NSAIDs Help Pain But Not Bone Healing

Imagine sustaining a fracture or undergoing orthopedic surgery and being prescribed a drug that helps control pain and inflammation. This medication is a non-steroidal anti-inflammatory drug (NSAID). But there is a catch: the drug that helps control your pain inhibits bone healing.

Unfortunately, this is not a hypothetical situation. According to Sabrina Barry, DVM, a surgical resident at Washington State University's Veterinary Teaching Hospital, whose literature review on the subject is set to publish in January:

  • All NSAIDs studied to date have the potential to inhibit bone formation, mostly during the early stages of bone healing;
  • NSAIDs appear to have a dose-dependent effect, meaning that the higher the dose, the more it will inhibit bone formation; and
  • NSAIDs are also thought to have a duration-dependent effect: the longer the drug is used, the more it will hinder bone healing.

The administration of NSAIDs prior to trauma and bone injury, however, does not appear to impact bone healing, she notes.

"Data on bone healing and NSAID administration has primarily been generated from rodents and rabbits," explains Barry. "Nonetheless, this point seems clear: NSAIDs, when given at high doses and for long durations, negatively impact bone healing. ... Only one study has been published on bone remodeling in horses."

In that study, bone biopsies were taken from the tibias of horses receiving doses of the the NSAID phenylbutazone (Bute), and those not receiving the medication. There was less mineralized tissue in the bone biopsy sites at 16 and 30 days in the phenylbutazone-treated horses as compared to the control group; the difference was minor, but still present.

"Whether the effect of NSAIDs on bone healing in horses is clinically important or not remains controversial," concluded Barry. "Prospective trials in horses are needed to guide veterinarians in determining which NSAID to use in horses after bone injury, at what dose, and for how long."

The article, "Non-steroidal anti-inflammatory drugs inhibit bone healing: a review" is scheduled to be published in the January 2011 edition of Veterinary and Comparative Orthopaedics and Traumatology. The abstract is available on PubMed.

Disclaimer: Seek the advice of a qualified veterinarian before proceeding with any diagnosis, treatment, or therapy.

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