Abstract
Purpose: To study the effectiveness of various nonsteroidal anti-inflammatory drugs (NSAIDs) in patients with vertebral fractures. Methods: A total of 78 patients (17 males and 61 females) with a mean age of 69.5 years were included. The major inclusion criterion was an osteoporotic vertebral fracture between T7 and L3. The exclusion criteria included fractures above T7 and below L3; and other bone disorders such as disc herniation, spondylolisthesis, an infection, or a tumour. Pain intensity was assessed with the aid of a 10-point visual analogue scale (VAS). Bone mineral density (BMD) data, delay in reunion, and any other matter of significance, were discussed with the treating doctors and cross-checked with independent doctors. The NSAIDs given were non-selective cyclo-oxygenase (COX) inhibitors (naproxen, indomethacin and flurbiprofen) and selective COX 2 inhibitors (piroxicam, celecoxib, and rofecoxib). All data were compiled and appropriately analysed. Results: Some NSAIDs interfered with bone healing. No male required surgery, but two females taking naproxen, one taking flurbiprofen, and another taking celecoxib, required surgery. In terms of bone healing, non-union and delay in reunion were more evident in those taking naproxen, indomethacin or flurbiprofen than in those taking piroxicam, celecoxib, or rofecoxib. All T scores were lower than -2.5, indicating that all the patients were osteoporotic. Positive changes in T scores after 12 weeks were evident only in those taking rofecoxib, celecoxib, or piroxicam. VAS scores were also better in these patients. Conclusions: Celecoxib seems to be the best of the six NSAIDs in terms of both analgesia and bone health. The study recommends the use of celecoxib in patients with vertebral fractures. Keywords: Orthopaedic, NSAID, COX, Bone reunion, Analgesic activity, Pain management, T score
Highlights
Nonsteroidal anti-inflammatory drugs (NSAIDs) are prescribed very frequently to patients with lumbar or intervertebral disc disorders for the effective management of pain and inflammation [1,2]
We studied the effectiveness of various NSAIDs in patients with vertebral fractures
We observed that some NSAIDs interfered with bone healing
Summary
Nonsteroidal anti-inflammatory drugs (NSAIDs) are prescribed very frequently to patients with lumbar or intervertebral disc disorders for the effective management of pain and inflammation [1,2]. COX-2(which is inducible) mediates pain, inflammation, and fever, in turn inhibiting the synthesis of prostaglandins from. NSAIDs affect bone destruction and bone formation by the pathway mediated by COX-2 only [7,8]. Decades-long investigations have explored the roles played by NSAIDs in bone healing, pain, and management of inflammation. Treatment seeks to reduce bone resorption and increase bone formation, either by inhibiting osteoclasts and/or stimulating osteoblasts [11,12].Vertebral fractures are the most common fractures in osteoporotic patients. We studied the effectiveness of various NSAIDs in patients with vertebral fractures
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