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

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Presentation transcript:

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

Introduction Short bio Previous and future work Utilisation Kohn Prize

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

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

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

: Senior Epidemiologist Medicines and Healthcare products Regulatory Agency London 1903, Monet

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

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

Fractures as potential side effects of drugs: corticosteroids

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

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

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

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

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

Corticosteroids Daily dose 2001 Inhaled corticosteroids 2005 Oral + I.V. corticosteroids 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

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 ( ) Recent booster, oral 4.7 ( ) Recent booster, i.v. 1.4 ( ) <1 gram 1.2 ( ) 1 – 2.5 gram 2.6 ( ) >2.5 gram 2.2 ( )

Future research 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