Chronic nonsteroidal anti-inflammatory drug use is associated with increased risk of distal biceps tendon injury

Background

Prior basic science literature suggests chronic nonsteroidal anti-inflammatory drugs (NSAID) use may be associated with impaired tendon health. The purpose of this study was to investigate the association between chronic NSAID use and risk of distal biceps tendon injury (BTI).

Methods

A retrospective study was conducted using the PearlDiver database. A sample of 500,000 chronic NSAID users were exact matched to controls for age, sex, Charlson Comorbidity Index, diabetes, and tobacco use. Multivariable logistic regression with sex-specific and age-specific subanalyses was conducted for 1- and 2-year risk of distal BTI and 2-year surgical repair rates as defined by International Classification of Disease and Current Procedural Terminology codes.

Results

After exact matching, 499,240 chronic NSAID users were matched with 499,240 controls. Patients with chronic NSAID use had a significantly increased risk of distal BTI at both 1-year (odds ratio: 1.51; 95% confidence interval: 1.32-1.71) and 2-year (odds ratio: 1.39; 95% confidence interval: 1.27-1.53) follow-up compared to controls. When stratified by sex, males and females with chronic NSAID use were significantly more likely to experience distal BTI compared to controls at 1- and 2-year follow-up.

Discussion

Chronic NSAID use was associated with increased risk of distal BTI at 1- and 2-year follow-up, including in sex-specific analysis. These findings may inform risks and expectations for providers prescribing chronic NSAIDs and merit further investigation.