Human studies on the effect of non-steroidal anti-inflammatory drugs (NSAIDS) on bone healing
| Reference | Year | Population | Intervention | Result | Quality |
|---|---|---|---|---|---|
| Adolphson et al23 | 1993 | Double blind randomised study of postmenopausal women with displaced Colles fractures | Piroxicam v placebo | No significant delay in healing | A |
| Butcher and Marsh25 | 1996 | Retrospective analysis of 94 patients with tibial fractures | Any NSAIDs | More likely to have delayed healing with NSAIDs | B |
| Glassman et al30 | 1997 | Retrospective analysis of 288 spinal surgery patients | Postoperative intramuscular ketorolac | Significantly increased risk of non-union after NSAIDs | B |
| Khan26 | 1997 | Retrospective analysis of patients with clavicle fractures | Any NSAID | Increased rate of non-union with NSAIDs | B |
| Alho et al.27 | 1999 | Survey of 165 elderly patients with femoral neck fractures | Standard treatments | No mention of NSAIDs | B |
| Perlman and Thordarson29 | 1999 | Retrospective analysis of 67 ankle fusions | None | Non-union associated with open trauma, smoking, alcohol, diabetes, and illicit drug use; no mention of NSAIDs | B |
| Giannoudis et al2 | 2000 | Retrospective analysis of 32 patients with non-union of the femoral diaphysis (67 controls) | Any, mainly diclofenac and ibuprofen | Significant association between NSAIDs and non-union | B |
| Van Staa et al9 | 2000 | Retrospective cohort of 500 000 patients taking NSAIDs in primary care with matched controls | Any NSAID | Not supportive of overall effect on bone metabolism | B |
| No differences in fracture risk between regular and irregular NSAID users | |||||
| Karladani et al28 | 2001 | 100 consecutive tibial shaft fractures | None | Increased rates of non-union with high energy trauma and with open fractures; no mention of NSAIDs | B |
| Reuben et al14 | 2001 | Retrospective analysis of 106 spinal surgery patients | Rofecoxib | No significantly increased risk of non-union compared with studies without NSAIDs | B |
| Clough3 | 2002 | Case report of femoral neck stress fracture | Not clear from article | Given NSAIDs before non-union | B |
| Burd et al24 | 2003 | 112 patients at risk of heterotopic ossification after open reduction and external fixation of acetabular fracture | Prospectively randomised to radiation therapy v indomethacin v no prophylaxis | Patients who received indomethacin had a greater risk of non-union of the long bones than those who either received radiotherapy or no prophylaxis | A |