Effect of NSAIDs on Bone Healing Rates: A Meta-analysis

Wheatley, B. M.; Nappo, Kyle E.; Christensen, Daniel; Holman, Ann M; Brooks, Daniel I.; Potter, Benjamin K.

doi:10.5435/jaaos-d-17-00727

Cited by 135 publications

(108 citation statements)

References 42 publications

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“…Though the literature is not conclusive, a recently published meta-analysis reported increased odds of nonunion (odds ratio = 2.07, 95% CI, 1.19 to 3.61) in orthopedic patients taking high doses or long courses of NSAIDs following fracture osteotomy and fusion surgeries. 82 In this study, low doses of NSAIDs (less than 125 mg/day diclofenac, 150 mg/day indomethacin, or 120 mg/day ketorolac) taken for less than 2 weeks were not shown to increase the odds of nonunion. 82 Several other studies also suggest that short courses of NSAIDs do not affect nonunion rates.…”

Section: Patients Should Be Discharged With a Prescriptionmentioning

confidence: 55%

Consensus Statement for the Prescription of Pain Medication at Discharge after Elective Adult Surgery

Clarke

Manoo

Pearsall

et al. 2020

Canadian Journal of Pain

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This Consensus Statement provides recommendations on the prescription of pain medication at discharge from hospital for opioid-naïve adult patients who undergo elective surgery. It encourages health care providers (surgeons, anesthesiologists, nurses/nurse practitioners, pain teams, pharmacists, allied health professionals, and trainees) to (1) use nonopioid therapies and reduce the prescription of opioids so that fewer opioid pills are available for diversion and (2) educate patients and their families/caregivers about pain management options after surgery to optimize quality of care for postoperative pain. These recommendations apply to opioid-naïve adult patients who undergo elective surgery. This consensus statement is intended for use by health care providers involved in the management and care of surgical patients. A modified Delphi process was used to reach consensus on the recommendations. First, the authors conducted a scoping review of the literature to determine current best practices and existing guidelines. From the available literature and expertise of the authors, a draft list of recommendations was created. Second, the authors asked key stakeholders to review and provide feedback on several drafts of the document and attend an in-person consensus meeting. The modified Delphi stakeholder group included surgeons, anesthesiologists, residents, fellows, nurses, pharmacists, and patients. After multiple iterations, the document was deemed complete. The recommendations are not graded because they are mostly based on consensus rather than evidence. RÉSUMÉ Cette déclaration de consensus fait des recommandations pour la prescription d'analgésiques à la sortie de l'hôpital pour les patients adultes n'ayant jamais pris d'opiacés et qui subissent une intervention chirurgicale non urgente. Elle encourage les prestataires de soins de santé (chirurgiens, anesthésiologistes, infirmières et infirmiers, infirmières et infirmiers praticiens, équipes antidouleur, pharmaciens, professionnels de la santé et stagiaires) à (1) utiliser des traitements non opiacés et à réduire la prescription d'opiacés afin de réduire le nombre de pilules opiacées pouvant être détournées; et (2) à éduquer les patients, ainsi que leurs familles et soignants, sur les options de prise en charge de la douleur après l'opération afin d'optimiser la qualité des soins pour la douleur postopératoire. Ces recommandations s'appliquent aux patients adultes n'ayant jamais pris d'opioïdes et qui subissent une intervention chirurgicale non urgente. Cette déclaration de consensus est destinée à être utilisée par les prestataires de soins de santé impliqués dans la prise en charge des patients opérés et les soins qui leur sont apportés. Un processus Delphi modifié a été utilisé pour parvenir à un consensus sur les recommandations. Tout d'abord, les auteurs ont procédé à une de la portée de la littérature afin de déterminer les pratiques exemplaires actuelles et les lignes directrices existantes. À partir de la littérature disponible et de l'expertise des ...

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Section: Patients Should Be Discharged With a Prescriptionmentioning

confidence: 55%

Consensus Statement for the Prescription of Pain Medication at Discharge after Elective Adult Surgery

Clarke

Manoo

Pearsall

et al. 2020

Canadian Journal of Pain

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“…Dodwell et al reported an increased risk of nonunion among NSAID‐treated patients in the pooled effect of 11 studies (OR 3.0 [95% CI 1.6, 5.6]), but no effect was observed when only 7 high‐quality studies were included . Another meta‐analysis by Wheatley et al also showed that NSAID use was associated with an increased risk of nonunion or delayed union (OR 2.07 [95% CI 1.19, 3.61]), but similar to the temporal effect observed in the animal studies, no association was found in studies with a short duration of NSAID treatment . In addition, no association was observed in studies with low‐dose NSAIDs or in pediatric groups .…”

Section: Introductionmentioning

confidence: 80%

“…Another meta‐analysis by Wheatley et al also showed that NSAID use was associated with an increased risk of nonunion or delayed union (OR 2.07 [95% CI 1.19, 3.61]), but similar to the temporal effect observed in the animal studies, no association was found in studies with a short duration of NSAID treatment . In addition, no association was observed in studies with low‐dose NSAIDs or in pediatric groups . Neither of these two meta‐analyses examined the difference between the effects of COX‐2 selective NSAIDs and nonselective NSAIDs.…”

Section: Introductionmentioning

confidence: 97%

Nonsteroidal Antiinflammatory Drugs as Potential Disease‐Modifying Medications in Axial Spondyloarthritis

Wang

Bathon

Ward

2020

Arthritis & Rheumatology

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Nonsteroidal antiinflammatory drugs (NSAIDs) are the first‐line pharmacotherapy for patients with axial spondyloarthritis (SpA). In recent years, treatment options have expanded with the availability of biologic agents, including tumor necrosis factor inhibitors and interleukin‐17 inhibitors. However, a treatment strategy that clearly prevents syndesmophyte formation has not been established. Observational studies of patients with ankylosing spondylitis indicated potential disease‐modifying effects of NSAIDs, but two randomized trials came to different conclusions. More broadly, whether any of the currently available medications for axial SpA have an effect on spine radiographic progression, beyond symptom control, remains inconclusive. In this article, we will review clinical studies of the disease modification effects of NSAIDs and biologics in axial SpA; examine genetic, animal, and clinical evidence of the effects of NSAIDs on bone formation; and discuss how future studies may investigate the question of disease modification in axial SpA.

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“…A recent meta-analysis15 concluded NSAIDs generally have a negative effect on bone healing secondary to impairing osteogenesis. The effect may be dose or time dependent because low-dose/short duration exposure did not affect union rates.…”

Section: Indicationsmentioning

confidence: 99%