Systematic Review of Nandrolone Use in Postoperative Orthopedic Management of Osteomyelitis

Background: Osteomyelitis (OM) presents a complex clinical challenge in orthopedic practice due to its chronic nature, surgical demands, and high recurrence rates. Recent advances in musculoskeletal pharmacology have raised interest in the use of nandrolone decanoate (ND), an anabolic-androgenic steroid, as a potential adjuvant to promote functional and structural recovery in post-infectious orthopedic patients. Objective: To systematically evaluate the scientific evidence regarding the use of nandrolone decanoate in orthopedic recovery following surgical treatment of osteomyelitis. Methods: A systematic review was conducted in accordance with PRISMA 2020 guidelines. Literature searches were performed across PubMed, Scopus, Web of Science, and Google Scholar databases up to April 2024. Studies were included if they evaluated or discussed ND use in the context of orthopedic rehabilitation or osteomyelitis, encompassing randomized controlled trials, cohort studies, systematic and narrative reviews, and clinical case reports. A qualitative narrative synthesis was conducted due to methodological heterogeneity. Results: From 140 identified records, 30 studies were included in the final analysis. Evidence supports the anabolic and osteogenic effects of ND in musculoskeletal recovery, particularly in elderly or sarcopenic patients. However, no clinical trials have directly evaluated ND use in patients with active or recently treated osteomyelitis. Theoretical models and preclinical data suggest potential benefits in bone regeneration following infection clearance, yet clinical validation remains limited. Safety concerns and lack of standardized protocols were recurrent limitations. Conclusion: While nandrolone decanoate demonstrates theoretical and preclinical promise as a rehabilitative adjunct in orthopedic patients’ post-osteomyelitis, current clinical evidence is insufficient. Future high-quality trials are needed to define its therapeutic efficacy, optimal dosing, and safety profile within infection-related musculoskeletal contexts.