Timing of ibuprofen use and musculoskeletal adaptations to exercise training in older adults

• The purpose was to determine whether musculoskeletal adaptations to exercise training in older adults are influenced by NSAID use.
• Ibuprofen use did not significantly alter changes in BMD or fat-free mass, but the study may have been inadequately powered.
• Study attrition was significantly lower in the group that took NSAIDs before exercise suggesting improved tolerance of vigorous bone-loading exercise.
• This was the first randomized, double-blinded placebo- controlled study of ibuprofen effects on BMD from exercise in an older population.

Prostaglandins (PGs) increase in bone in response to mechanical loading and stimulate bone formation. Inhibition of cyclooxygenase (COX), the enzyme responsible for PG synthesis, by non-steroidal anti-inflammatory drugs (NSAIDs) impairs the bone formation response to loading in animals when administered before, but not after, loading. The aim was to determine whether the timing of ibuprofen use (400 mg before versus after exercise sessions) is a significant determinant of the adaptive response of BMD to exercise training in older adults. We hypothesized that taking ibuprofen before exercise would attenuate the improvements in total hip and lumbar spine BMD in response to 36 weeks of training when compared with placebo or with ibuprofen use after exercise. Untrained women and men (N = 189) aged 60 to 75 years were randomly assigned to 1 of 3 treatment arms: placebo before and after exercise (PP); ibuprofen before and placebo after exercise (IP); and placebo before and ibuprofen after exercise (PI).The difference between groups in the change in BMD was not significant when IP was compared with either PP (hip, − 0.5% (− 1.4, 0.4); spine, 0.1% (− 0.9, 1.2)) or PI (hip, 0.3% (− 0.6, 1.2); spine, 0.5% (− 0.5, 1.5)). Ibuprofen use appeared to have more adverse effects on BMD in women than men. The study demonstrated that ibuprofen use did not significantly alter the BMD adaptations to exercise in older adults, but this finding should be interpreted cautiously. It had been expected that the inhibition of bone formation by ibuprofen would be more robust in men than in women, but this did not appear to be the case and may have limited the power to detect the effects of ibuprofen. Further research is needed to understand whether NSAID use counteracts, in part, the beneficial effects of exercise on bone.