Prevalence, risk factors and management of bone complications in Cushing's syndrome across Europe. Data from the European Registry on Cushing's syndrome (ERCUSYN) - 08/03/26

Doi : 10.1016/j.ando.2026.102490

Aleksandra Zdrojowy-Wełna ^a,^⁎ , Claudia Amaral ^b, Marta Araujo-Castro ^c, Nienke Biermasz ^d, Marek Bolanowski ^a, Jens Bollerslev ^e, Thierry Brue ^f, Davide Carvalho ^g, Frederic Castinetti ^h, Filippo Ceccato ⁱ, Justine Cristante ^j, Daniela Dadej ^k, Mario Detomas ^l, Timo Deutschbein ^l,^m, Emanuele Ferrante ⁿ, Atanaska Elenkova ^o, Joan Gil ^p,^q, Ezio Ghigo ^r, Aleksandra Gilis-Januszewska ^s, Roberta Giordano ^t, Miklos Goth ^u, Cecile Greaud ^v, Yona Greenman ^w, Daniela Guelho ^x, Irena Ilovayskaya ^y, Sonia Kaniuka-Jakubowska ^z, Darko Kastelan ^aa, Tomaz Kocjan ^ab,^ac, Irina Komerdus ^y, Michal Krsek ^ad, Dominique Maiter ^ae, Olga Moros ^af, Katarina Mlekuš Kozamernik ^ab, Eleni Papakokkinou ^ag, Giuseppe Reimondo ^ah, Oskar Ragnarsson ^ag, Martin Reincke ^ai, Helga Sigurjonsdottir ^aj, Christian J. Strasburger ^ak, Antoine Tabarin ^al, Miklós Tóth ^am, Greisa Vila ^an, Birute Zilaitiene ^ao, Alicia Santos ^q, Susan M. Webb ^q, Elena Valassi ^p,^ap

ERCUSYN Study Group

^a Department of Endocrinology and Internal Diseases, Wroclaw Medical University, Wyb. Pasteura 4, 50-367 Wroclaw, Poland

^b Centro Hospitalar Universitário de Santo António, Porto, Portugal

^c Department of Endocrinology & Nutrition. Ramón y Cajal University Hospital, Madrid, Spain

^d Leiden University Medical Center, Leiden, The Netherlands

^e Faculty of Medicine, University, Oslo, Norway

^f Aix-Marseille Université, Inserm, UMR1251, Marseille Medical Genetics, Institut MarMaRa and Department of Endocrinology, La Conception Hospital, AP–HM, Marseille, France

^g Hospital de Sao João, Faculty of Medicine, Universidade do Porto, Porto, Portugal

^h Aix-Marseille Université, Marseilles, France

ⁱ Endocrinology Unit, University-Hospital of Padova, Padova, Italy

^j Centre Hospitalier Universitaire de Grenoble, Grenoble, France

^k Poznan University of Medical Sciences, Poznań, Poland

^l Department of Internal Medicine I, Division of Endocrinology and Diabetes, University Hospital, University of Würzburg, Würzburg, Germany

^m Medicover Oldenburg MVZ, Oldenburg, Germany

ⁿ Endocrinology Unit, Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy

^o Expert Center for Rare Endocrine Diseases – Sofia, Department of Endocrinology, Medical University, Sofia, Bulgaria

^p Germans Trias i Pujol Hospital and Research Institute, Badalona, Spain

^q IR SANT PAU, Hospital de la Santa Creu i Sant Pau, EndoERN and CIBERER U747, ISCIII, Universitat Autònoma Barcelona, Barcelona, Spain

^r Division of Endocrinology, Diabetology and Metabolism, University of Turin, Turin, Italy

^s Department of Endocrinology, Jagiellonian University, Medical College, Krakow, Poland

^t Department of Biological Science; University of Turin, Turin, Italy

^u Division of Endocrinology, 2nd Department of Internal Medicine, Central Hospital Northern Pest – Military Hospital, Budapest, Hungary

^v Bicêtre Hospital, Paris, France

^w Institute of Endocrinology, Diabetes, Metabolism and Hypertension, Tel Aviv-Sourasky Medical Center and Tel Aviv University, Tel Aviv, Israel

^x Centro Hospitalar e Universitário de Coimbra (CHUC), Coimbra, Portugal

^y Department of Neuroendocrine Diseases, Moscow Regional Research and Clinical Institute, Moscow, Russia

^z Department of Endocrinology and Internal Medicine, Medical University of Gdansk, Gdansk, Poland

^aa Department of Endocrinology, University Hospital Zagreb, Zagreb, Croatia

^ab Department of Endocrinology, Diabetes and Metabolism, University Medical Centre Ljubljana, Ljubljana, Slovenia

^ac Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia

^ad 3rd Department of Medicine, Department of Endocrinology and Metabolism, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic

^ae Department of Endocrinology, UCLouvain Cliniques Saint Luc, Brussels, Belgium

^af Zentrum für Endokrinologie, Diabetologie, Rheumatologie, Dortmund, Germany

^ag Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden

^ah Department of Clinical and Biological Sciences, AOU San Luigi, University of Turin, Turin, Italy

^ai Medical Department IV, University Hospital, LMU Munich, Munich, Germany

^aj Department of Medicine, Landspitali University Hospital and School of Medicine, University of Iceland, Reykjavik, Iceland

^ak Department of Endocrinology and Metabolism, Charitè Universitätsmedizin Berlin, Berlin, Germany

^al Endocrinologie – Diabète et Nutrition, CHU de Bordeaux, Bordeaux, France

^am Department of Internal Medicine and Oncology, Semmelweis University, Budapest, Hungary

^an Division of Endocrinology and Metabolism, Department of Medicine III, Medical University of Vienna, Vienna, Austria

^ao Institute of Endocrinology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania

^ap School of Medicine, Universitat Internacional de Catalunya (UIC), Barcelona, Spain

^⁎ Corresponding author.

Abstract

Objective

The aim of the study was to investigate bone comorbidities and their management in patients included in the European Register on Cushing's syndrome (ERCUSYN).

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.

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Keywords : Osteoporosis, Bone fractures, Cushing's syndrome, Hypercortisolism, ERCUSYN

Plan

Introduction

Materials and methods

The analysis of the ERCUSYN database

The survey among ERCUSYN centers

Statistical analysis

Results

General characteristics

Baseline DXA results

Factors associated with osteoporosis (OP) at baseline DXA examination

Baseline X-ray results

Factors associated with fractures at baseline

Follow-up

Results from the survey among the ERCUSYN partners

Discussion

Conclusions

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Vol 87 - N° 1

Article 102490- février 2026 Retour au numéro

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Prevalence, risk factors and management of bone complications in Cushing's syndrome across Europe. Data from the European Registry on Cushing's syndrome (ERCUSYN) - 08/03/26

Abstract

Objective

Design

Methods

Results

Conclusions

Plan

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