fractures as adverse events of drugs: from risk factor to predictor in clinical practice frank de...
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Fractures as Adverse Events of Drugs:From Risk Factor to Predictor in Clinical Practice
Frank de Vries, PhD
Introduction
Short bioPrevious and future workUtilisation Kohn Prize
Short bio
1977 born, Groningen, Netherlands
Short bio
1994
Starck, Himmelblau, Mendini
Short bio
1977 born, Groningen, Netherlands
2002: PharmD, Utrecht University2007: PhD in Pharmacoepidemiology2007 – current: assistant professor
1924 Gerrit Rietveld
2007-current: Visiting Researcher, University of Southampton
1817 Hume Lancaster
2006-2010: Senior Epidemiologist
Medicines and Healthcare products Regulatory Agency
London
1903, Monet
Sources of academic research funding related to osteoporosis / osteoarthritis (1.5 million euro)
MRC Netherlands
ECTS
Other non-commercial
Other private -public
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
CorticosteroidsDaily dose 2001
Fractures as potential side effects of drugs: corticosteroids
CorticosteroidsDaily dose 2001
Inhaled corticosteroids 2005
Fractures as potential side effects of drugs: corticosteroids
Source: de Vries / Van Staa / Cooper et al ERJ 2005
Inhaled corticosteroids 2005
Fractures as potential side effects of drugs: corticosteroids
Fractures as potential side effects of drugs: corticosteroids
Source: de Vries / Van Staa / Cooper et al ERJ 2005
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
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
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
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)
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
People
Utilisation of the Kohn Prize
• Grant preparations
• Publications
• Travel
• Facilitating access to data