Clinical Practice Patterns in Bone Health Assessment and Management in Endogenous Cushing's Syndrome

Area of Science:

• Endocrinology
• Bone Metabolism
• Clinical Medicine

Background:

• Skeletal fragility is a frequent complication of endogenous Cushing's Syndrome (CS).
• Current guidelines for managing bone health in CS patients are lacking.
• Clinicians' engagement with bone health assessment and management in CS requires evaluation.

Purpose of the Study:

• To assess the current practices of bone health assessment and management in patients with endogenous CS.
• To evaluate the prevalence of skeletal impairment and fractures in CS.
• To identify the need for improved bone health strategies in CS.

Main Methods:

• Retrospective-cohort study of 79 patients with endogenous CS.
• Recorded frequency of bone health assessment (vitamin D measurement) and management (calcium/vitamin D optimization, bone-protective agents).
• Assessed changes in bone mineral density (BMD) via DEXA and fracture prevalence pre- and post-CS treatment.

Main Results:

• Bone health was assessed in only 43% and managed in 39.2% of patients.
• Osteoporosis was present in 22.9% of patients with assessed BMD during active CS.
• Fractures occurred in 17.7% within 2 years of diagnosis, with persistent risk post-remission. Bone-protective agents improved lumbar spine BMD.

Conclusions:

• Skeletal impairment and fragility fractures are highly prevalent in endogenous CS.
• Fracture risk may persist even after CS remission.
• Inadequate bone health assessment and management highlight an urgent need for evidence-based guidelines and improved clinical awareness.