1 Introduction
Erectile dysfunction (ED) is defined as the inability of a man to achieve or maintain an erection sufficient for satisfactory sexual function [1]. ED belongs to a neurovascular process dependent on the health of the central and peripheral nervous systems and the vascular health of the erectile tissue [2]. It has been equally well-established that the incidence of ED increases with age [3]. Approximately 50% of all men above 40 years old experience some degree of ED and an estimated 322 million men were expected to suffer from ED by 2025 [4, 5]. ED is a facet of men’s health that open a window into certain chronic diseases, such as cardiovascular disease (CVD), chronic kidney disease (CKD), diabetes mellitus (DM), hypertension, metabolic syndrome, psychological distress and osteoporosis [6-8]. Several important take-home messages are quite clear. The large amount of time between the diagnosis of ED and other diseases provides healthcare providers with a window of opportunity for intervention and possible prevention.
Osteoporosis is defined as age-related bone loss[9]. It has been recognized as an important public health concern for aging females, especially for post-menopausal women, whereas the risk to men is real and likely underappreciated[10]. Up to one third of fractures occur in men, and fracture-related morbidity and mortality is higher in men than in women[11]. Osteoporosis is a systemic metabolic bone disease which exposes patients to fragility fractures [12], which is a withering event in which subsequent pain, decreased quality of life, functional disability and morbidity can contribute to high medical expenditures and even mortality[13]. It is important to predict the risk of osteoporotic fractures via the use of risk factor analysis.
ED and osteoporosis were closely associated with age, with significant effects on the quality of life in men. Hence, the association of ED and osteoporosis has attracted attention of the public and researchers alike. The relationship between ED and osteoporosis has been recently questioned. An analysis of 95 men with ED and 82 men without ED indicated that the men with ED had a higher risk for osteoporosis[14]. Moreover, a study based on 4460 patients aged ≥40 years diagnosed with ED and 17480 age-matched patients without ED showed that patients with a history of ED, particularly younger men, had a higher risk of osteoporosis[15]. However, 76 men aged ≥50 years concluded that the frequencies of osteoporosis and ED increased with age, but the association between these conditions seems to be independent of each other[16]. There were only a small number of studies concerning the relationship between ED and osteoporosis, and most of these studies had a limited scope because of a small sample size. A research based on the National Health Insurance (NHI) program database clarified that ED was associated with a high risk of osteoporosis and hip fractures based on a large sample size, however they only enrolled patients aged ≥40 years[17]. As far as we knowledge, no previous studies have investigated the diagnosis ability of ED for prevalence of osteoporosis. Therefore, we included a large sample which included the all-aged (18-87 years) adult male population in our study to explore the relationship between ED and the risk of osteoporosis and compared models with or without ED for assessing the prevalence of osteoporosis. Further clarification the association of ED with the risk of osteoporosis would probably shed light on the prevention and treatment of related diseases.