Objective To explore the efficacy and safety of non-steroidal anti-inflammatory drugs (NSAIDs) in bone healing period by Meta-analysis.

Methods PubMed, Cochrane Library, Web of science, Embase database, China National Knowledge Infrastructure, Wanfang and VIP databases were searched by computer from establishment of database until December 2022. The published randomized controlled trial(RCT) literatures treated with NSAIDs during bone healing was included. The outcome indexes included the incidence of nonunion, the incidence of adverse drug reactions, postoperative Visual Analogue Scale (VAS) score, callus formation rate, bone mineral density, bone healing time (months), and bone healing score. RevMan 5.3 software was used for Meta-analysis.

Results A total of 20 RCT studies were included. A total of 1, 839 patients were included in this study(927 patients in NSAIDs group and 912 patients in non-NSAIDs group). Meta-analysis showed that the incidence of nonunion(OR=3.94; 95%CI, 2.06 to 7.53; P < 0.000 1), callus occurrence rate(OR=0.20; 95%CI, 0.10 to 0.40; P < 0.000 01), bone mineral density (OR=-0.05; 95%CI, -0.06 to -0.04; P < 0.000 01) and bone healing time (OR=1.45; 95%CI, 1.13 to 1.76; P < 0.000 01) and bone healing score (OR=-1.18; 95%CI, -1.74 to -0.61; P < 0.000 1) in the non-NSAIDs group were significantly better, while the incidence of adverse drug reactions (OR=0.64; 95%CI, 0.48 to 0.87; P=0.004) and postoperative VAS score (MD=-1.96; 95%CI, -3.09 to -0.83; P=0.000 7) in the NSAIDs group were lower than those in the non-NSAIDS group.

Conclusion NSAID had obvious analgesic effect in the perioperative period of bone healing, and its adverse effects are small. However, it will inevitably affect the process of fracture healing. Therefore, it is suggested that the use of NSAIDs drugs should be avoided in patients with the risk of bone nonunion or delayed healing.