Nonsteroidal Anti-Inflammatory Drugs and Fracture Nonunion: An Ongoing Debate: Commentary on an article by Michael D. George, MD, MSCE, et al.: 'Risk of Nonunion with Nonselective NSAIDs, COX-2 Inhibitors, and Opioids'
| Autor: | Willem-Jan Metsemakers |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
musculoskeletal diseases
medicine.medical_specialty Scientific Articles medicine.drug_class Nonunion Non steroidal Anti-inflammatory chemistry.chemical_compound Internal medicine medicine Humans Orthopedics and Sports Medicine Nonsteroidal Cyclooxygenase 2 Inhibitors business.industry Anti-Inflammatory Agents Non-Steroidal General Medicine medicine.disease Analgesics Opioid Opioid chemistry Pharmaceutical Preparations Fractures Ununited Surgery business medicine.drug Fracture nonunion |
| Zdroj: | J Bone Joint Surg Am |
| ISSN: | 1535-1386 |
| Popis: | BACKGROUND: Cyclooxygenase-2 (COX-2) has been found to be important for fracture-healing in animal models, raising concerns about use of nonsteroidal anti-inflammatory drugs (NSAIDs) and selective COX-2 inhibitors after fractures. We evaluated associations of NSAIDs, COX-2 inhibitors, and opioids with nonunion after long-bone fracture. METHODS: Using private health insurance claims data from Optum’s de-identified Clinformatics Data Mart database from January 1, 2000, to September 30, 2015, we identified adults with a single long-bone fracture or commonly paired long-bone fractures who had 1 year of available follow-up data. Using multivariable logistic regression models, we examined associations between NSAID, COX-2-inhibitor, or opioid prescription fills after the fracture and the risk of nonunion within 1 year, defined as a nonunion diagnosis with a procedure to treat the nonunion. RESULTS: A nonunion diagnosis with a procedure to treat the nonunion was identified after 2,996 (0.9%) of the 339,864 fracture episodes, with rates varying by fracture site. The risk of that outcome was greater in patients who had filled COX-2-inhibitor prescriptions (adjusted odds ratio = 1.84 [95% confidence interval = 1.38 to 2.46]) or opioid prescriptions (1.69 [1.53 to 1.86]), but not in patients who had filled nonselective-NSAID prescriptions (1.07 [0.93 to 1.23]) after the fracture. Results were similar when the outcome definition was changed to just a nonunion diagnosis. CONCLUSIONS: COX-2 inhibitors, but not nonselective NSAIDs, were associated with a greater risk of nonunion after fracture. Opioids were also associated with nonunion risk, although patients filling prescriptions for opioids may have had more severe fractures. LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence. |
| Databáze: | OpenAIRE |
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