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Three members of CSM were recognised for the excellence of their epidemiological research into osteoarthritis and musculoskeletal conditions at a conference this weekend.

Sam Hawley (left), Cesar Gariga (middle), and Danielle Robinson (right) stand with their arms around one another and smile.

Three members of CSM were recognised for the excellence of their epidemiological research at the World Congress on Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (WCO) in Krakow, Poland, this weekend. Cesar Garriga and Sam Hawley were given Young Investigator Awards. Danielle Robinson was given an ESCEO-AgNovos Healthcare Young Investigator Award, based on work done during her doctoral degree at the University of Manchester.

Out of 1513 abstracts submitted to WCO 2018, Danielle was among 39 selected oral presentations, and Cesar and Sam were among just 21 poster presentations selected for oral presentation.

The WCO is organised by the International Osteoporosis Foundation (IOF) and the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO), and brings together the world’s best in the field of musculoskeletal health and disease.

Cesar, Sam, and Danielle work within the observational research theme of CSM, under CSM PIs Daniel Prieto-Alhambra and Andrew Judge. “It’s great to work in an epidemiology team where there’s an emphasis on using rigorous and interesting methods, but that’s essentially focused on research that’s clinically meaningful,” says Sam.

Cesar Garriga, postdoctoral researcher in epidemiology

Cesar was lead author of a study exploring the association between taking bisphosphonates and developing vision problems called age-related macular degeneration. Patients with osteoporosis who have had a bone fracture are often prescribed bisphosphonates to prevent more fractures. We don’t yet know the cause of age-related macular degeneration, which affects one in three people older than 75 in industrialised countries. There are also no preventive therapies or cures for age-related macular degeneration.


This award is a fantastic recognition of the development of my research career. - Cesar Garriga

The team, overseen by Andrew Judge, looked at data from a group of patients with hip fractures. They found that simply taking bisphosphonates didn’t change the risk of developing age-related macular degeneration, but that taking higher doses of bisphosphonates was associated with higher risk. Further research is needed to understand whether there is just an association between using this drug and developing vision problems, or whether the drugs cause the vision problems.

Cesar first presented this work at the 2017 American Society for Bone and Mineral Research meeting in Denver, USA, and was invited to contribute to WCO 2018 by the organisers due to the outstanding nature of the work. The work was also recently published in the Annals of the New York Academy of Sciences.

“This award is a fantastic recognition of the development of my research career,” says Cesar. “As an epidemiologist, I enjoy learning about the complex design details behind pharmaco-epidemiology studies.”

Sam Hawley, DPhil student in epidemiology

Sam was lead author of a study investigating whether the introduction of NICE guidelines and the release of a relatively cheap generic version of a common bisphosphonate (alendronate) have helped reduce new fractures in patients who have had a hip fracture. The team, overseen by Andrew Judge and NDORMS’ Kassim Javaid, specifically looked at whether any effects were seen in much older patients, as many studies of bisphosphonates exclude the very elderly.

They found that three years after the NICE guidance and generic alendronate were introduced, new fractures had dropped by 15% in both patients younger than 85 years and very elderly patients (over 85 years). This research used an observational design, using routinely collected data from patients. Although it shows an association between the NICE guidance and generic alendronate versus the fracture rate, it doesn’t prove whether the change seen was due to the guidance and drugs. However, the study does suggest that these events had a role to play and that anti-osteoporotic medications remain effective among very elderly and frail patients.

Danielle Robinson, Research assistant in statistics

Danielle was lead author of a study exploring the association between oral glucocorticoid use and fracture risk in patients with rheumatoid arthritis. Glucocorticoids inhibit inflammation and are used to treat things like asthma and allergies, but have side effects that might affect fracture risk. Whilst this area has been widely explored, most models only consider one aspect of strength of glucocorticoid dose, how long the drug was used, or how recently the drug was used. As glucocorticoids are prescribed in complex patterns that have patients starting and stopping the drugs and changing dose, all three aspects might affect fracture risk.

I am delighted to receive this award for my PhD work. I really enjoy...seing the potential effect of my work on patient safety. - Danielle Robinson

Danielle and her supervisory team used a new method known as the weighted cumulative exposure to incorporate all three factors in one model assessing the effect of oral glucocorticoid use on fracture risk. They found that the past year of oral glucocorticoid use affects the risk of fracture, and that the risk of fracture drops to the same level as those not taking the drugs between six months and one year after stopping treatment. The team also compared the risk of fracture for two patterns of use with equal cumulative dose for the first time. They found that the risk of fracture changes depending on the exact prescription pattern to create the cumulative dose and that lower doses over a longer time have a lower risk than higher doses over a shorter time.

“I am delighted to receive this award for my PhD work," says Danielle. "Having originally started off studying maths at university, I really enjoy applying the content I learnt in the statistics modules to pharmaco-epidemiological problems and seeing the potential effect of my work on patient safety.”