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Review
. 2025 Nov;18(11):504-512.
doi: 10.1007/s12178-025-09983-6. Epub 2025 Jun 5.

Do Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) Adversely Impact Fracture Healing? A Critical Review of the Literature

Affiliations
Review

Do Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) Adversely Impact Fracture Healing? A Critical Review of the Literature

Sarah G Stroud et al. Curr Rev Musculoskelet Med. 2025 Nov.

Abstract

Purpose of review: The purpose of this review was to critically appraise the literature and establish an evidence-based clinical guideline for the use of non-steroidal anti-inflammatory drugs (NSAIDs) in a fracture setting.

Recent findings: With few exceptions, studies in animals suggest that NSAIDs impair fracture healing. It is unclear if nonselective or cyclooxygenase-(COX)2-selective NSAIDs pose differing effects on fracture healing. Human studies show NSAID use to be a consistent risk factor for fracture non-union in skeletally mature populations across the literature and indicates that indomethacin in particular poses a significant risk for non-union of adult acetabular fractures. Current evidence appears to suggest no harm in using ketorolac or ibuprofen in a pediatric fracture population, while indomethacin poses a significant risk for non-union in adult acetabular fracture patients when used for six weeks. Despite the majority of available clinical studies showing NSAID use as a recurring risk factor for fracture non-union in adult populations, a lack of standardization amongst studies makes it difficult to determine any clinical recommendations about timing, dosage, duration, or type of agent administered. More high-quality prospective studies are needed.

Keywords: Bone healing; Cyclooxygenase; Fracture; Non-steroidal anti-inflammatory Drugs; Non-union.

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Conflict of interest statement

Declarations. Human and Animal Rights and Informed Consent: This article does not contain any studies with human or animal subjects performed by any of the authors. Competing Interests: Sarah G. Stroud, Lara Passfall, Juhayer S. Alam, Frank (A) Segreto, Rachel Baum, Neil V. Shah, Jad Bou Monsef, and Carl (B) Paulino declare that they have no conflict of interest. Bassel G. Diebo reports he has received speaker/consulting honorarium from Clariance, Spineart, and Spinevision, and research support from Alphatec Spine and Medtronic.

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