Related Experiment Videos
NSAID Use and Bone Healing: An Umbrella Review with a Reconstructed Meta-Analysis
Rinat Komargodski1, Sewar Kittany, Ibrahim Abu-Kishk
1From the School of Pharmacy (Komargodski, Kittany, Matok), Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel, the Pharmacy Services (Komargodski), Shamir Medical Center (Assaf Harofeh), Zerifin, Affiliated to Faculty of Medical and Health Sciences, Tel-Aviv University, Tel Aviv, the Pediatric Intensive Care Unit (Abu-Kishk, Beeri Berkovitch), Shamir Medical Center (Assaf Harofeh), Zerifin, Affiliated to Faculty of Medical and Health Sciences, Tel-Aviv University, Tel Aviv, and the Pediatric Orthopedic Unit (Epstein), Shamir Medical Center (Assaf Harofeh), Zerifin, Affiliated to Faculty of Medical and Health Sciences, Tel-Aviv University, Tel Aviv.
Nonsteroidal anti-inflammatory drugs (NSAIDs) can impair bone healing, especially at higher doses or with prolonged use. Short-term NSAID use (≤14 days) appears safe, with risks varying by patient age, fracture type, and procedure context.
Area of Science:
- Orthopedics
- Pharmacology
- Evidence-Based Medicine
Background:
- Nonsteroidal anti-inflammatory drugs (NSAIDs) are frequently used for pain relief after surgery.
- The impact of NSAIDs on bone healing remains a subject of debate.
- Understanding NSAID effects is crucial for optimizing perioperative care and fracture management.
Purpose of the Study:
- To evaluate whether NSAIDs negatively affect bone healing.
- To determine how risks associated with NSAID use vary across different patient populations, fracture types, dosages, and treatment durations.
Main Methods:
- Conducted an umbrella review of systematic reviews and meta-analyses.
- Performed a reconstructed meta-analysis of primary studies using data from major databases.
- Assessed study quality and risk of bias, analyzing subgroups for age, clinical context, bone type, dose, and duration.
Main Results:
- Most included reviews suggested NSAIDs increase impaired bone healing risk, particularly with higher doses or longer use.
- Meta-analysis showed NSAID exposure associated with higher nonunion risk (OR 1.56) in adults, but not pediatric patients.
- Risk was higher for long-bone fractures than spinal fusion and in traumatic versus elective procedures; short-term use (≤14 days) showed no elevated risk.
Conclusions:
- NSAID-induced impairment of bone healing is dependent on dose and clinical context.
- Significant risk is observed in adults, long-bone fractures, and with higher NSAID doses.
- Short-term NSAID use (≤14 days) is not linked to increased nonunion risk, suggesting a potentially safe option when high doses are avoided.