Observational Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Rheumatol. Mar 12, 2017; 7(1): 1-7
Published online Mar 12, 2017. doi: 10.5499/wjr.v7.i1.1
Physicians’ knowledge and attitude regarding bisphosphonates-related adverse events: An observational study
Lana El Osta, Nada El Osta, Reine Tannous, Antoine Aoun, Marwan Ghosn, Hazem El Osta
Lana El Osta, Nada El Osta, Reine Tannous, Department of Public Health, School of Medicine, Saint-Joseph University, Beirut 1107 2180, Lebanon
Antoine Aoun, Faculty of Nursing and Health Sciences, Notre Dame University, Zouk Mosbeh 1211, Lebanon
Marwan Ghosn, Department of Hematology-Oncology, School of Medicine, Saint-Joseph University, Beirut 1107 2180, Lebanon
Hazem El Osta, Feist-Weiller Cancer Center, Louisiana State University Health Sciences Center, Shreveport, LA 71103, United States
Author contributions: El Osta L, El Osta N and El Osta H contributed with conception and design; Tannous R and Aoun A participated in the acquisition of the data; El Osta N, Aoun A and Ghosn M participated in the analysis and interpretation of the data; El Osta L and El Osta N drafted the initial manuscript; Tannous R, Aoun A, Ghosn M and El Osta H revised critically the manuscript for important intellectual content; all authors read and approved the final manuscript.
Institutional review board statement: The Institutional Review Board of the Hôtel-Dieu de France hospital of Beirut approved the study protocol.
Informed consent statement: All study participants provided their written informed consent to participate in the study. All data were encoded and kept confidentially.
Conflict-of-interest statement: The authors have no conflicts of interest to disclose.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Lana El Osta, MD, Department of Public Health, School of Medicine, Saint-Joseph University, PO Box 11-5076, Riad El Solh, Beirut 1107 2180, Lebanon. lanaosta@hotmail.com
Telephone: +961-70-955964 Fax: +961-1-613397
Received: December 4, 2016
Peer-review started: December 5, 2016
First decision: January 16, 2017
Revised: February 10, 2017
Accepted: March 3, 2017
Article in press: March 5, 2017
Published online: March 12, 2017

To assess the knowledge and attitude of Lebanese physicians regarding bisphosphonates (BPs)-related complications.


An observational cross-sectional study was conducted at a major tertiary teaching hospital in Beirut city, and its affiliated primary health care center. Data were collected through a new self-administered questionnaire distributed via a delegated secretary to physicians expected to regularly prescribe BPs (n = 215). It assessed participants’ knowledge, fear and experience regarding BPs-reported complications.


One hundred and fifty-seven physicians fulfilled the questionnaire (response rate: 73.0%): 77.7% and 75.2% considered that gastrointestinal intolerance and osteonecrosis of the jaw are linked to BPs, respectively. Conversely, the least recognised complications are ocular inflammation (7.6%) and severe musculoskeletal pain (37.6%). The association of BPs with oesophageal cancer, atrial fibrillation and hepatotoxicity was reported by 11.5%, 13.4% and 24.8% of respondents, respectively. The multivariate analysis showed a significant association between level of knowledge and physicians’ department affiliation (P-value = 0.043), their gender (P-value = 0.044), whether or not they prescribe a BP (P-value = 0.012), and the number of BP prescriptions delivered monthly (P-value = 0.012). Physicians are mainly concerned about osteonecrosis of the jaw and nephrotoxicity when prescribing a BP. Yet, the complications commonly met in their practice are gastrointestinal intolerance (44.6%) and acute phase reactions (26.7%).


This study revealed the presence of a deficient knowledge regarding BPs-related adverse events among our physicians. Professional training proposals are needed to increase their knowledge and improve their practices. Pharmaceutical industries should reconsider the instructions they provide to physicians regarding the complications of medications they promote. Moreover, they must actively collaborate with education providers and institutions in educational interventions.

Keywords: Knowledge, Bisphosphonates, Malignant bone diseases, Osteoporosis, Drug complications

Core tip: Bisphosphonates (BPs) have been proven to be effective, tolerated and relatively safe to a large number of patients. However, they were associated with reports of multiple adverse events. Given the widespread use of these medications, detailed knowledge on occurrence of even rare side effects is imperative. In this study, we assess the knowledge and approach of our physicians regarding BPs-related complications. Eventually, this evaluation will facilitate the elaboration of appropriate training programs to increase their awareness and improve their practice. It will incite pharmaceutical companies to reconsider the instructions they provide to physicians about the complications of treatments they promote.