What information can the lay public find about osteoporosis treatment? A descriptive study coding the content and quality of bisphosphonate information on the internet
Despite its effectiveness, bisphosphonate use for osteoporosis is low. We assessed bisphosphonate information on the internet and found the most commonly listed benefits/risks were bone density loss, gastrointestinal issues, and jaw necrosis, that risk quantification was rare, and information quality varied. Findings underscore the importance of clinical communication about bisphosphonates.
The US Preventative Services Task Force recommends osteoporosis screening and treatment with bisphosphonates in high-risk populations. However, bisphosphonate use among individuals with osteoporosis remains low. The content and quality of information from outside sources may influence individuals’ bisphosphonate decisions. Therefore, we sought to assess the content and quality of osteoporosis treatment information available to the public by conducting an internet search and coding available bisphosphonate information.
Eleven search terms about osteoporosis and bisphosphonates were entered into four search engines. Two raters assessed websites for information about bisphosphonates, whether and how benefits and side effects were described and quantified, contraindications, and dosing instructions. Coders also assessed website interface and slant/balance of information.
One thousand four hundred seventy-three websites were identified. Two hundred twenty-seven websites met inclusion criteria and were coded. The most common bisphosphonate benefit described was prevention of bone density loss (77.1% of websites). The most common side effects described were gastrointestinal problems (66.1%) and jaw osteonecrosis (58.6%). Most websites did not quantify bisphosphonate benefits (78.0%) or side effects (82.4%). Complementary/integrative health websites (p < .001) and pharmaceutical litigation websites (p < .001) were more often slanted against taking bisphosphonates, compared to all websites coded. General medical knowledge websites were more balanced than other websites (p = .023).
The quality of bisphosphonate information on the internet varies substantially. Providers counseling patients about osteoporosis treatment should inquire about patients’ baseline bisphosphonate knowledge. Providers can complement accurate information and address potential bisphosphonate misconceptions.
KeywordsBisphosphonates Health communication Online information Osteoporosis
Agency for Healthcare Research and Quality
Advanced Summer Program for Investigation and Research Education
Centers for Disease Control and Prevention
International Business Machines
International Osteoporosis Foundation
Statistical Package for the Social Sciences
This study was supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases, part of the National Institutes of Health, under Award Number AR060231-06 (PI: Fraenkel), the National Cancer Institute, part of the National Institute of Health, under award T32CA190194 (PIs: Colditz/James), the Foundation for Barnes-Jewish Hospital, Siteman Cancer Center, and Advanced Summer Program for Investigation and Research Education (ASPIRE) of the Clinical Research Training Center at Washington University School of Medicine. The content of this manuscript is solely the responsibility of the authors and does not necessarily represent the official views of the organizations supporting this work.
Compliance with ethical standards
Conflicts of interest
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