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J Am Acad Orthop Surg, Vol 12, No 3, May/June 2004, 139-143.
© 2004 the American Academy of Orthopaedic Surgeons
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Effects of Nonsteroidal Anti-Inflammatory Drugs on Bone Formation and Soft-Tissue Healing

Laurence E. Dahners, MD and Brian H. Mullis, MD

Dr. Dahners is Professor, Department of Orthopaedics, University of North Carolina School of Medicine, Chapel Hill, NC. Dr. Mullis is Resident, Department of Orthopaedics, University of North Carolina School of Medicine.

Reprint requests: Dr. Dahners, University of North Carolina School of Medicine, Campus Box 7055, 3153 Bioinformatics Building, Chapel Hill, NC 27599-7055.

Nonsteroidal anti-inflammatory drugs continue to be prescribed as analgesics for patients with healing fractures even though these drugs diminish bone formation, healing, and remodeling. Inhibition of bone formation can be clinically useful in preventing heterotopic ossification in selected clinical situations. In this regard, naproxen may be more efficacious than the traditional indomethacin, and short-term administration is as effective as long-term. When fracture healing or spine fusion is desired, nonsteroidal anti-inflammatory drugs should be avoided. Some nonsteroidal anti-inflammatory drugs have a positive effect on soft-tissue healing; they stimulate collagen synthesis and can increase strength in the early phases of repair during skin and ligament healing. Cyclooxygenase-2 inhibitors have an adverse effect on bone healing and may have an adverse effect on ligament healing. Therefore, further investigation is necessary to confirm that traditional nonsteroidal anti-inflammatory drugs may be preferable for the healing of collagenous tissues.




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