This analysis of 10 years of safety incident reporting through CPiRLS, identified 268 SIs, with learning documented in 143 (53.4%) of these. CPiRLS relies on chiropractors to proactively report patient SIs rather than actively screen for them. It is notable that some chiropractors perceived reported AEs as having resulted from treatment, and categorised and described them as such. Before considering manual therapy, patients should be adequately and periodically screened for osteoporosis and the risk of fragility fractures. The aim of CPiRLS should be reviewed to prioritise the type of incident reporting and learning that will drive patient safety within chiropractic.