Clinical practice patterns in bone health assessment and management in endogenous Cushing's Syndrome
Author(s)
Type
Journal Article
Abstract
Objective
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.
Design
Retrospective-cohort design.
Patients
Seventy-nine patients with confirmed endogenous CS, treated at a tertiary endocrine centre.
Measurements
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.
Results
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.
Conclusions
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.
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.
Design
Retrospective-cohort design.
Patients
Seventy-nine patients with confirmed endogenous CS, treated at a tertiary endocrine centre.
Measurements
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.
Results
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.
Conclusions
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.
Date Issued
2026-04-01
Date Acceptance
2025-12-04
Citation
Clinical Endocrinology, 2026, 104 (4), pp.302-311
ISSN
0300-0664
Publisher
Wiley
Start Page
302
End Page
311
Journal / Book Title
Clinical Endocrinology
Volume
104
Issue
4
Copyright Statement
© 2025 The Author(s). Clinical Endocrinology published by John Wiley & Sons Ltd. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
License URL
Identifier
https://www.ncbi.nlm.nih.gov/pubmed/41423826
Subjects
ADULT PATIENTS
bone health
bone mineral density (BMD)
calcium
COMPLICATIONS
Cushing's Syndrome
DISEASE
Endocrinology & Metabolism
FRACTURES
fragility fractures
GLUCOCORTICOID-INDUCED OSTEOPOROSIS
Life Sciences & Biomedicine
MASS
MINERAL DENSITY
osteoporosis
RECOVERY
Science & Technology
SURGICAL CURE
vitamin D
Publication Status
Published
Coverage Spatial
England
Date Publish Online
2025-12-21