Effect of NSAIDs on Bone Healing Rates: A Meta-analysis
Eight articles on PainSci cite Wheatley 2019: 1. Icing for Injuries, Tendinitis, and Inflammation 2. The Complete Guide to IT Band Syndrome 3. The Complete Guide to Patellofemoral Pain Syndrome 4. The Complete Guide to Muscle Strains 5. Repetitive Strain Injuries Tutorial 6. Achilles Tendinitis Treatment Science 7. The Science of Pain-Killers
PainSci notes on Wheatley 2019:
This is a meta-analysis of 16 trials, showing that common over-the-counter pain-killers interfere with bone healing. Chronic overuse roughly doubles the risk that a fracture will heal slowly or not at all (“non-union,” a very serious complication).
The effect was not evident in children or in lower doses or temporary usage — this bad news applies only to adults taking too much of the stuff for too long. Unfortunately, a lot of people do that! The pain-killers in question are the non-steroidal anti-inflammatory drugs or NSAIDs like aspirin, ibuprofen, and naproxen — already notorious for several other significant side effects, and yet still widely overused.
original abstract †Abstracts here may not perfectly match originals, for a variety of technical and practical reasons. Some abstacts are truncated for my purposes here, if they are particularly long-winded and unhelpful. I occasionally add clarifying notes. And I make some minor corrections.
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.
related content
- “Effects of anti-inflammatory (NSAID) treatment on human tendinopathic tissue,” Katja Maria Heinemeier, Tommy F Øhlenschlæger, Ulla Ramer Mikkelsen, Freja Sønder, Peter Schjerling, Rene B Svensson, and Michael Kjaer, J Appl Physiol (1985), 2017.
- “Oral Ibuprofen Interferes with Cellular Healing Responses in a Murine Model of Achilles Tendinopathy,” Adam Bittermann, Shuguang Gao, Sabah Rezvani, Jun Li, Katie J Sikes, John Sandy, Vincent Wang, Simon Lee, George Holmes, Johnny Lin, and Anna Plaas, J Musculoskelet Disord Treat, 2018.
This page is part of the PainScience BIBLIOGRAPHY, which contains plain language summaries of thousands of scientific papers & others sources. It’s like a highly specialized blog. A few highlights:
- Association of Lumbar MRI Findings with Current and Future Back Pain in a Population-based Cohort Study. Kasch 2022 Spine (Phila Pa 1976).
- A double-blinded randomised controlled study of the value of sequential intravenous and oral magnesium therapy in patients with chronic low back pain with a neuropathic component. Yousef 2013 Anaesthesia.
- Is Neck Posture Subgroup in Late Adolescence a Risk Factor for Persistent Neck Pain in Young Adults? A Prospective Study. Richards 2021 Phys Ther.
- Sudden amnesia resulting in pain relief: the relationship between memory and pain. Choi 2007 Pain.
- Photobiomodulation therapy is not better than placebo in patients with chronic nonspecific low back pain: a randomised placebo-controlled trial. Guimarães 2021 Pain.