Physicians’ knowledge and attitude regarding bisphosphonates-related adverse events: An observational study

Table 1 Bisphosphonates-reported side effects, characteristics, and rating

Side effects	BPs incriminated	Causality link	Rating of correct answers	Rating of false answers
Upper GI intolerance	Oral amino-BPs	Established	2	0
Acute phase reaction	IV amino-BPs	Established	2	0
Hypocalcaemia	IV > oral BPs	Established	2	0
Renal toxicity	Zoledronate and pamidronate	Established	2	0
Severe musculoskeletal pain	Oral BPs	Probable	1	0
Ocular inflammation	All BPs	Probable	1	0
Atypical femoral fractures	BPs treatment for osteoporosis	Probable	1	0
Osteonecrosis of the jaw	IV BPs treatment in oncology	Probable	1	0
Atrial fibrillation	---	Unproven	1	-1
Esophageal cancer	---	Unproven	1	-1
Hepatotoxicity	---	Unproven	1	-1

BPs: Bisphosphonates; GI: Gastrointestinal; IV: Intravenous.

Table 2 Our 157 physicians’ knowledge, fear and experience regarding bisphosphonates-reported side effects

Side effects	Reported by physicians n (%)	Feared by physicians n (%)	Encountered by physicians n (%)
Acute phase reaction	86 (54.8)	12 (7.6)	42 (26.8)
Atrial fibrillation	21 (13.4)	12 (7.6)	0 (0.0)
Atypical femoral fractures	67 (42.7)	48 (30.6)	13 (8.3)
Esophageal cancer	18 (11.5)	11 (7.0)	0 (0.0)
Hepatotoxicity	39 (24.8)	18 (11.5)	2 (1.3)
Hypocalcaemia	72 (45.9)	33 (21.0)	27 (17.2)
Ocular inflammation	12 (7.6)	3 (1.9)	2 (1.3)
Osteonecrosis of the jaw	118 (75.2)	93 (59.2)	38 (24.2)
Renal toxicity	84 (53.5)	67 (42.7)	33 (21.0)
Severe musculoskeletal pain	59 (37.6)	10 (6.4)	24 (15.3)
Upper GI intolerance	122 (77.7)	45 (28.7)	70 (44.6)
No side effect	2 (1.3)	7 (4.5)	32 (20.4)

GI: Gastrointestinal.

Table 3 Univariate analyses of factors associated with the level of knowledge

Independent variables	Knowledge score (mean ± SD)	n	P-value
Professional position			0.232
Professor	8.82 ± 2.83	17
Attending physician	8.65 ± 2.57	54
Fellowship resident	7.93 ± 2.90	86
Department affiliation			< 0.0001a
Medical	8.92 ± 2.55	114
Surgical	6.56 ± 2.69	43
Department affiliation			< 0.0001a
Rheumatology	10.62 ± 2.83	8
Oncology	10.10 ± 1.77	20
Nephrology	9.70 ± 2.63	10
Endocrinology	9.45 ± 2.51	11
Internal medicine	8.21 ± 2.48	29
Family medicine	8.08 ± 2.52	36
Orthopedics	7.38 ± 3.09	21
Gynecology	5.77 ± 2.02	22
Age			0.213
< 30 yr	7.91 ± 2.87	80
30-50 yr	8.53 ± 2.77	55
> 50 yr	8.95 ± 2.46	22
Gender			0.016a
Male	7.84 ± 2.63	95
Female	8.94 ± 2.91	62
No. of patients attended per day			0.874
< 10 patients	8.29 ± 2.84	52
10-20 patients	8.32 ± 2.89	65
> 20 patients	8.03 ± 2.42	34
No. of medical sales representatives received per week			0.149
0	7.55 ± 2.60	20
< 10	7.98 ± 2.76	86
10-20	8.91 ± 2.62	34
> 20	9.07 ± 2.99	14
Time consumed for patients care			0.906
< 25%	8.25 ± 2.06	4
25%-50%	8.00 ± 2.77	37
51%-75%	8.43 ± 2.88	68
> 75%	8.25 ± 2.75	44
Time consumed for academic work			0.171
< 25%	8.23 ± 2.78	57
25%-50%	8.42 ± 2.80	76
51%-75%	7.25 ± 2.54	16
> 75%	10.50 ± 1.91	4
BP prescription			0.001a
Yes	8.78 ± 2.69	108
No	7.16 ± 2.70	49
No. of BP prescriptions delivered per month			0.006a
≤ 5 prescriptions	8.27 ± 2.64	73
6-10 prescriptions	9.70 ± 2.46	27
> 10 prescriptions	10.86 ± 2.48	7
Most frequent form of BP prescribed			0.033a
Oral form	8.48 ± 2.73	87
Intravenous form	9.90 ± 2.22	20
No. of patients on BP attended per month			< 0.0001a
0 patient	6.64 ± 2.06	11
1-5 patients	7.85 ± 2.52	81
6-10 patients	8.26 ± 2.81	34
> 10 patients	9.97 ± 2.99	31

^aP-value < 0.05 (level of significance). BP: Bisphosphonate.

Table 4 Multiple regression analysis of factors associated with the level of knowledge

	Unstandardized coefficients		Standardized coefficients	Student	P-value	Partial correlations
	β	Standard error	β
Department affiliation	1.253	0.610	0.201	2.054	0.043a	0.204
Gender	1.103	0.539	0.194	2.045	0.044a	0.203
No. of medical sales representatives received per week	0.167	0.330	0.048	0.506	0.614	0.051
Time consumed for academic work	0.144	0.331	0.038	0.434	0.665	0.044
BP prescription	-1.455	0.566	-0.242	-2.569	0.012a	-0.252
No. of BP prescriptions delivered per month	1.106	0.431	0.241	2.567	0.012a	0.252
Most frequent form of BP prescribed	0.870	0.671	0.122	1.296	0.198	0.130

^aP-value < 0.05 (level of significance). BP: Bisphosphonate.