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

2. Introduction Short bio Previous and future work Utilisation Kohn Prize

3. Short bio 1977 born, Groningen, Netherlands Short bio 1994 Starck, Himmelblau, Mendini

4. Short bio 1977 born, Groningen, Netherlands 2002: PharmD, Utrecht University 2007: PhD in Pharmacoepidemiology 2007 – current: assistant professor 1924 Gerrit Rietveld

5. 2007-current: Visiting Researcher, University of Southampton 1817 Hume Lancaster

6. 2006-2010: Senior Epidemiologist Medicines and Healthcare products Regulatory Agency London 1903, Monet

7. Sources of academic research funding related to osteoporosis / osteoarthritis (1.5 million euro)

8. 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 Corticosteroids Daily dose 2001

9. Fractures as potential side effects of drugs: corticosteroids

10. Corticosteroids Daily dose 2001 Inhaled corticosteroids 2005 Fractures as potential side effects of drugs: corticosteroids Source: de Vries / Van Staa / Cooper et al ERJ 2005

11. Inhaled corticosteroids 2005 Fractures as potential side effects of drugs: corticosteroids

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

13. Corticosteroids Daily dose 2001 Inhaled corticosteroids 2005 Oral corticosteroids Intermittent use 2007 Corticosteroids Daily dose 2001 Inhaled corticosteroids 2005 Fractures as potential side effects of drugs: corticosteroids Source: de Vries / Van Staa / Cooper et al Arthritis & Rheumatism 2007

14. Intermittent use of oral corticosteroids and hip fracture risk Prednisone equivalents Hip fracture, adjusted risk (95% CI) >= 15 mg <= 1 gram0.9 (0.6-1.4) 1-5 gram1.4 (0.8-2.4) > 5 gram1.9 (1.0-3.7)* Source: de Vries / Van Staa / Cooper et al Arthritis & Rheumatism 2007

15. Corticosteroids Daily dose 2001 Inhaled corticosteroids 2005 Oral + I.V. corticosteroids 2010-2011 Inhaled corticosteroids 2005 Corticosteroids Daily dose 2001 Inhaled corticosteroids 2005 Oral corticosteroids Intermittent use 2007 Fractures as potential side effects of drugs: corticosteroids Source: Bazelier / de Vries / Vestergaard / Van Staa / Cooper et al. In progress

16. 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)

17. 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

18. People

19. Utilisation of the Kohn Prize Grant preparations Publications Travel Facilitating access to data