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.