BackgroundThe 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 using data from the Clinical Practice Research Datalink. Patients with vertebral fracture were identified and matched to patients without fracture by age and gender. Incident self-harm was defined by medical 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 age and gender. ResultsThe number of cases of vertebral fracture was 16,293, with a matched unexposed cohort of the same size. Patients were predominantly female (70.1%), mean age was 74 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 younger (3.2(1.8, 5.7)) and male (3.9(1.8, 8.5)). ConclusionsPrimary care patients with vertebral fracture are at increased risk of self-harm compared to people without these fractures. Younger, male patients appear to be at greatest risk of self-harm. Clinicians need to be aware of the potential for self-harm in this patient group.