Health Answers

NSAIDs inhibit bone healing

By Judy Foreman
June 22, 2009
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Q. Is it OK to take ibuprofen if you have a broken bone?

A. It’s not a great idea. Ibuprofen - and other NSAIDs (non-steroidal anti-inflammatory drugs) - can impede healing.

“Smoking and NSAIDs are probably the most important causes of failure in bone healing,’’ says Dr. Malcolm Smith, chief of the Orthopedic Trauma Service at Massachusetts General Hospital. In fact, he said, with a patient who has had surgery to remove bone, “we give them NSAIDs to make sure the bone doesn’t grow back.’’

NSAIDs inhibit bone healing by blocking a natural substance in the body, prostaglandin, which supports the activity of bone-building cells, called osteoblasts. Without it, osteoblasts can still make new bone, “but not as robustly,’’ said Dr. Thomas Einhorn, chairman of orthopedic surgery at the Boston University School of Medicine.

High-quality human studies are scare, but animal studies, including work in Einhorn’s lab, clearly demonstrate that NSAIDs inhibit healing. The good news, he said, is that once NSAIDs are discontinued, bone healing resumes.

“In the absence of good human data, I now tell people that if they have arthritis and need to take NSAIDs regularly but then break a bone, they should try to stop the NSAIDs until the fracture heals,’’ Einhorn said. If you do have to continue taking NSAIDs for arthritis despite a broken bone, bone healing will probably eventually catch up, he added. “But all this is inference from animal studies.’’

Aspirin also inhibits prostaglandin and therefore theoretically might retard bone healing, said Einhorn. But people who regularly take low-dose aspirin typically do so to prevent blood clots that can cause a stroke or heart attack. “If you’re taking low-dose aspirin to prevent stroke or heart disease,’’ he said, “don’t stop if you have a broken bone because that’s a very important preventive reason and we don’t know for sure if that would inhibit bone healing.’’

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