Retraso en la consolidación de fracturas asociada con el uso de antiinflamatorios no esteroideos: revisión sistemática

Abstract

Background: Bone healing occurs in three key phases: inflammatory, proliferative, and remodeling—but nonsteroidal anti-inflammatory drugs (NSAIDs) used for post-fracture pain may delay this process by altering chondrogenesis and ossification, increasing the risk of delayed union or pseudoarthrosis. Objective: To analyze delayed fracture healing associated with the use of nonsteroidal anti-inflammatory drugs. Methods: This systematic review will follow the PRISMA guidelines, using observational studies with high clinical relevance. The ROBINS-I tool will be used to assess the risk of bias in this review. Results: A higher incidence of nonunion and even pseudoarthrosis was found in patients treated with NSAIDs. Likewise, evidence from all articles revealed consistent patterns regarding prolonged healing times and in imaging studies, particularly with exposures longer than 14 days, especially with non-selective NSAIDs, as they affect osteoblastic proliferation in the early phases of healing. Furthermore, the findings highlight differences in risk according to the type of fracture, duration of drug exposure, and patient demographic characteristics, suggesting inhibitory mechanisms on bone callus formation mediated by prostaglandins. Keywords: NSAIDs, fractures, delayed bone healing