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Medications: Do Anti-inflammatory medications inhibit bone healing?

This subject was first raised on the board in October 2000 I did a literature search on the subject. There is not a lot of good studies on the subject. Most of the work has been done in the lab and there is little to show that fracture healing in humans is actually affected. However, there is some evidence -
  1. Giannoudis PV, MacDonald DA, Matthews SJ, Smith RM, Furlong AJ, De Boer P.

    Nonunion of the femoral diaphysis. The influence of reaming and non-steroidal anti-inflammatory drugs.
    J Bone Joint Surg Br. 2000 Jul;82(5):655-8.
    This study is the most direct evidence that these drugs influence bone healing adversely.
     
  2. Reikeraas O, Engebretsen L.

    Effects of ketoralac tromethamine and indomethacin on primary and secondary bone healing. An experimental study in rats.
    Arch Orthop Trauma Surg. 1998;118(1-2):50-2.
    Experimental study that suggests that Indocid affects bone healing in rats but Ketorolac doesn't.
     
  3. Glassman SD, Rose SM, Dimar JR, Puno RM, Campbell MJ, Johnson JR.

    The effect of postoperative nonsteroidal anti-inflammatory drug administration on spinal fusion.
    Spine. 1998 Apr 1;23(7):834-8.
    This study suggests that Ketorolac does have an effect on the rates of healing after spinal fusion (which is a similar process to fracture healing).

Review of the available evidence by Bandolier suggests that the case against NSAIDs "does not stack up"

Unpublished evidence posted as a"study" on the Internet suggests that NSAIDS do promote nonunion

A Literature review by medical librarians at Vanderbilt came up with conflicting answers

I realize that this does not answer all your questions but hope it shows that there is lack of certainty on this subject. I had never associated nonunion (which is rare) with anti-inflammatory medications (which we use often) until I read this up. If there is an association it probably exists during the early phase of healing. If the bone has begun to show hard callus formation it is unlikely (IMO) to reverse itself.

Myles Clough MD Jan 25th 2002


From: Monica

Hi,
I have read that ibuprofin and other NSAIDs can hinder bone healing. I am in Germany and none of my docs seem to believe this -- they keep telling me to take Ibuprofin for pain (which doesn't help too much when it is really hurting badly anyway).
I've had several different (types of) doctors since my accident (trimalleolare fracture on Aug. 28, 10 screws and a plate) and here is what they have said:

1. Orthopaedic surgeon - put me on Voltaren Resinat (diclofenac colestyramin) at first, but on a follow-up visit, told me to stop taking it because it can hinder bone growth. Said I should be taking paracetamol, if anything

2. General Practitioner - told me to go on taking the Voltaren and gave me some Valoron N (Tilidin hydrochloride and Naloxon hydrochloride) for stronger pain

3. Orthopaedic doctor Number one - refilled the Valoron N and said it's ok to take

4. Orthopaedic Dr. Number two - told me I should not be taking anything except ibuprofin.

Now: I am by no means a junkie for this medicine and stuff. I have ups and downs with the pain. On some days, it's totally ok not to take anything at all. On others, I can hardly take a step without relatively severe pain. I have found that ibuprofin does not really help on the really bad days, and I have problems with the Voltaren upsetting my stomach (especially since I had my gall bladder out in December).

My question about all of this is: is it true about some of these inhibiting bone growth? And if so, does that apply to all phases of healing, or just the initial phase?

Could you suggest a painkiller that does not cause any side effects as far as bone healing goes, and also that is strong enough to help with the pain on bad days, as well as does not mess with the gastrointestinal system? I know it's asking a lot, but I am getting desperate here. I need to find something to ask my doctor about and see if he will prescribe it for me. Also geting quite irked about all the conflicting opinions and recommendations.

Thank you!


From: Anonymous

To the above commenter:

Acetaminophen with codeine should fit the bill. As long as it\'s legal where you live, and aren\'t an alcoholic :)


From: Douglas

Hi

I have left leg spiral tibia + fibula, right thigh bone, left elbow fractures done 16 February 2002. It is 10 October 2002 today.

My friend who is a Registered Nurse (NSW Australia), has just shown me \"Nursing 2002\", Volume 32 Number 8 dated August 2002. This is a US nursing magazine.

On page 33 there is an article titled \"Bad break for NSAIDs\". Just quickly (I have to go and see my Surgeon!), it says that anti-inflamatory drugs such as Celebrex, Vioxx (which is what I am currently taking), ibuprofen and indomethacin adeversely affect bione healing.

A study was done on rats with splinted broken bones. The group was split into those getting no pain drugs, those getting the various other drugs mentioned.

Those on indomethacin took a week longer to heal and the new bone was strong.

Those on Celebrex or Vioxx had not fully healed 2 months later and the new bone was in some cases weaker.

The Researchers concluded that the COX-2 function that the above drugs block is essential for fracture healing.

I threw my Vioxx in the bin after reading this. I work in the medical industry (as an Engineer) and I know how slow it is for a formal descision from drug manufacturers to be made, i.e to add this information to the \"Warnings\" section for the drug.

I am going to see my General Practicioner soon and get a new pain drug (I will show him this article!


From: Douglas

Here is a link that I found to with regard to my last posting.

 http://www.yourlawyer.com/practice/news.htm?story_id=704&topic=Vioxx


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