Men with erectile dysfunction (ED) are at increased risk for osteoporosis and should undergo bone density screening, according to findings from a large study reported in Medicine.
“Our results indicate that patients with a history of ED, particularly younger men, had a high risk of osteoporosis,” said Chih-Lung Lin, PhD, Professor and Chief, Department of Neurosurgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan. “ED can be considered an early predictor of osteoporosis. Patients with ED should be examined for bone mineral density, and men with osteoporosis should be evaluated for ED.”
“Erectile dysfunction is a sensitive barometer not only of cardiovascular health, but also of overall men’s health,” commented Natan Bar-Chama, MD Associate Professor of Urology, Obstetrics, Gynecology, and Reproductive Science at Icahn School of Medicine at Mount Sinai, and Director of Male Reproductive Medicine at The Mount Sinai Hospital; both in New York, NY.
“Today, ED is a medical condition that when present warrants an aggressive evaluation for underlying pathologies, including metabolic syndrome, diabetes, and cardiovascular disease. Now, this study adds to that list an assessment of bone health,” Dr. Bar-Chama said.
Large Nationwide Study
Using data from the Taiwan National Health Insurance Research Database (NHIRD), Dr. Lin and colleagues retrospectively studied the relationship between ED and the subsequent risk of osteoporosis. The study included data on 4,460 patients (aged ≥40 years) diagnosed with ED between 1996 and 2010, as well as 17,480 randomly selected patients without ED who were age-matched to patients in a 1:4 ratio.
Over a maximum follow-up of 5 years, 264 patients with ED (5.92%) and 651 patients without ED (3.65%) developed osteoporosis. The hazard ratio of osteoporosis was 3.04-fold higher in the ED group than in the non-ED group (incidence, 9.74 vs 2.47 per 1,000 person-years, respectively) after controlling for the following potentially confounding factors: age, Charlson comorbidity index scores, and related comorbidities of hypertension, diabetes mellitus, hyperlipidemia, stroke, chronic kidney disease, chronic liver disease, chronic pulmonary disease, hyperthyroidism, hyperparathyroidism, and testosterone and corticosteroid use.
The risk was particularly increased (hazard ratio 3.59) among men aged 40 to 59.
How Are Osteoporosis and Erectile Dysfunction Linked?
While the study showed that ED is linked to a higher risk for osteoporosis, it is not clear what if any is the causative link, Dr. Bar-Charma said. Possible mechanisms underlying the association are multifold, Dr. Lin explained.
“First, patients with ED have lower naturally available free testosterone than those without ED,” Dr. Lin said. “Androgens may play a critical role in the regulation of bone formation in men. ED has been highly associated with inflammation, thus contributing to endothelial dysfunction, which subsequently leads to osteoporosis. Lower vitamin D levels lead to substantial losses in bone mass, eventually causing osteoporosis. In addition, nitric oxide bioactivity is a possible explanation for the relationship between ED and osteoporosis.”
“This study adds osteoporosis to the robust scientific literature implicating ED as an early signal for undiagnosed medical conditions and will hopefully contribute to a more proactive and preventive approach to men’s health,” Dr. Bar-Chama concluded.
August 17, 2016
Wu CH, Lu YY, Chai CY, et al. Increased risk of osteoporosis in patients with erectile dysfunction: A nationwide population-based cohort study. Medicine (Baltimore). 2016;95(26):e4024.