Vertebral fracture as a risk factor for self-harm: a retrospective cohort study

Abstract

Background The prevention of self-harm is an international public health priority. It is vital to identify at-risk populations, particularly as self-harm is a risk factor for suicide. This study aims to examine the risk of self-harm in people with vertebral fractures. Methods Retrospective cohort study. Patients with vertebral fracture were identified within the Clinical Practice Research Datalink and matched to patients without fracture by sex and age. Incident self-harm was defined by primary care record codes following vertebral fracture. Overall incidence rates (per 10,000 person-years (PY)) were reported. Cox regression analysis determined risk (hazard ratios (HR), 95 % confidence interval (CI)) of self-harm compared to the matched unexposed cohort. Initial crude analysis was subsequently adjusted and stratified by median age and sex. Results The number of cases of vertebral fracture was 16,293, with a matched unexposed cohort of the same size. Patients were predominantly female (70.1 %), median age was 76.3 years. Overall incidence of self-harm in the cohort with vertebral fracture was 12.2 (10.1, 14.8) /10,000 PY. There was an initial crude association between vertebral fracture and self-harm, which remained after adjustment (HR 2.4 (95 %CI 1.5, 3.6). Greatest risk of self-harm was found in those with vertebral fractures who were aged below 76.3 years (3.2(1.8, 5.7)) and male (3.9(1.8, 8.5)). Conclusions Primary care patients with vertebral fracture are at increased risk of self-harm compared to people without these fractures. Male patients aged below 76 years of age appear to be at greatest risk of self-harm. Clinicians need to be aware of the potential for self-harm in this patient group.

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

“… 13 , 14 , 20 Of the studies reporting osteoporosis, three reported suicidal ideation as the outcome, 18 – 20 and five reported suicide as the outcome. 11 , 13 , 14 , 21 , 22 Of the studies examining fractures, two reported the outcome of self-harm, 23 , 26 two of suicidal ideation, 15 , 20 six of suicide, 13 , 14 , 24 – 28 and one included the outcome of self-harm and suicide. 26 In the three studies examining both population groups of osteoporosis and fractures, one reported the outcome suicidal ideation 20 and two reported on the risk of suicide ( Table 1 ).…”

“… 13 , 14 Most studies included a relatively even sample of male and female participants, but only three stratified risk estimates by sex. 13 , 19 , 23 The majority of studies showed moderate to high risk of bias (Supplementary Figure S1).…”

“…Ten studies, mostly conducted in East Asia 14 , 15 , 24 , 27 , 28 and Europe 13 , 20 , 23 examined fracture as a risk factor. Study settings included primary care, 23 a retirement community, 25 secondary care, 24 across primary and secondary care, 14 and the general population ( Table 1 ).…”

“…Ten studies, mostly conducted in East Asia 14 , 15 , 24 , 27 , 28 and Europe 13 , 20 , 23 examined fracture as a risk factor. Study settings included primary care, 23 a retirement community, 25 secondary care, 24 across primary and secondary care, 14 and the general population ( Table 1 ). 13 , 20 , 26 Most studies included a balanced sample of men and women, or a higher percentage of females (as expected in osteoporotic studies).…”

“…Hip and vertebral fractures were the most consistently reported fracture sites, reported in five and four studies, respectively. 13 , 14 , 20 , 23 , 25 , 28 However, these studies utilised a range of risk estimate types ( Table 3 ).…”