Use of nonsteroidal anti-inflammatory drugs and risk of fractures

In animal models, prostaglandin synthesis has been found to mediate bone me tabolism. Nonsteroidal anti-inflammatory drugs (NSAIDs), given their inhibi tory effects of prostaglandin synthesis, may play a role in the prevention of osteoporosis. The primary objective of this study is to describe and qua ntify the fracture risks of patients exposed to NSAIDs in a representative general medical practice setting. A retrospective cohort study was conducte d in a general medical practice setting in the UK (using data from the Gene ral Practice Research Database). Regular NSAID users (who received three or more NSAID prescriptions), aged 18 years or older, were compared with matc hed control patients and incidental NSAID users. The study comprised 214,57 7 regular NSAID users, 286,850 incidental NSAID users, and 214,577 control patients. The relative rate of nonvertebral fractures during regular NSAID treatment compared with control was 1.47 (95% confidence interval [CI] 1.42 -1.52) and that of hip fracture 1.08 (0.98-1.19); No differences in nonvert ebral fractures were found between the regular and incidental NSAID users ( RR = 1.04; 95% CI 0.99-1.09), The rate of nonvertebral fractures among user s of diclofenac (RR = 1.00; 95% CI 0.93-1.08) and naproxen (RR = 0.91; 95% CI 0.82-1.00) was similar to that of ibuprofen, The results of this study a re not supportive of clinically significant effects of NSAIDs on bone metab olism. (Bone 27:563-568; 2000) (C) 2000 by Elsevier Science Inc. All rights reserved.