Femoral Neck Stress Fracture Medication

Updated: May 31, 2017
  • Author: Scott D Flinn, MD; Chief Editor: Sherwin SW Ho, MD  more...
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Medication

Medication Summary

The goals of pharmacotherapy are to reduce morbidity and to prevent complications in patients with FNSFs.

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Mineral supplements

Class Summary

Calcium supplementation may be necessary for patients with FNSFs. The average daily recommendations for children aged 9-18 years is 1300 mg of calcium daily. Individuals aged 19-50 years and postmenopausal women should have a daily calcium intake of 1000 mg of calcium. Middle-aged women and males 50 years and older should receive 1200 mg of calcium daily. Vitamin D supplementation may also be necessary.

Calcium carbonate (Os-Cal)

Used for the supplementation of calcium. Give the amount that is needed to supplement an individual's diet to reach the recommended daily amounts.

Calcium citrate (Citracal)

Moderates nerve and muscle performance by regulating the action potential excitation threshold. Give the amount that is needed to supplement an individual's diet to reach the recommended daily amounts.

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Nonsteroidal anti-inflammatory drugs

Class Summary

NSAIDs have analgesic, anti-inflammatory, and antipyretic activities. The mechanism of action of these agents is not known, but they may inhibit cyclooxygenase activity and prostaglandin synthesis. Other mechanisms may exist as well, such as inhibition of leukotriene synthesis, lysosomal enzyme release, lipoxygenase activity, neutrophil aggregation, and various cell membrane functions. Many NSAIDs are currently on the market. There is no evidence to support that one agent is more efficacious than another; however, individual response may differ.

The routine use of NSAIDs for treating stress fractures has been called into question because these drugs have been shown to slow bone formation and may mask the pain that serves as a guide for the timing of advancing rehabilitation. [15, 16] Therefore, administer NSAIDs sparingly for initial pain, if at all. Furthermore, with the other complications of NSAIDs (eg, gastrointestinal [GI] bleeding) and the known difficulties with COX-2 inhibitors, caution is advised.

Ibuprofen (Motrin, Ibuprin)

DOC for patients with initial mild to moderate pain. Inhibits inflammatory reactions and pain by decreasing prostaglandin synthesis. May slow bone healing, so use sparingly.

Naproxen (Aleve, Naprelan, Naprosyn, Anaprox)

For relief of mild to moderate pain; inhibits inflammatory reactions and pain by decreasing the activity of cyclooxygenase, which results in a decrease of prostaglandin synthesis. May slow bone healing, so use sparingly.

Ketoprofen (Actron, Orudis, Oruvail)

For relief of mild to moderate pain and inflammation.

Small dosages are initially indicated in small and elderly patients and in those with renal or liver disease. Doses over 75 mg do not increase therapeutic effects. Administer high doses with caution, and closely observe patient for response. May slow bone healing, so use sparingly.

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