Men With Osteoporosis Are At Increased Risk for Erectile Dysfunction

Co-author Chih-Lung Lin, PhD and SpineUniverse Editorial Board Member Joshua M. Ammerman, MD Comment

Peer Reviewed

Men with osteoporosis should be evaluated for erectile dysfunction (ED), and men with ED should be screened for low bone mass density (osteoporosis), according to findings from a large nationwide study from Taiwan.
middle-aged male doctor greeting patient, shaking hands.Patients with a history of ED, particularly younger men, had a high risk of osteoporosis”. Photo Source:“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.”

Large Nationwide Study

The researchers used data from the Taiwan National Health Insurance Research Database (NHIRD) to retrospectively study 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. The patients were age-matched in a 1:4 ratio to 17,480 randomly selected patients without ED.

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.

“On the basis of a large retrospective, observational study, the authors have established a strong link between osteoporosis and ED, as demonstrated by the over 3-fold increase in the incidence of osteoporosis in men with ED as compared to their matched non-ED counterparts,” commented Joshua Ammerman, MD, who is a Neurosurgeon at Washington Neurosurgical Associates in Washington, DC. “This linkage appears to be at least in part independent of comorbid conditions such as diabetes, hypertension, and steroid use.”

How Are Osteoporosis and Erectile Dysfunction Linked?

“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.”

Dr. Ammerman concurred with these proposed mechanistic links between osteoporosis and ED. “The links are likely multifactorial, including androgen insufficiency leading to reduced bone formation, reduced nitric oxide activity (a biochemical step crucial to penile engorgement) with a concomitant loss of osteoclast inhibition and increased bone reabsorption, and low vitamin D, which has been implicated in both ED and osteoporosis.”

Clinical Implications

“ED and the fragility fractures of osteoporosis (such as vertebral compression fractures) are both associated with significant physical and psychological stress in men over the age of 40 years,” Dr. Ammerman said. “The aggressive concomitant treatment of both conditions can result in meaningful improvement in patient QOL thorough improved sexual performance and avoidance of fractures.  In addition, men with osteoporosis needing surgical intervention for spinal disease have poorer outcomes in terms of bone healing.”

Updated on: 12/31/19
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Joshua M. Ammerman, MD
Washington Neurosurgical Associates
Washington, DC

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