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Point: NSAIDs for Fractures – More Good than Harm?

December 21, 2020

Written by Clay Smith

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Short term use of NSAIDs for acute fractures appears safe and is preferable to using opioids. Read the counterpoint to this tomorrow.

Why does this matter?
NSAIDs are an effective way to control pain in patients with acute fractures. A large population-based study showed no effect of regular NSAIDs on nonunion but showed selective COX-2 inhibitors likely did. Also, a pediatric study found no association, but duration of NSAID use was not mentioned in that study. If we can avoid opioids, that’s a good thing. But is is safe to use NSAIDs?

If it’s not broke…or even if it is…
This is a point/counterpoint. These authors argue that short term NSAID use for fractures is safe. They point to several studies that showed no association of NSAID use with delayed healing or nonunion. They also note that many of the studies that found a potential association did not adjust for confounders, such as diabetes and smoking, that are known to impair fracture healing. Also, several studies that found an association with poor fracture healing were in patients receiving long-term NSAIDs (over 30 days) as opposed to acute, short-term usage. Given the known risk of opioid prescribing, these authors conclude that the benefit of NSAIDs outweighs the risk, especially in patients who are younger, have no diabetes, no smoking, and have uncomplicated fractures. Make sure to read tomorrow’s counterpoint post.

Nonsteroidal Anti-inflammatory Drugs May Be Considered in Patients With Acute Fractures. Ann Emerg Med. 2020 Nov;76(5):675-676. doi: 10.1016/j.annemergmed.2019.08.424.

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What are your thoughts?