{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T19:30:06Z","timestamp":1789500606562,"version":"build-2803163510"},"reference-count":36,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2025,12,21]],"date-time":"2025-12-21T00:00:00Z","timestamp":1766275200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,12,21]],"date-time":"2025-12-21T00:00:00Z","timestamp":1766275200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Endocrinology"],"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Skeletal fragility is a common complication of endogenous Cushing's Syndrome (CS), although specific guidelines for managing bone health are lacking. This study aimed to assess clinicians' current engagement with bone health assessment and management in patients with endogenous CS.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Retrospective\u2010cohort design.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Patients<\/jats:title>\n                    <jats:p>Seventy\u2010nine patients with confirmed endogenous CS, treated at a tertiary endocrine centre.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Measurements<\/jats:title>\n                    <jats:p>The frequency of bone health assessment, evidenced by vitamin D measurement, and bone health management, evidenced by a composite outcome of calcium and\/or vitamin D optimisation and\/or initiation of bone\u2010protective agents, was recorded. Changes in bone mineral density (BMD), measured by Dual\u2010energy X\u2010ray absorptiometry (DEXA) and fracture prevalence were assessed pre\u2010 and post\u2010CS treatment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Vitamin D was measured in only 43% (34\/79), and bone health was managed in only 39.2% (31\/79). BMD was assessed in 44.3% (35\/79) during active CS; of these, 22.9% had osteoporosis. Improved BMD was observed within a year of CS remission. Fractures occurred in 17.7% (14\/79) within 2 years of CS diagnosis, and 12 additional fractures occurred during follow\u2010up despite CS remission. Treatment with bone\u2010protective agents expedited recovery with a significant increase in lumbar spine BMD, compared to those not treated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Our data demonstrate that skeletal impairment and fragility fractures are highly prevalent in endogenous CS, and fracture risk may persist despite remission. However, currently, bone health is inadequately assessed and managed. These findings identify an urgent need for improved awareness, assessment, and management of bone\u2010health in this high\u2010risk population and call for specific evidence\u2010based practice guidelines.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/cen.70085","type":"journal-article","created":{"date-parts":[[2025,12,22]],"date-time":"2025-12-22T05:31:15Z","timestamp":1766381475000},"page":"302-311","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Clinical Practice Patterns in Bone Health Assessment and Management in Endogenous Cushing's Syndrome"],"prefix":"10.1111","volume":"104","author":[{"given":"Preeshila","family":"Behary","sequence":"first","affiliation":[{"name":"Section of Endocrinology &amp; Investigative Medicine Imperial College London London UK"},{"name":"Endocrine Bone Unit Imperial College NHS Trust London UK"},{"name":"Department of Endocrinology Imperial College NHS Trust London 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