Journal of the American Academy of Orthopaedic Surgeons · IF 2.9 · Jul 21, 2026 · LoE II
NSAID Use and Bone Healing: An Umbrella Review with a Reconstructed Meta-Analysis
This study combined an umbrella review of 16 prior systematic reviews/meta-analyses with a newly reconstructed meta-analysis of 38 primary studies to ask whether NSAIDs impair bone healing, and if so, in whom. Pooling roughly 82,000 NSAID-exposed and 756,000 unexposed patients, NSAID use was associated with higher odds of nonunion (OR 1.56, 95% CI 1.18-2.11), with the risk concentrated in adults, traumatic (not elective) fractures, long bones (not spine), and higher-dose regimens, while short courses of 14 days or less and pediatric patients showed no significant increase in risk.
AI summary · from the full text
Why it mattersThis gives clerkship students and residents a risk-stratified framework for the common question of whether to give NSAIDs after a fracture, suggesting short low-dose courses are likely safe while caution is warranted with high-dose or prolonged use in adult long-bone fractures.
Patient-important outcome and fragility index 12304, offset by no power calculation and high heterogeneity.