Osteoporosis and fracture as risk factors for self-harm and suicide: a systematic review and meta-analysis
Increases in the presentation of self-harm in primary care, has led to an expansion in interest in identifying at-risk populations for self-harm and suicide. Recent studies have indicated an increased risk in people with physical health conditions. As with other chronic conditions frequently resulting in reduced function, pain, and deformity, psychological health can be affected by osteoporosis and fractures.
This study aimed to examine whether osteoporosis or fractures are risk factors for self-harm, suicidal behavior and suicide.
A systematic review of cohort and case-control studies. 6 literature databases were searched from inception to July 2019. Screening, data extraction and quality assessment of full-articles selected for inclusion were performed independently by two authors. Participants included adults with osteoporosis and/or fractures with an outcome of self-harm, suicidal behavior or suicide.
Findings: 12 studies were included, 7 relating to suicide, 4 on suicidal behavior and 1 on self-harm. Meta-analysis was run on 4 papers that provided crude odds ratio on the risk of suicide in those with osteoporosis. Pooled analysis of crude data found that patients with osteoporosis are 60% more likely to die from suicide than patients without osteoporosis. The risk of suicide was significant in crude data in 4/5 studies and remained in approximately half of studies after adjustments were made. 2/4 papers on suicidal ideation showed significance after adjustment. Despite a limited number of articles examining the role of fractures on subsequent suicide, suicidal ideation or self-harm, a significant association was found for ‘any’ fracture and specifically vertebral fractures. Similarly, despite few papers, males seemed specifically at higher risk of both suicide and self-harm.
Implications: This study indicates that those diagnosed with osteoporosis, especially men and those with vertebral fractures might benefit from depression case-finding and mood monitoring to identify self-harm risk and improve health outcomes.
Statement of funding (if appropriate):
ZP is funded by the National Institute of Health Research (NIHR) [Clinician Scientist Award (CS-2018-18-ST2-010)/NIHR Academy]. FMM is part funded by the NIHR Clinical Research Network Scholar Programme. FM is funded by a NIHR Doctoral Fellowship [NIHR300957]. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR, or the Department of Health & Social Care. CCG part-funded by WM ARC.