Osteoporosis and fracture as risk factors for self-harm and suicide: a systematic review and meta-analysis

Abstract

Background: Increase in presentations of self-harm to primary care, a risk factor of suicide has led to a growing interest in identifying at-risk populations. Aim: To examine whether osteoporosis or fractures are risk factors for self-harm, suicidal ideation, and suicide. Design and Setting: Systematic review of observational studies in adults (18> years) which had examined the role of osteoporosis and/or fractures in subsequent self-harm, suicidal ideation, and/or suicide. Method: Six databases were searched from inception to July 2019. Additional citation tracking of eligible studies was done in November 2022. Screening, data extraction and quality assessment of full-text articles were performed independently by at least two authors. Where possible, meta-analysis was run on comparable risk estimates. Results and Conclusion: Fifteen studies were included, two examined the outcome of self-harm, three suicidal ideation and 10 suicide. In approximately half of studies on osteoporosis, the risk of suicidal ideation and suicide remained significant. However, pooling of adjusted odds ratios from three studies indicated no association between osteoporosis and suicide (1.14(95% confidence interval 0.88-1.49)). Nine studies examined the risk of a mixture of fracture types across different outcomes, limiting comparisons. However, all studies examining vertebral fracture (n=3) reported a significant adjusted negative association for self-harm and suicide. In conclusion, Patients with vertebral fractures may benefit from case-finding for mood disorders in primary care, which are risk factors for suicide, and the subsequent management. However, due to the limited number and quality of studies and mixed findings, further examination of these associations is warranted.