Royal College of Surgeons in Ireland
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Osteoporosis and fracture as risk factors for self-harm and suicide: a systematic review and meta-analysis

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journal contribution
posted on 2023-11-01, 16:39 authored by Fay M Manning, Faraz Mughal, Hazem Ahmed Saad Mohamed Ismail, Libby M Baines, Carolyn A Chew-Graham, Zoe Paskins, James A Prior

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: This was a systematic review of observational studies in adults (>18 years) that 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 undertaken 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: 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 to 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.

Conclusion: Patients with vertebral fractures, a risk potential factor for suicide, may benefit from clinical case finding for mood disorders with personalised primary care management. However, because of the limited number and quality of studies and mixed findings, further examination of these associations is warranted.


National Institute for Health and Care Research (NIHR) Doctoral Fellowship (NIHR300957)

NIHR Greater Manchester Patient Safety Research Collaboration (PSRC, NIHR204295)

NIHR Clinician Scientist Award (CS-2018–18-ST2–010/ NIHR Academy)

NIHR Clinical Research Network Scholar Programme

NIHR National Priorities Programme, Health Ageing, Dementia and Frailty

NIHR ARC West Midlands



The original article is available at

Published Citation

Manning FM. et al. Osteoporosis and fracture as risk factors for self-harm and suicide: a systematic review and meta-analysis. Br J Gen Pract. 2023;73(735):e735-e743.

Publication Date

28 September 2023

PubMed ID



  • RCSI Bahrain


Royal College of General Practitioners


  • Published Version (Version of Record)