Nonsteroidal anti-inflammatory drugs (NSAIDs) play an essential part in our approach to control pain in the posttraumatic setting. Over the last decades, several studies suggested that NSAIDs interfere with bone healing while others contradict these findings. Although their analgesic potency is well proven, clinicians remain puzzled over the potential safety issues. We have systematically reviewed the available literature, analyzing and presenting the available in vitro animal and clinical studies on this field. Our comprehensive review reveals the great diversity of the presented data in all groups of studies. Animal and in vitro studies present so conflicting data that even studies with identical parameters have opposing results. Basic science research defining the exact mechanism with which NSAIDs could interfere with bone cells and also the conduction of well-randomized prospective clinical trials are warranted. In the absence of robust clinical or scientific evidence, clinicians should treat NSAIDs as a risk factor for bone healing impairment, and their administration should be avoided in high-risk patients.

BMP-7, BMP-2, PTH, and PDGF-BB were observed to have a positive effect on osteogenic differentiation of MSCs. BMP-7 and PDGF-BB (in high doses) could be considered most potentially advantageous because they enhance both proliferation and osteogenic differentiation of MSCs derived from elderly osteoporotic bone.

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For centuries, nonsteroidal anti-inflammatory drugs (NSAIDs) have been part of our clinical practice. They started out as drugs with anti-inflammatory and analgesic action, and gradually their use has been expanded to new therapeutic targets, some of which are unrelated to their primary mode of action. Today, our armamentarium includes a large range of compounds, attesting to their utility in the treatment of clinical pathologies ranging from pain and inflammation to prevention and treatment of cancer. On the other hand, although NSAIDs share many common properties, their use poses risks, and physicians should be cognizant of their subtle differences and potential complications. In this context, this review article presents insight into NSAIDs' pathophysiology and mode of action in the clinical setting, their indications, and their potential side effects.