The Effect of Nonsteroidal Anti-inflammatory Drugs and Selective COX-2 Inhibitors on Bone Healing

Abstract

A recently published study, “Risk of Nonunion With Nonselective NSAIDs, COX-2 Inhibitors, and Opioids” by George et al ( J Bone Joint Surg Am. 2020;102:1230–1238), assesses whether the use of nonselective nonsteroidal anti-inflammatory drugs (NSAIDs), selective cyclooxygenase 2 (COX-2) enzyme inhibitors, or opioids was associated with a risk of long bone fracture nonunion in Optum’s deidentified private health database. This review analyzes the study, including strengths, weaknesses, and areas for future research. The study found an association between COX-2 inhibitor and opioid use with fracture nonunion but not with nonselective NSAID use. Although the literature on this topic is varied, these results are at least partially aligned with several animal studies that show COX-2 inhibitors to be associated with fracture nonunion. The George et al study design has several important limitations, indicating that further research is needed on this topic.

Creating an Optimal In Vivo Environment to Enhance Outcomes Using Cell Therapy to Repair/Regenerate Injured Tissues of the Musculoskeletal System

“…Obviously, the use of some medications to treat co-morbidities could also influence outcomes depending on the type and dosages being used. Treatment with anti-inflammatory medications, such as NSAIDS [ 67 , 68 , 69 ] or high or continuous doses of glucocorticoids [ 70 , 71 ], could potentially adversely affect outcomes after interventions with cell therapy approaches. Therefore, the presence of co-morbidities and their treatment, as well age and sex, should be recognized and addressed before initiating interventions to enhance the repair/regeneration of injured connective tissues of the MSK system.…”

CE: Pain and Mental Health Symptoms After Traumatic Orthopedic Injury

“…For this reason, some orthopedists caution patients not to use these drugs during the acute phase of fracture healing 35. Nevertheless, these drugs' effects on fracture healing remains controversial and requires further study 34, 35. Anticonvulsants, such as pregabalin and gabapentin, and antidepressants, such as tricyclic antidepressants and serotonin–norepinephrine reuptake inhibitors (SNRIs), are effective in treating neuropathic pain 29, 30…”

“…The association between fracture healing and prostaglandins has raised concerns about using COX-2 inhibitors as well as nonselective NSAIDs, which inhibit both COX-1 and COX-2, to treat pain in people with orthopedic fractures since, theoretically, both may increase the risk of nonunion 34. For this reason, some orthopedists caution patients not to use these drugs during the acute phase of fracture healing 35. Nevertheless, these drugs' effects on fracture healing remains controversial and requires further study 34, 35.…”

“…34 For this reason, some orthopedists caution patients not to use these drugs during the acute phase of fracture healing. 35 Nevertheless, these drugs' effects on fracture healing remains controversial and requires further study. 34,35 Anticonvulsants, such as pregabalin ajnonline.com many as 18% of survivors report sleep disturbances.…”

Nonsteroidal anti-inflammatory drugs for pain relief in case of injuries: Is there a risk of bone metabolism disorders and nonunion of bone fractures?

“…Помимо этих хорошо известных НР, для НПВП обсуждается еще один тип осложнений, имеющий прямое отношение к обезболиванию при травмах, -повышение риска несращения переломов костей [9,10]. Репарация переломов -сложный процесс, включающий элементы воспаления (в частности, реакцию макрофагов и остеокластов, направленную на удаление погибших клеток и разрушенного межклеточного матрикса), стимуляцию выработки факторов роста, пролиферацию и дифференциацию мезенхимальных стволовых клеток с появлением новых остео-, хондро-и теноцитов, неоангиогенез, синтез коллагена и протеогликанов, формирование новообразованных костных и хрящевых структур [11,12].…”