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

Skeletal fragility is a common complication of endogenous Cushing's Syndrome (CS), although specific guidelines for managing bone health are lacking. This study aimed to assess clinicians' current engagement with bone health assessment and management in patients with endogenous CS.

Retrospective-cohort design.

Seventy-nine patients with confirmed endogenous CS, treated at a tertiary endocrine centre.

The frequency of bone health assessment, evidenced by vitamin D measurement, and bone health management, evidenced by a composite outcome of calcium and/or vitamin D optimisation and/or initiation of bone-protective agents, was recorded. Changes in bone mineral density (BMD), measured by Dual-energy X-ray absorptiometry (DEXA) and fracture prevalence were assessed pre- and post-CS treatment.

Vitamin D was measured in only 43% (34/79), and bone health was managed in only 39.2% (31/79). BMD was assessed in 44.3% (35/79) during active CS; of these, 22.9% had osteoporosis. Improved BMD was observed within a year of CS remission. Fractures occurred in 17.7% (14/79) within 2 years of CS diagnosis, and 12 additional fractures occurred during follow-up despite CS remission. Treatment with bone-protective agents expedited recovery with a significant increase in lumbar spine BMD, compared to those not treated.

Our data demonstrate that skeletal impairment and fragility fractures are highly prevalent in endogenous CS, and fracture risk may persist despite remission. However, currently, bone health is inadequately assessed and managed. These findings identify an urgent need for improved awareness, assessment, and management of bone-health in this high-risk population and call for specific evidence-based practice guidelines.