Abstract
The aims of this study were to investigate the risk of hip fracture and contributing factors in patients with erectile dysfunction(ED). This population-based study was performed using the Taiwan National Health Insurance Research Database. The analysis included4636 patients aged ≥ 40 years who had been diagnosed with ED (International Classification of Diseases, Ninth Revision, Clinical Modification codes 302.72, 607.84) during 1996–2010. The control group included 18,544 randomly selected age-matched patients without ED (1:4 ratio). The association between ED and hip fracture risk was estimated using a Cox proportional hazard regression model. During the follow-up period, 59 (1.27%) patients in the ED group and 140 (0.75%) patients in the non-ED group developed hip fracture. After adjusting for covariates, the overall incidence of hip fracture was 3.74-times higher in the ED group than in the non-ED group (2.03 vs. 0.50 per 1000 person-years, respectively). The difference in the overall incidence of hip fracture was largest during the 3-year follow-up period (hazard ratio = 7.85; 95% confidence interval = 2.94–20.96; P <0.0001). To the best of our knowledge, this nationwide population-based study is the first to investigate the relationship between ED and subsequent hip fracture in an Asian population. The results showed that ED patients had a higher risk of developing hip fracture. Patients with ED, particularly those aged 40–59 years, should undergo bone mineral density examinations as early as possible and should take measures to reduce the risk of falls.
Highlights
Erectile dysfunction (ED), a common sexual problem in men, is defined as the inability to achieve or sustain a penile erection for satisfactory sexual performance
The following comorbidities were significantly more likely in the ED cohort versus the non-ED cohort, respectively: hypertension (67.56% vs. 44.61%, P < 0.0001), diabetes mellitus (41.48% vs. 21.77%, P < 0.0001), hyperlipidaemia (61.95% vs. 37.28%, P < 0.0001), osteoporosis (10.09% vs. 3.67%, P < 0.0001), chronic kidney disease (23.06% vs. 10.34%, P < 0.0001), chronic liver disease (54.85% vs. 35.01%, P < 0.0001), chronic pulmonary disease (58.02% vs. 36.86%, P < 0.0001), hyperthyroidism (5.16% vs. 2.31%, P < 0.0001), dementia (7.18% vs. 2.23%, P < 0.0001), stroke (14.69% vs. 5.18%, P < 0.0001), epilepsy (3.24% vs. 1.89%, P < 0.0001), depression (20.56% vs. 7.77%, P < 0.0001), Parkinson’s disease (4.21% vs. 1.51%, P < 0.0001), and Charlson comorbidity index (CCI) (41.03% vs. 15.57%, P < 0.0001)
Testosterone use and corticosteroid use were significantly more prevalent in the ED cohort compared to the non-ED cohort (2.72% vs. 0.21%, P < 0.0001 and 11.45% vs. 6.05%, P < 0.0001, respectively)
Summary
Erectile dysfunction (ED), a common sexual problem in men, is defined as the inability to achieve or sustain a penile erection for satisfactory sexual performance. Hip fractures are considered the most severe osteoporotic fractures They increase morbidity rates and negatively affect quality of life. Because there are common pathophysiological mechanisms of the bone and vasculature and because the calcification process in vascular walls is similar to the bone formation process [11,12], coronary heart disease (CHD) is a noted risk factor for hip fracture. Since both ED and hip fracture are associated with CHD risk factors, we hypothesized that ED is associated with hip fracture. A nationwide population-based cohort in Taiwan was used to investigate the risk of hip fracture in patients with ED
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