Fractures as Adverse Events of Drugs: From Risk Factor to Predictor in Clinical Practice Frank de...

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


Fractures as potential side effects of drugs: corticosteroids


Inhaled corticosteroids 2005


Source: de Vries / Van Staa / Cooper et al ERJ 2005


Source: de Vries / Van Staa / Cooper et al ERJ 2005



Oral corticosteroidsIntermittent use 2007




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



Oral + I.V. corticosteroids 2010-2011




Oral corticosteroidsIntermittent use 2007


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

Fractures as Adverse Events of Drugs: From Risk Factor to Predictor in Clinical Practice Frank de...

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