ECE2024 Poster Presentations Adrenal and Cardiovascular Endocrinology (95 abstracts)
Prevalence and treatment of osteoporosis and bone fractures in Cushing’s syndrome across Europe
Aleksandra Zdrojowy-Welna 1 , Claudia Amaral 2 , Marta Araujo-Castro 3 , Nienke Biermasz 4 , Marek Bolanowski 1 , Jens Bollerslev 5 , Thierry Brue 6 , Davide Carvalho 7 , Frederic Castinetti 8 , Filippo Ceccato 9 , Olivier Chabre 10 , Daniela Dadej 11 , Mario Detomas 12 , Timo Deutschbein 13 , Emanuele Ferrante 14 , Atanaska Elenkova 15 , Ezio Ghigo 16 , Roberta Giordano 16 , Aleksandra Gilis-Januszewska 17 , Miklos Goth 18 , Cecile Greaud 19 , Yona Greenman 20 , Daniela Guelho 21 , Irina Ilovayskaya 22 , Sonia Kaniuka-Jakubowska 23 , Darko Kastelan 24 , Irina Komerdus 22 , Michal Krsek 25 , Dominique Maiter 26 , Olga Moros 27 , Katarinamlekuš Kozamernik 28 , Eleni Papakokkinou 29 , Oskar Ragnarsson 29 , Giuseppe Reimondo 16 , Martin Reincke 30 , Alicia Santos 31 , Helga Sigurjonsdottir 32 , Christian Strasburger 33 , Miklos Toth 34 , Antoine Tabarin 35 , Greisa Vila 36 , Susan Webb 31 , Birutę Žilaitienę 37 & Elena Valassi 38,39
1Wroclaw Medical University, Department of Endocrinology, Diabetes and Isotope Therapy, Wroclaw, Poland; 2Centro Hospitalar Universitário de Santo António, Porto, Portugal; 3Ramón y Cajal University Hospital, Madrid, Spain; 4Leiden University Medical Center, Leiden, Netherlands; 5Rikshospitalet Radium Hospitalet, Oslo, Norway; 6Association pour le Devéloppement des Recherches Biologiques et Médicales, Marseille, France; 7University of Porto, Porto, Poland: 8Aix Marseille Université, Marseille, France; 9University-Hospital of Padova, Padova, Italy; 10Centre Hospitalier Universitaire de Grenoble, La Tronche, France; 11Chair, Department of Endocrinology, Faculty of Medicine, Metabolism and Internal Diseases, Poznan University of Medical Sciences, Poznan, Poland; 12University Hospital of Würzburg, Würzburg, Germany; 13PI Medicover Oldenburg MVZ, Oldenburg, Germany; 14Endocrinology Unit, Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy; 15Medical University of Sofia, Sofia, Bulgaria; 16University of Turin, Turin, Italy; 17Department of Endocrinology, Jagiellonian University, Medical College, Kraków, Poland; 18Division of Endocrinology, 2nd Department of Medicine, State Health Center, Budapest, Hungary; 19Bicêtre Hospital, Le Kremlin-Bicêtre, France; 20Tel Aviv University, Tel Aviv, Israel; 21Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal; 22Moscow Regional Research Clinical Institute n.a.Vladimirsky, Moscow, Russia; 23Medical University of Gdańsk, Gdańsk, Poland; 24University Hospital Zagreb, Zagreb, Croatia; 25Charles University, Prague, Czechia; 26University Hospital Saint Luc, Woluwe-Saint-Lambert, Belgium; 27Zentrum für Endokrinologie, Diabetologie, Rheumatologie Dr. Demtröder & Kollegen im MVZ Dr. Eberhard &Partner und Klinikum Dortmund, Dortmund, Germany; 28Klinicni Center Ljubljana; 29Goteborg University, Gothenburg, Sweden; 30Medizinische Klinik und Poliklinik IV; Campus Innenstadt; Klinikum der Universität München, Munich, Germany; 31Institut de Recerca de la Santa Creu i Sant Pau, Barcelona, Spain; 32Landspitali University Hospital, Reykjavik, Iceland; 33Charité Universitatsmedizin Berlin, Berlin, Germany; 34Semmelweis University, Budapest, Hungary; 35Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France; 36Medizinische Universitat Wien, Vienna, Austria; 37Lithuanian University of Health Sciences, Kaunas, Lithuania; 38School of Medicine, Universitat Internacional de Catalunya (UIC), Barcelona, Spain; 39Germans Trias i Pujol Hospital and Research Institute, Badalona, Spain
Introduction: Real-world data on management of bone alterations in Cushing’s syndrome (CS) are scanty. The aim of our study was to assess the prevalence of osteoporosis (OP) and bone fractures (BF) in CS patients included in the European Registry on Cushing’s Syndrome (ERCUSYN), and to describe the diagnostic and therapeutic strategies adopted across Europe to address these comorbidities.
Patients and methods: In this retrospective, observational cohort study, we evaluated the prevalence of OP and BF in 1684 patients (81% females; mean age 44 (±14.1) years) of whom 1234 (73%) had a pituitary-dependent (PIT-CS) and 450 (27%) an adrenal-dependent (ADR-CS) CS from 60 European centers in 26 countries. In addition, we created a survey to collect real-life data on bone disease management in CS.
Results: A dual-energy X-ray absorptiometry (DXA) was performed in 766 (51%) patients at diagnosis. Lumbar and hip OP were found in 21% and 13% of patients, respectively. After treatment, lumbar and hip OP were found in 18% and 11% of patients respectively, after a median follow-up of 24 (36) months, with a similar prevalence between patients in remission (78%) and those with persistent disease (22%). Fractures were present in 17% of patients at diagnosis, most in the spine (30%). Patients with BF at the time of diagnosis were older than patients without [mean (±S.D.) age 48.3±13.1 vs 43.4±14.2 years; P<0.001] and were more often males (P<0.001). Median delay to diagnosis was longer in patients with BF as compared with those without [3 (3.5) vs 2 (2) years, P=0.02] at diagnosis. Most of the survey responders (87%) evaluate bone health using DXA in all newly diagnosed patients, whereas the remaining only assess it in high-risk patients. Forty-six percent of responders perform X-ray only in patients with fracture symptoms. Seventy-six percent of the centers start specific treatment in all patients with OP at diagnosis, 21% only treat patients with fractures. After successful treatment, 59% of the responders re-check bone status within two years,whereas the remaining individualize control based on fracture risk stratification. The most widely used medications to treat OP and/or BF are vitamin D with calcium (74%), zolendronate (72%), alendronate (59%), denosumab (49%), risendronate (25%) and teriparatide (25%).
Conclusions: There is a need to optimize the management of bone impairment across Europe. In the ERCUSYN cohort, older age, male sex and longer delay to diagnosis were associated with increased rate of fractures at the time of diagnosis.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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