Endocrine Abstracts

In Cushing syndrome (CS), glucocorticoid-induced osteoporosis is suggested to be the main reason for drug-induced osteoporosis. This health condition creates weaknesses in bones which are then easily fractured.Studies estimate that osteoporosis is under diagnosed in the UK by around 50%, and according to the International Osteoporosis Foundation 2021, osteoporosis is a major healthcare burden in Europe with 4.3 million fragility fractures and healthcare costs more than 56billion euros annually. Primary prevention rates are very low, and most patients only receive a Dual-Energy X-ray Absorptiometry (DEXA), scan following a first or second fracture. Osteoporosis is one of the most common comorbidities in CS patients.A recent Doctor of Philosophy (PhD) survey of CS members of a support group found 30 (42%) of the female members and 1 male member (6.6%), had been diagnosed with this condition. Only 12 of them initially had a DEXA scan to confirm their osteoporosis, and 23.8% reported that they had found an improvement in their condition after being prescribed medical therapy.However, the length of waiting time for a DEXA scan was between 8 months to 2 years. Over 70% of the women and 40% of the men in the survey reported bone pain, proximal muscle weakness, and mobility disabilities, and this had impacted on their social, personal, and working lives.The findings from recent clinical trials have shown that by using advanced physics modelling and Artificial Intelligence (AI), methods, accurate measure of bone mineral density from standard digital x-ray (DXR), images, example wrist and hip, can be achieved. This means for the first time, patients who undergo skeletal imaging can be opportunistically assessed for osteoporosis.Interestingly, in this PhD study, 33.3% (n=24), of the other members including males, were referred for skeletal x-ray examinations mainly due to fractures which occurred following their CS diagnosis.AI technology could revolutionize the way in which the early onset of osteoporosis is identified and subsequently lead to earlier treatment and improved quality of life. Additional benefits being a reduction in the socioeconomic cost of long-term treatment for fractures and unnecessary radiation doses to patients. The recommendation from the PhD study being, that more research using AI technology is required and could become an integral part of the diagnostic workup for endocrine patients, thus avoiding the wait for a DEXA scan, as DXR equipment is more readily available.