The inability for a man to achieve an erection may also signal a silent chronic disease he is unaware he is at risk for – osteoporosis.  Erectile dysfunction (ED) is the most common sexual problem in men mainly over the age of 40.  It has been suggested that various medical, psychological, environmental, and lifestyle factors such as cardiovascular disease and hypertension contribute to ED.  Now osteoporosis appears to be added to this list since it has similar risk factors also.

A 2016 study using the Taiwan National Health Insurance Research Database compared 4,460 men aged 40 years and older diagnosed with erectile dysfunction from 1996 to 2010 with 17,480 randomly selected age-matched patients without ED.

What the research found was that 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. Men who had either psychogenic or organic ED had a 3 times more likelihood of developing osteoporosis when compared with men who did not have ED.  Men with ED between the ages of 40 to 59 years had a 3.6 times increased risk of osteoporosis and men aged 60 years and older had a 3.5 times increased risk compared with the non-ED group.

Osteoporosis is a metabolic bone disease in which the bones become brittle and porous escalating the rate of bone loss and increasing the chance of a fracture.  It is a disease more associated with postmenopausal women than men but it is now seen that bone loss occurs equally in men. 

The researchers gave some possible explanations as to why men with ED exhibited a high risk of osteoporosis.  One reason they gave was that men who have ED have lower naturally available free testosterone than men without ED.  Androgens may play a critical role in the regulation of bone formation in men and there have been studies of a higher risk of fractures in men with low testosterone levels.  Men who have undergone androgen deprivation therapy have seen an increased risk of osteoporosis and fractures which points back to reduction of testosterone might increase this risk. 

Inflammation is another reason cited – different inflammatory cytokines can damage the endothelium in the systemic vascular circulation such as the penis which can then lead to ED.  These same cytokines may inhibit osteoblast growth, thus causing osteoporosis.

Another explanation involves the status of vitamin D.  Men who are deficient in this fat-soluble vitamin may experience ED as low vitamin D levels may promote endothelial dysfunction.  Vitamin D also plays an important role in maintaining bone health in all people thus lower vitamin D levels can lead to substantial losses in bone mass of men leading to osteoporosis. 

This study points out a couple of interesting findings that men and their doctors should take note of – one is that a man with ED should be considered to be at a greater risk of osteoporosis and two, that men with ED should be examined for osteoporosis by having a bone mineral density test, a simple and noninvasive method to evaluate this. In addition, a man with osteoporosis should be evaluated for ED.

Men can avoid osteoporosis by taking the following steps:

·         Avoid smoking, reduce alcohol intake and increase weight bearing physical activity

·         Consume at least 1,000 milligrams of calcium daily for men ages 19-70 and 1,200 milligrams a day for men ages 71 and up.  Choose good food sources of calcium. 

·         Consume an adequate vitamin D intake of 600 International Units (IU) daily for men ages 19-70 and 800 IU for men 71 and up. Obtain adequate sunlight and choose good food sources of vitamin D.  A man should discuss with his doctor if he needs a supplement of vitamin D3 – if so, it generally is recommended to take 1000-2000 IU/day.

·         Discuss with his doctor of any medications that are known to cause bone loss such as glucocorticoids

·         If experiencing ED, discuss with his doctor about this condition and its effect on bone health.