Bone health assessment and management are suboptimal in endogenous cushing

Dinushan Raveendran; Ramesh Nair; Marco Aimee Di; Debbie Papadopoulou; Florian Wernig; Karim Meeran; Niamh Martin; Jeremy Cox; Alex Comninos; Preeshila Behary

doi:10.1530/endoabs.109.P65

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Endocrine Abstracts (2025) 109 P65 | DOI: 10.1530/endoabs.109.P65

SFEBES2025 Poster Presentations Bone and Calcium (25 abstracts)

Bone health assessment and management are suboptimal in endogenous cushing’s syndrome: a large tertiary centre experience

Dinushan Raveendran ¹ , Ramesh Nair ² , Aimee Di Marco ² , Debbie Papadopoulou ² , Florian Wernig ² , Karim Meeran ² , Niamh Martin ² , Jeremy Cox ² , Alex Comninos ² & Preeshila Behary ²

Author affiliations

¹Imperial College London, London, United Kingdom; ²Imperial Hospital NHS Trust, London, United Kingdom

Background: Skeletal impairment and fragility fractures are frequent complications of endogenous Cushing’s Syndrome (CS). Despite this, specific guidelines for managing bone health are lacking, and little is known about clinicians’ engagement with bone health in this high-risk population. Therefore, I aimed to assess engagement with bone health assessment and management in endogenous CS using real-world data from a tertiary referral centre. I hypothesised that bone health would be assessed and managed in less than 50% of patients with endogenous CS.

Methods: 79 patients with endogenous CS were retrospectively investigated. The frequency of bone health assessment, indicated by vitamin D measurement, and bone health management were recorded as primary outcomes. Changes in bone mineral density (BMD), fracture risk using FRAX, and fracture prevalence were assessed before and after CS treatment. A sub-group analysis compared BMD changes in patients treated with bone-protective agents to those not treated.

Results: Vitamin D was measured in only 34 patients (43%). Bone health was managed in only 31 patients (39.2%) with either calcium, vitamin D, or bone-protective agents. Improved BMD was observed after CS treatment. BMD was measured in only 35 patients (44.3%) during active CS; of these, 22.9% had osteoporosis. 14 patients (17.7%) had fractures within two years of CS diagnosis, and 12 fractures occurred during follow-up, despite CS remission. Treatment with bone-protective agents significantly improved lumbar spine BMD compared to those not treated.

Conclusion: These data demonstrate that skeletal impairment and fragility fractures are highly prevalent during active endogenous CS, and fracture risk may persist despite CS remission. However, bone health assessment and management were inadequate. These results indicate specific practice guidelines are needed to improve the assessment and management of skeletal complications in endogenous CS. Long-term prospective studies are needed to evaluate the efficacy of bone-protective agents on skeletal recovery in endogenous CS.