Prevalence, risk factors and management of bone complications in Cushing's syndrome across Europe. Data from the European Registry on Cushing's syndrome (ERCUSYN).
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Zdrojowy-Wełna Aleksandra, Amaral Claudia, Araujo-Castro Marta, Biermasz Nienke, Bolanowski Marek, Bollerslev Jens, Brue Thierry, Carvalho Davide, Castinetti Frederic, Ceccato Filippo, Cristante Justine, Dadej Daniela, Detomas Mario, Deutschbein Timo, Ferrante Emanuele, Elenkova Atanaska, Gil Joan, Ghigo Ezio, Gilis-Januszewska Aleksandra, Giordano Roberta, Goth Miklos, Greaud Cecile, Greenman Yona, Guelho Daniela, Ilovayskaya Irena, Kaniuka-Jakubowska Sonia, Kastelan Darko, Kocjan Tomaz, Komerdus Irina, Krsek Michal, Maiter Dominique, Moros Olga, Mlekuš Kozamernik Katarina, Papakokkinou Eleni, Reimondo Giuseppe, Ragnarsson Oskar, Reincke Martin, Sigurjonsdottir Helga, Strasburger Christian J, Tabarin Antoine, Tóth Miklós, Vila Greisa, Zilaitiene Birute, Santos Alicia, Webb Susan M, Valassi Elena, ERCUSYN Study Group
Аннотация
DESIGN: A retrospective multicentric cohort study and on-line survey.
METHODS: We analyzed the prevalence of osteoporosis (OP) and fractures among 1682 patients with Cushing's syndrome (CS), at initial evaluation and during follow-up. All the ERCUSYN partners received a survey addressing bone disease management in CS.
RESULTS: Seven hundred and sixty-six patients (45%) had DXA examination at baseline, of whom 157 (21%) presented OP at spine and 103 (13%) at hip. Risk factors for OP were older age (P=0.038) and lower BMI (P=0.022). An X-ray was performed in 492 (29%) patients and fracture was detected in 87 (18%). Risk factors for fractures at baseline were male sex (P<0.001), muscle weakness (P=0.026) and bone mineral density (BMD) at hip indicating OP (P=0.026). During follow-up, spine BMD deterioration was more common in older patients (P=0.005) and in those with diabetes mellitus (P=0.024), while worsening of hip BMD was more frequent in patients with hypopituitarism (P=0.021), diabetes mellitus (P=0.034), on levothyroxine substitution (P=0.008) and those less often treated with anti-osteoporotic agents (P=0.022). The survey evidenced significant heterogeneity in terms of timing of bone evaluation and treatment initiation.
CONCLUSIONS: A significant number of patients with CS experienced OP and fractures. Clinical factors may help to select patients at the highest risk. There are currently no standards of care for the management of bone complications in CS across Europe.