for procollagen type 1 N-terminal propeptide, bone alkaline phosphatase, osteocalcin, C-terminal telopeptide of type 1 collagen, tartrate-resistant acid phosphatase, sclerostin, osteoprotegerin, parathyroid hormone, and ionized calcium (all P < 0.05), but no NSAID treatment effect for any biomarker (all P > 0.05). Area under the curve analyses were not different for any biomarker ( P > 0.05). Prostaglandin E2 metabolite was higher during the placebo trial (322 ± 153 pg·mg -1 creatinine, P < 0.05) compared with ibuprofen (135 ± 83 pg·mg -1 ), celecoxib (202 ± 107 pg·mg -1 ), and flurbiprofen (159 ± 74 pg·mg -1 ).

Plyometric exercise induced changes in bone metabolism, but the responses were unaltered by consuming NSAID 2 h before exercise.