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Fractures as Adverse Events of Drugs:From Risk Factor to Predictor in Clinical Practice
Frank de Vries, PhD
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Introduction
Short bioPrevious and future workUtilisation Kohn Prize
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Short bio
1977 born, Groningen, Netherlands
Short bio
1994
Starck, Himmelblau, Mendini
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Short bio
1977 born, Groningen, Netherlands
2002: PharmD, Utrecht University2007: PhD in Pharmacoepidemiology2007 – current: assistant professor
1924 Gerrit Rietveld
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2007-current: Visiting Researcher, University of Southampton
1817 Hume Lancaster
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2006-2010: Senior Epidemiologist
Medicines and Healthcare products Regulatory Agency
London
1903, Monet
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Sources of academic research funding related to osteoporosis / osteoarthritis (1.5 million euro)
MRC Netherlands
ECTS
Other non-commercial
Other private -public
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Previous and Future work: fractures as potential side effects of drugs: corticosteroids
Sources: Van Staa / Cooper et al Rheumatology 2001
Daily Dose Corticosteroids (mg prednisone eq)
0 25
Adj RR of fracture
CorticosteroidsDaily dose 2001
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CorticosteroidsDaily dose 2001
Fractures as potential side effects of drugs: corticosteroids
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CorticosteroidsDaily dose 2001
Inhaled corticosteroids 2005
Fractures as potential side effects of drugs: corticosteroids
Source: de Vries / Van Staa / Cooper et al ERJ 2005
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Inhaled corticosteroids 2005
Fractures as potential side effects of drugs: corticosteroids
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Fractures as potential side effects of drugs: corticosteroids
Source: de Vries / Van Staa / Cooper et al ERJ 2005
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CorticosteroidsDaily dose 2001
Inhaled corticosteroids 2005
Oral corticosteroidsIntermittent use 2007
CorticosteroidsDaily dose 2001
Inhaled corticosteroids 2005
Fractures as potential side effects of drugs: corticosteroids
Source: de Vries / Van Staa / Cooper et al Arthritis & Rheumatism 2007
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Intermittent use of oral corticosteroids and hip fracture risk
Prednisone equivalents
Hip fracture, adjusted risk (95% CI)
>= 15 mg
<= 1 gram 0.9 (0.6-1.4)
1-5 gram 1.4 (0.8-2.4)
> 5 gram 1.9 (1.0-3.7)*
Source: de Vries / Van Staa / Cooper et al Arthritis & Rheumatism 2007
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CorticosteroidsDaily dose 2001
Inhaled corticosteroids 2005
Oral + I.V. corticosteroids 2010-2011
Inhaled corticosteroids 2005
CorticosteroidsDaily dose 2001
Inhaled corticosteroids 2005
Oral corticosteroidsIntermittent use 2007
Fractures as potential side effects of drugs: corticosteroids
Source: Bazelier / de Vries / Vestergaard / Van Staa / Cooper et al. In progress
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Corticosteroid boosters and osteoporotic fracture risk: multiple sclerosis (n=5,500)
Osteoporotic fracture, adjusted risk (95% CI)
MS (corticosteroid dose prednisone eq.) yr prior
1.4 (1.1-1.6)
Recent booster, oral 4.7 (1.9-11.5)
Recent booster, i.v. 1.4 (0.4-4.4)
<1 gram 1.2 (0.5-2.9)
1 – 2.5 gram 2.6 (1.1-6.3)
>2.5 gram 2.2 (1.1-4.5)
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Future research
2010-2014
• Fracture prediction in (rare) neurological diseases, movement disorders and autoimmune diseases
• Improvement of Dutch FRAX ®
• Clinical risk prediction, extending FRAX ® risk factors with:
• psychotropic drug use
• rheumatoid arthritis
• Outcomes in patients with arthroplasties
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People
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Utilisation of the Kohn Prize
• Grant preparations
• Publications
• Travel
• Facilitating access to data