Selective and Non-Selective Cyclooxygenase Inhibitors Delay Stress Fracture Healing in the Rat Ulna
ABSTRACT Anti-inflammatory drugs are widely used to manage pain associated with stress fractures (SFxs), but little is known about their effects on healing of those injuries. We hypothesized that selective and non-selective anti-inflammatory treatments would retard the healing of SFx in the rat ulna. SFxs were created by cyclic loading of the ulna in Wistar rats. Ulnae were harvested 2, 4 or 6 weeks following loading. Rats were treated with non-selective NSAID, ibuprofen (30 mg/kg/day); selective COX-2 inhibition, [5,5-dimethyl-3-3 (3 fluorophenyl)-4-(4 methylsulfonal) phenyl-2 (5H)-furanone] (DFU) (2.0 mg/kg/day); or the novel c5a anatagonist PMX53 (10 mg/kg/day, 4 and 6 weeks only); with appropriate vehicle as control. Quantitative histomorphometric measurements of SFx healing were undertaken. Treatment with the selective COX-2 inhibitor, DFU, reduced the area of resorption along the fracture line at 2 weeks, without affecting bone formation at later stages. Treatment with the non-selective, NSAID, ibuprofen decreased both bone resorption and bone formation so that there was significantly reduced length and area of remodeling and lamellar bone formation within the remodeling unit at 6 weeks after fracture. The C5a receptor antagonist PMX53 had no effect on SFx healing at 4 or 6 weeks after loading, suggesting that PMX53 would not delay SFx healing. Both selective COX-2 inhibitors and non-selective NSAIDs have the potential to compromise SFx healing, and should be used with caution when SFx is diagnosed or suspected. © 2012 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res.
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ABSTRACT: The effects of cyclooxygenase (COX) inhibition following the reconstruction of the anterior cruciate ligament remain unclear. We examined the effects of selective COX-2 and nonselective COX inhibition on bone-tendon integration in an in vitro model. We measured the dose-dependent effects of ibuprofen and parecoxib on the viability of lipopolysaccharide- (LPS-) stimulated and unstimulated mouse MC3T3-E1 and 3T3 cells, the influence on gene expression at the osteoblast, interface, and fibroblast regions measured by quantitative PCR, and cellular outgrowth assessed on histological sections. Ibuprofen led to a dose-dependent suppression of MC3T3 cell viability, while parecoxib reduced the viability of 3T3 cultures. Exposure to ibuprofen significantly suppressed expression of Alpl (P < 0.01), Bglap (P < 0.001), and Runx2 (P < 0.01), and although parecoxib reduced expression of Alpl (P < 0.001), Fmod (P < 0.001), and Runx2 (P < 0.01), the expression of Bglap was increased (P < 0.01). Microscopic analysis showed a reduction in cellular outgrowth in LPS-stimulated cultures following exposure to ibuprofen and parecoxib. Nonselective COX inhibition and the specific inhibition of COX-2 led to region-specific reductions in markers of calcification and cell viability. We suggest further in vitro and in vivo studies examining the biologic and biomechanical effects of selective and nonselective COX inhibition.Mediators of Inflammation 05/2015; 2015. DOI:10.1155/2015/926369 · 2.42 Impact Factor
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ABSTRACT: Synopsis Bone stress injuries (BSIs) represent an inability of a bone to withstand repetitive loading which results in structural fatigue, and localized bone pain and tenderness. They occur along a pathology continuum beginning with stress reactions, which can progress to stress fractures and ultimately complete bone fractures. BSIs are a source of concern in long distance runners not only because of their frequency and the morbidity they cause, but also because of their tendency to recur. While most BSIs readily heal with a period of modified loading and a progressive return to running activities, the high recurrence rate of BSIs signals a need to address underlying causative factors. BSIs result from disruption of the homeostasis between microdamage formation and its removal, with microdamage accumulation and subsequent risk for development of a BSI relating to both the load being applied to a bone and the ability of the bone to resist load. The former is most amenable to intervention, and may be modified by interventions aimed at training program design, reducing impact related forces (such as instructing an athlete to 'run softer' or with a higher stride rate), and increasing the strength and/or endurance of local musculature (such as the calf for tibial BSIs and foot intrinsics for BSIs of the metatarsals). Similarly, malalignments and abnormal movement patterns should be explored and addressed. The current commentary discusses management and prevention of BSIs in runners. In doing so, information is provided on the pathophysiology, epidemiology, risk factors, clinical diagnosis, and classification of BSIs. Level of Evidence Therapy, level 5. J Orthop Sports Phys Ther, Epub 7 August 2014. doi:10.2519/jospt.2014.5334.Journal of Orthopaedic and Sports Physical Therapy 08/2014; 44(10):1-50. DOI:10.2519/jospt.2014.5334 · 2.38 Impact Factor
Article: NSAIDs and fracture healing[Show abstract] [Hide abstract]
ABSTRACT: PURPOSE OF REVIEW: Published data raise concerns about the use of nonselective NSAIDs and selective cyclo-oxygenase (COX)-2 inhibitors as anti-inflammatory or analgesic drugs in patients after a recent fracture or who are undergoing (uncemented) arthroplasty or osteotomy. However, clinical reports on the effect of COX-2 inhibition on fracture healing in humans have been variable and inconclusive. This review gives an overview of the published data and an advice when to avoid NSAIDs. RECENT FINDINGS: Prostaglandins play an important role as mediators of inflammation and COX are required for their production. Inflammation is an essential step in the fracture healing process in which prostaglandin production by COX-2 is involved. Data from animal studies suggest that NSAIDs, which inhibit COX-2, can impair fracture healing due to the inhibition of the endochondral ossification pathway. Animal data suggest that the effects of COX-2 inhibitors are dependent on the timing, duration, and dose, and that these effects are reversible. SUMMARY: These animal data, together with the view of limited scientifically robust clinical evidence in humans, indicate that physicians consider only short-term administration of COX-2 inhibitors or other drugs in the pain management of patients who are in the phase of fracture or other bone defect healing. COX-2-inhibitors should be considered a potential risk factor for fracture healing, and therefore to be avoided in patients at risk for delayed fracture healing.Current opinion in rheumatology 05/2013; 25(4). DOI:10.1097/BOR.0b013e32836200b8 · 5.07 Impact Factor