NSAID Exposure and Risk of Nonunion: A Meta-Analysis of Case–Control and Cohort Studies
- 15 June 2010
- journal article
- research article
- Published by Springer Science and Business Media LLC in Calcified Tissue International
- Vol. 87 (3), 193-202
- https://doi.org/10.1007/s00223-010-9379-7
Abstract
Nonsteroidal anti-inflammatory drugs (NSAIDs) are frequently used for postoperative pain control. However, concerns regarding the potential deleterious effects of NSAIDs on bone healing have compelled many physicians to avoid NSAIDs in patients with healing fractures, osteotomies, and fusions. We systematically reviewed and analyzed the best clinical evidence regarding the effects of NSAID exposure on bone healing. Medline, Embase, and Cochrane electronic databases were searched for prospective and retrospective clinical studies of fracture, osteotomy, and fusion studies of patients with NSAID exposure and nonunion as an outcome. Study quality was assessed using the Newcastle–Ottawa Scale. Data on study design, patient characteristics, and risk estimates were extracted. Pooled effect estimates were calculated. Subanalyses were performed by bone type and by NSAID dose, duration, and route of administration. In the initial analysis of 11 cohort and case-control studies, the pooled odds ratio for nonunion with NSAID exposure was 3.0 (95% confidence interval 1.6–5.6). A significant association between lower-quality studies and higher reported odds ratios for nonunion was observed. When only higher-quality studies were considered, seven spine fusion studies were analyzed, and no statistically significant association between NSAID exposure and nonunion was identified (odds ratio = 2.2, 95% confidence interval 0.8–6.3). There was no increased risk of nonunion with NSAID exposure when only the highest-quality studies were assessed. Randomized controlled trials assessing NSAID exposure in fracture, fusion, and osteotomy populations are warranted to confirm or refute the findings of this meta-analysis of observational studies.This publication has 64 references indexed in Scilit:
- Nonsteroidal antiinflammatory drugs for postoperative pain management after lumbar spine surgery: a meta-analysis of randomized controlled trialsJournal of Neurosurgery: Spine, 2008
- Use of β2agonists and risk of acute myocardial infarction in patients with hypertensionBritish Journal of Clinical Pharmacology, 2008
- Lumbar fusion outcomes in patients with rheumatoid arthritisEuropean Spine Journal, 2008
- Inhibition of fracture healingThe Journal of Bone and Joint Surgery. British volume, 2007
- COX-2 inhibitors in sports medicine: utility and controversyBritish Journal of Sports Medicine, 2006
- Assessment of Malunion in Spinal FusionNeurosurgery Quarterly, 2005
- Is there an inhibitory effect of COX-2 inhibitors on bone healing?Pharmacological Research, 2004
- COX-2 selective inhibitors: a literature review of analgesic efficacy and safety in oral-maxillofacial surgeryOral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology, 2004
- Regulation of bone morphogenetic protein‐2 expression by endogenous prostaglandin E2 in human mesenchymal stem cellsJournal of Cellular Physiology, 2004
- Considerations in the Use of COX-2 Inhibitors in Spinal Fusion SurgeryAnesthesia & Analgesia, 2001