Men with a history of erectile dysfunction (ED) are at higher risk of osteoporosis, according to a new study.

“ED can be considered an early predictor of osteoporosis,” the investigators concluded in Medicine (2016;95:p e4024).

Using the Taiwan National Health Insurance Research Database, investigators led by Chih-Lung Lin, PhD, of Kaohsiung Medical University in Taiwan, compared 4460 men aged 40 years or older diagnosed with ED from 1996 to 2010 with 17,480 randomly selected age-matched patients without ED.

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During follow-up, osteoporosis developed in 264 patients with ED (5.92%) and 651 without ED (3.65%). The overall incidence of osteoporosis was 3-fold higher in the ED group than the non-ED group (9.74 vs. 2.47) per 1000 person-years) after controlling for covariates. Osteoporosis was 3 times more likely to develop in men with either psychogenic or organic ED compared with those who did not have ED. The risk varied by age. ED patients aged 40 to 59 years had a 3.6 times increased risk of osteoporosis and those aged 60 years and older had a 3.5 times increased risk compared with the non-ED group.

“Because of the easy and noninvasive evaluation of osteoporosis, patients with ED should be examined for bone mineral density, and men with osteoporosis should be evaluated for ED,” the investigators wrote.

Dr Lin and colleagues discussed possible mechanisms underlying the relationship between ED and osteoporosis. For example, men with ED have lower naturally available free testosterone than those without ED, they noted, adding that androgens may have a key role in regulating bone formation in men. In addition, men with low testosterone have a marked increase in the risk of fragility fractures, and androgen deprivation therapy and orchiectomy have been associated with an increased risk of osteoporosis and fractures. “Therefore, testosterone depletion might increase the risk of osteoporosis,” the investigators stated.

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