Potential impact of selective cyclooxygenase-2 inhibitors on bone metabolism in health and disease

Prostaglandins are potent local regulators of bone cell function and may play a critical role in both physiologic and pathologic changes in the human skeleton. The availability of cyclooxygenase-2 (COX-2)–specific inhibitors, which are likely to be used frequently and for long periods because of their improved safety profile, mandates an investigation of their possible effects on bone. This is particularly important in older individuals, who are at risk of developing bone loss as a result of estrogen deficiency and aging. This review describes the major effects of prostaglandins on bone resorption and formation and outlines an approach to further studies on the potential effect of COX-2–specific inhibitors on bone remodeling, thereby possibly answering some of the key questions about their benefits and potential risks.