Bone protection in progressive supranuclear palsy

<h3>Purpose</h3> The study aims were to analyse risk factors for fractures in patients with Progressive Supranuclear Palsy (PSP) and evaluate the accuracy of standard fracture risk assessment tools for this population. <h3>Method</h3> We retrospectively analysed the electronic health records of 101 PSP patients, looking at potential predictive factors including demographics, disease severity, fracture history, and bone therapy. The accuracy of FRAX and QFracture risk scores were assessed. Time-to-fracture, institutionalisation, and death were analysed after stratifying by fracture risk. The cost-effectiveness of preventative bisphosphonate therapy was estimated. <h3>Results</h3> None of the variables collected predicted PSP fractures. There was a non-significant trend between fracture occurrence and ambulatory status, diagnosis of osteoporosis, and previous bisphosphonate use. Standard fracture risk stratification tools and thresholds did not accurately predict fracture risk. PSP patients with fractures showed significantly increased mortality but no change in institutionalisation. Cost-effectiveness analysis estimated £286,000 in net savings over three years of zolendronate treatment for 101 patients, by reducing hip and vertebral fractures. <h3>Conclusion</h3> Results suggest usual risk models are not valid in PSP. Significant mortality rate increase after fractures and potential cost savings from reducing hip and vertebral fractures support consideration of preventative bisphosphonate therapy for ambulatory PSP patients.