School of Medicine, Keele University, Keele, and Department of Medical Imaging, University of Exeter, Exeter, UK.
School of Medicine, Keele University, Keele; Centre for Mental Health and Safety, Division of Psychology and Mental Health, University of Manchester, Manchester; and honorary clinical research fellow, Warwick Medical School, Warwick, UK.
Br J Gen Pract. 2023 Sep 28;73(735):e735-e743. doi: 10.3399/BJGP.2023.0035. Print 2023 Oct.
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.
To examine whether osteoporosis or fractures are risk factors for self-harm, suicidal ideation, and suicide.
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.
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.
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 ( = 3) reported a significant adjusted negative association for self-harm and suicide.
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.
自残行为就诊于初级保健机构的人数不断增加，这是自杀的一个风险因素，因此人们越来越关注识别高危人群。
探讨骨质疏松症或骨折是否是自残、自杀意念和自杀的危险因素。
这是一项对成人（>18 岁）观察性研究的系统评价，这些研究检查了骨质疏松症和/或骨折在随后的自残、自杀意念和/或自杀中的作用。
从开始到 2019 年 7 月，我们在六个数据库中进行了搜索。2022 年 11 月还对符合条件的研究进行了额外的引文追踪。至少两名作者独立进行了筛查、全文文章的数据提取和质量评估。在可能的情况下，对可比风险估计值进行了荟萃分析。
共纳入 15 项研究：两项研究检查了自残的结果，三项研究检查了自杀意念，10 项研究检查了自杀。在大约一半的骨质疏松症研究中，自杀意念和自杀的风险仍然显著。然而，从三项研究中汇总调整后的优势比表明，骨质疏松症与自杀之间没有关联（1.14，95%置信区间=0.88 至 1.49）。九项研究检查了不同结局的多种骨折类型的风险，限制了比较。然而，所有研究都检查了椎体骨折（=3），发现与自残和自杀有显著的负相关。
患有椎体骨折（自杀的潜在风险因素之一）的患者可能受益于针对情绪障碍的临床发现，并接受个性化的初级保健管理。然而，由于研究数量和质量有限且结果存在差异，需要进一步研究这些关联。
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