Men with erectile dysfunction (ED) should receive a checkup of their bone health, Taiwanese researchers suggest.

Noting common pathogenic processes at work in the bone and vasculature and the contribution of coronary heart disease risk factors to both conditions, a team led by Chih-Lung Lin, MD, of Kaohsiung Medical University in Taiwan, hypothesized that ED and hip fracture are associated. They used the Taiwan National Health Insurance Research Database, which reflects the general population, to identify 4,636 men older than 40 diagnosed with ED (psychogenic or organic) during 1996–2010. To compare the risk of hip fracture, the investigators matched each ED patient randomly to 4 men without ED of the same age (18,544 controls).

During follow-up, hip fractures occurred in 59 men with ED (1.27%) compared with 140 controls (0.75%), according to results published in PLOS One. The ED patients had a 3.7 times higher risk of hip fracture than controls after adjusting for age, corticosteroid and testosterone use, and relevant comorbidities, such as osteoporosis, hyperparathyroidism, hypertension, stroke, and Parkinson’s disease. ED patients aged 40–59 and 60 and older had a nearly 4.9-fold and 3.4-fold increased risk, respectively.

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Hip fracture risk varied by the cause of ED. Men with psychogenic ED had a non-significant 27% increased risk, whereas those with organic ED had a significant 4-fold increased risk.

A study of elderly Danish men by Morten Frost, MD, and colleagues  also found higher fracture risks with ED (Osteoporos Int 2012;23:521–31). 

ED and osteoporosis can have a joint effect, the researchers determined. They hypothesized that several conditions comorbid with ED also may contribute to falls and fracture, including testosterone deficiency, poor mental status/depression, cognitive impairment, vitamin D deficiency, Parkinson’s disease, cardiovascular disease, and chronic obstructive pulmonary disease. As the investigators did not have access to patient information such as tobacco use, exercise habits, nutritional status, and weight, they could not examine the influence of these factors.

“Patients with ED, particularly those aged 40–59 years, should undergo bone mineral density examinations as early as possible and should take measures to reduce the risk of falls,” Dr Lin and colleagues concluded.

Hip fracture can contribute to disability and even mortality, so it is important to prevent it.


  1. Chieh-Hsin Wu CH, Tung YC, Lin TK, et al. Hip Fracture in People with Erectile Dysfunction: A Nationwide Population-Based Cohort Study. PLOS One. doi: 10.1371/journal.pone.0153467.