Notable lacking of bone mineral density measurement in cushing syndrome: a nationwide study based on the US insurance claim database.

Abstract

This study examined the underuse of bone mineral density (BMD) testing in Cushing's syndrome patients, using a US insurance claims database. Despite osteoporosis risks, only 6.40% of 53,101 patients received BMD testing. The study underscores significant care gaps, particularly among males and older adults, necessitating improved screening efforts.

Background: Cushing syndrome (CS) is caused by long-term exposure to elevated glucocorticoid levels, primarily due to chronic steroid use, though it can also result from pituitary tumors. This condition leads to significant bone mineral density (BMD) loss and a heightened risk of osteoporosis. Despite guidelines for BMD testing in at-risk patients, osteoporosis has remained underdiagnosed in CS. The prevalence of BMD measurement in this group in the US continues to be unknown, indicating a gap in care.

Methods: We conducted a retrospective study using data from the PearlDiver Patient Records Database (2010-2020). Patients diagnosed with Cushing's syndrome who underwent BMD testing were included, while those with prior osteoporosis diagnoses were excluded. We analyzed patient demographics, comorbidities, and outcomes using t-tests, chi-squared tests, and logistic regression with significance set at p < 0.001.

Results: Among 53,101 identified Cushing's syndrome patients, only 6.40% underwent bone mineral density (BMD) testing within two years of diagnosis. Females were significantly more likely to be tested (7.85% vs. 2.58%; p < 0.001), and those tested were younger (mean age: 62.79 vs. 65.21 years; p < 0.001). The Midwest region had the highest testing rate at 7.1%, and patients with commercial insurance had the highest testing frequency at 7.5%. Factors associated with reduced BMD testing included male gender (OR = 0.31; p < 0.001), older age (OR = 0.96; p < 0.001), and higher Elixhauser Comorbidity Index (ECI) scores (OR = 0.89; p < 0.001). Conversely, obesity (OR = 1.51; p < 0.001) and chronic kidney disease (OR = 1.38; p < 0.001) increased the likelihood of testing. Among those tested, 12.56% were diagnosed with osteoporosis, with older age and tobacco use significantly increasing the odds of diagnosis.

Conclusion: Despite guideline recommendations, only 6.40% of patients with Cushing's syndrome underwent BMD screening. Among those screened, 12.56% were diagnosed with osteoporosis.. These findings highlight the need for improved adherence to screening guidelines, particularly for high-risk populations, to better manage and prevent osteoporosis in Cushing's syndrome patients.