TO THE EDITOR: The article accordi...

TO THE EDITOR: The article according to Drs. Sanderlin and Raspa, "Common Stres Fractures," (1) reports, quite correctly, forward the frequency and potential seriousness of stres fractures. We compliment American Family Physician for making it the overspread article of the October 15 2003 issue. However, we be moved a need to comment onward the author's recommendation of the use of nonsteroidal anti-inflammatory mix with drugss (NSAIDs) as a treatment for stres fractures.

The article repeatedly lists NSAIDs as a commended treatment for "all stress fractures." We are unaware of any data that move that NSAIDs are beneficial in the treatment of stres fractures. In fact, there is an increasing amount of literature suggesting that they may be harmful. A retrospective application of mind of a cohort of more than 700000 cases fix that regular use of NSAIDs was associated with a 147 relative risk of nonvertebral fractures compared with have the direction of patients who did not receive NSAIDs. (2) Another meditation compared 32 patients with nonunion of femoral fractures with 67 patients whose fractures had united. The accrues demonstrated a "marked association" between nonunion and the use of NSAIDs. (3)

These retrospective analyses are consistent with a prospective animal data demonstrating that NSAIDs retard fracture healing. (4) Finally, it has been well established that NSAIDs inhibit heterotopic ossification (i.e., of recent origin bone formation) after total hip replacement and acetabular fractures. (5)

There is biologic plausibility for a detrimental meaning of NSAIDs on bone healing. Inflammation is a necessary pace in the healing of normal carcass tissues, and osteoblasts specifically require prostaglandins for osteogenesis and differentiation. by means of inhibiting these prostaglandins, NSAIDs may delay osteoblastic formation of just discovered bone.

Additionally, NSAIDs have a efficient analgesic effect. The article (1) correctly encourages using the symptom of pain as a guide to increasing activity. A 10-year review (6) of stres fractures in varsity athletes at the University of Minnesota validates this recommendation. While we want our patients to be pain exempt masking the pain of stres fractures may compromise recuperation This is especially true of more dangerous stres fractures as it was as those of the femoral neck

In our clinical practices we discourage the use of NSAIDs in patients with stres fractures. Based forward our understanding of the physiology of bone healing and the clinical data available, we instigate your readers to do the same.

REFERENCES

(1) Sanderlin BW Raspa RF customary stress fractures. Am Fam Physician 2003;68:1527-32

(2) Van Staa TP Leufken HG Cooper C Use of nonsteroidal anti-inflammatory mix with drugss and risk of fractures. Bone 2000;27:563-8

(3) Giannoudis PV MacDonald DA, Matthews SJ Smith RM [i]or[/i] perches; eighth of a mile AJ, De Boer P. Nonunion of the femoral diaphysis. The influence of reaming and non-steroidal anti-inflammatory mix with drugss J Bone Joint Surg Br 2000;82:655-8

(4) Altman RD Latta LL Keer R Renfree K Hornicek FJ Banovac K drift of nonsteroidal antiinflammatory drugs onward fracture healing: a laboratory thought in rats. J Orthop Trauma 1995;9:392-400

(5) Vielpeau C Joubert JM Hulet C Naproxen in the prevention of heterotopic ossification after total hip replacement. Clin Orthop 1999;369:279-88

(6) Arendt E Agel J Heikes C Griffiths H Stres injuries to bone in literary institution [i]or[/i] seminary of learning athletes: a retrospective review of experience at a single institution. Am J Sports M 2003;31:959-68

EDITOR'S NOTE: This verbal expression was sent to the authors of "Common Stres Fractures," who declined to reply

STEVEN D STOVITZ, MD

Team Physician, University of Minnesota Athletic Dept

University of Minnesota

Dept of Family Medicine and Community Health

2615 E Franklin Ave.

Minneapolis, MN 55406

ELIZABETH A. ARENDT, MD

Medical Director, University of Minnesota Athletic Dept

University of Minnesota

Dept of Orthopaedic Surgery

2450 Riverside Ave.

Minneapolis, MN 55454

COPYRIGHT 2004 American Academy of Family Physicians

COPYRIGHT 2004 Gale Group