Paper 32: Performance & promises: a social media review of alleged indications, risks and usage of “peptides” in musculoskeletal health

Objectives: Peptides are short chains of amino acids that exert biological effects, often by binding to high-affinity receptors on target cells. Between 2016 and 2022, the U.S. Food and Drug Administration (FDA) approved 26 peptide-based drugs, with approximately 200 more currently in clinical development. Research interest in peptides targeting tendon, ligament, and cartilage conditions has grown significantly, from a few dozen publications annually in the 1990s to more than 1,000 per year (Figure 1). The global peptide therapeutics market, currently valued at $42 billion USD, accounts for approximately 5% of the pharmaceutical industry and is projected to grow by a compound annual growth rate of 10% annually over the next decade. Injectable peptides such as BPC-157, TB-500, and CJC-1295 are gaining popularity on social media platforms for their alleged therapeutic benefits. Despite their widespread promotion, these compounds are not approved by regulatory bodies like the FDA and are banned in competitive athletics by the World Anti-Doping Agency. Their increasing visibility online raises concerns about misinformation, public safety, and illegal sales.The objective of this study is to systematically evaluate peptide-related content across social media platforms and to examine the frequency of posts, the nature of proposed indications, presence of medical disclaimers, and engagement metrics.
Methods: A systematic content analysis was conducted across YouTube, Instagram, TikTok, Reddit and X (formerly Twitter) to identify the most popularly referenced peptides and how they are presented to the public. Posts were selected using relevant hashtags, with the top-10 ranking posts for each peptide and platform included. Extracted variables included: post metadata (quantity of views, likes, comments, and shares); type of account (e.g., physician, fitness influencer, organization, or clinic); content characteristics (peptide(s) mentioned, stated indications, adverse effects), and post format (e.g., infographic, interview, instructional video). Quality assessment was performed using the modified DISCERN tool for social media posts, which rates the reliability and presentation of information on a scale from 0 (low reliability) to 5. Additionally, each post was measured against the FDA criteria for presenting risk and benefit information for drugs on social media, to identify any violations.
Results: A total of 239 posts were analyzed (10,087,381 views), with posts having approximately three times greater post engagement than another similar study of ACL recovery exercises on TikTok. BPC-157 was the most frequently mentioned peptide, often recommended in conjunction with TB-500. Promoted benefits included: healing of soft tissue, tendon, and bone injuries (51.2%), improved muscle and joint recovery (39.5%), anti-inflammatory effects (32.6%), enhanced cognition and mood (20.9%), improved metabolism and longevity (14.0%).Ipamorelin, CJC-1295, and IGF1-LR3 were the other most popular peptides. Influencer-driven content, especially on TikTok and Instagram, promoted dramatic health claims with little or no scientific backing. Few posts included FDA-compliant disclaimers (15.9%) or adverse effects (12.5%), and many contained links to unregulated retailers (31.0%). YouTube content such as @HubermanLab was more likely to cite research and mention risks or adverse effects (38%), while X was heavily commercialized (58%). Instagram was visually driven and promotional, with infographics and aesthetic-focused content catering to male body insecurity (Figure 2). Mean quality score was generally rated as low (1.0 [1.3]) using the modified DISCERN tool, but highest on YouTube (mean: 2.8, p<.001).
Conclusions: Peptides are being widely advertised and sold through social media, often with exaggerated claims and minimal regulatory oversight. Most posts extrapolate from preclinical or anecdotal data, marketing peptides as panaceas for health, performance, and aesthetics, as evidenced by the poor DISCERN scores. The absence of clinical trials and safety data highlight concerns for responsible use. The FDA has raised concerns regarding unverified peptide compositions and poor manufacturing practices. Without robust human data on efficacy and adverse effects, regulatory bodies are limited in their ability to act, and consumers remain unaware of potential risks. Clearer regulations, molecular analysis of products, and high-quality human trials are urgently needed to address this growing health infodemic that may lead to harm from inappropriate use.