title: NSAIDs and fracture healing.
abstract: OBJECTIVE
  Published data raise concerns about the use of nonselective NSAIDs and selective cyclo-oxygenase (COX)-2 inhibitors as anti-inflammatory or analgesic drugs in patients after a recent fracture or who are undergoing (uncemented) arthroplasty or osteotomy. However, clinical reports on the effect of COX-2 inhibition on fracture healing in humans have been variable and inconclusive. This review gives an overview of the published data and an advice when to avoid NSAIDs.
  
  
  RESULTS
  Prostaglandins play an important role as mediators of inflammation and COX are required for their production. Inflammation is an essential step in the fracture healing process in which prostaglandin production by COX-2 is involved. Data from animal studies suggest that NSAIDs, which inhibit COX-2, can impair fracture healing due to the inhibition of the endochondral ossification pathway. Animal data suggest that the effects of COX-2 inhibitors are dependent on the timing, duration, and dose, and that these effects are reversible.
  
  
  CONCLUSIONS
  These animal data, together with the view of limited scientifically robust clinical evidence in humans, indicate that physicians consider only short-term administration of COX-2 inhibitors or other drugs in the pain management of patients who are in the phase of fracture or other bone defect healing. COX-2-inhibitors should be considered a potential risk factor for fracture healing, and therefore to be avoided in patients at risk for delayed fracture healing.
authors.affiliation: Department of Rheumatology, Maastricht University Medical Center, Maastricht, The Netherlands. piet.geusens@scarlet.be
authors.forename: Piet
authors.initials: P
authors.lastname: Geusens
authors.forename: Pieter J
authors.initials: PJ
authors.lastname: Emans
authors.forename: Joost J A
authors.initials: JJ
authors.lastname: de Jong
authors.forename: Joop
authors.initials: J
authors.lastname: van den Bergh
mesh_terms: D000818:Animals; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects / Q000494:pharmacology*; D052246:Cyclooxygenase 2 Inhibitors / Q000494:pharmacology; D004195:Disease Models, Animal; D017102:Fracture Healing / Q000187:drug effects*; D050723:Fractures, Bone / Q000139:chemically induced; D006801:Humans; D012307:Risk Factors
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D052246:Cyclooxygenase 2 Inhibitors