Effect of Sex Steroids on the Bone Health of Transgender Individuals: A Systematic Review and Meta-Analysis

Ospina, Naykky M Singh; Maraka, Spyridoula; Rodríguez-Gutiérrez, René; Davidge‐Pitts, Caroline; Nippoldt, Todd B.; Prokop, Larry J.; Murad, M. Hassan

doi:10.1210/jc.2017-01642

Cited by 102 publications

(83 citation statements)

References 33 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Indeed, Wiepjes et al have recently described an increase in lumbar spine (+3.67%), total hip (+0.97%), and femoral neck (+1.86%) BMD in the presence of oestrogen and antiandrogen therapy in a multicenter study including 231 transgender women undergoing CSHT for 1 year. Moreover, a systematic review and meta‐analysis including 392 transwomen revealed an increase in BMD at the lumbar spine, but not at femoral neck, after 12 and 24 months of oestrogen therapy. The increased BMD observed in the first years of CSHT in those studies might have resulted from oestrogen‐mediated filling of the remodelling space, affecting the balance of osteoblast and osteoclast activity and suppressing bone turnover .…”

Section: Discussionmentioning

confidence: 48%

Impact of cross‐sex hormone therapy on bone mineral density and body composition in transwomen

Fighera

Silva

Lindenau

et al. 2018

Clinical Endocrinology

View full text Add to dashboard Cite

show abstract

Section: Discussionmentioning

confidence: 48%

Impact of cross‐sex hormone therapy on bone mineral density and body composition in transwomen

Fighera

Silva

Lindenau

et al. 2018

Clinical Endocrinology

View full text Add to dashboard Cite

show abstract

“…(16,32) Although earlier short-term and long-term studies did not show a detrimental effect of HT on BMD, (18,31) higher fracture risk in young trans women compared with age-matched reference women may be explained by lower initial BMD even before start of HT. Earlier studies found that trans women, also at younger ages, had a high prevalence of osteoporosis or low BMD even before hormonal treatment.…”

Section: Discussionmentioning

confidence: 89%

“…Earlier studies found either a maintenance (16)(17)(18)(19)(20) or increase (16)(17)(18)(21)(22)(23)(24)(25)(26) in BMD in both adult trans women and trans men after short-term HT. Earlier studies found either a maintenance (16)(17)(18)(19)(20) or increase (16)(17)(18)(21)(22)(23)(24)(25)(26) in BMD in both adult trans women and trans men after short-term HT.…”

Section: Introductionmentioning

confidence: 91%

Fracture Risk in Trans Women and Trans Men Using Long-Term Gender-Affirming Hormonal Treatment: A Nationwide Cohort Study

Wiepjes

Blok

Staphorsius

et al. 2019

Journal of Bone and Mineral Research

View full text Add to dashboard Cite

Concerns about bone health in transgender people using gender‐affirming hormonal treatment (HT) exist, but the fracture risk is not known. In this nationwide cohort study, we aimed to compare the fracture incidence in transgender people using long‐term HT with an age‐matched reference population. All adult transgender people who started HT before 2016 at our gender‐identity clinic were included and were linked to a random population‐based sample of 5 age‐matched reference men and 5 age‐matched reference women per person. Fracture incidence was determined using diagnoses from visits to hospital emergency rooms nationwide between 2013 and 2015. A total of 1089 trans women aged <50 years (mean 38 ± 9 years) and 934 trans women aged ≥50 years (mean 60 ± 8 years) using HT for median 8 (interquartile range [IQR] 3–16) and 19 (IQR 11–29) years, respectively, were included. A total of 2.4% of the trans women aged <50 years had a fracture, whereas 3.0% of the age‐matched reference men (odds ratio [OR] = 0.78, 95% confidence interval [CI] 0.51–1.19) and 1.6% of the age‐matched reference women (OR = 1.49, 95% CI 0.96–2.32) experienced a fracture. In trans women aged ≥50 years, 4.4% experienced a fracture compared with 2.4% of the age‐matched reference men (OR = 1.90, 95% CI 1.32–2.74) and 4.2% of the age‐matched reference women (OR = 1.05, 95% CI 0.75–1.49). A total of 1036 trans men (40 ± 14 years) using HT for median 9 (IQR 2–22) years were included. Fractures occurred in 1.7% of the trans men, 3.0% of the age‐matched reference men (OR = 0.57, 95% CI 0.35–0.94), and 2.2% of the age‐matched reference women (OR = 0.79, 95% CI 0.48–1.30). In conclusion, fracture risk was higher in older trans women compared with age‐matched reference men. In young trans women, fracture risk tended to be increased compared with age‐matched reference women. Fracture risk was not increased in young trans men. © 2019 The Authors. Journal of Bone and Mineral Research published by American Society for Bone and Mineral Research.

show abstract

“…Gender‐affirming hormonal treatment (HT) in transgender people influences bone metabolism. After 1 year of HT the BMD increases in transwomen (male‐to‐female transgender people), whereas in transmen (female‐to‐male transgender people) a maintenance or increase in BMD is described. More specifically, a larger increase in BMD was found in postmenopausal transmen with estrogen deficiency prior to HT compared with premenopausal transmen with normal estradiol concentrations.…”

Section: Introductionmentioning

confidence: 99%

Bone Safety During the First Ten Years of Gender-Affirming Hormonal Treatment in Transwomen and Transmen

Wiepjes

Jongh

Blok

et al. 2018

Journal of Bone and Mineral Research

113

View full text Add to dashboard Cite

Concerns about the effects of gender‐affirming hormonal treatment (HT) on bone mineral density (BMD) in transgender people exist, particularly regarding the decrease in estrogen concentrations in transmen. Although it is known that HT is safe for BMD in the short term, long‐term follow‐up studies are lacking. Therefore this study aimed to investigate the change in BMD during the first 10 years of HT, to determine whether HT is safe and if assessing BMD during HT is necessary. A follow‐up study was performed in adult transgender people receiving HT at the VU University Medical Center Amsterdam between 1998 and 2016. People were included if they were HT naive and had a dual‐energy X‐ray absorptiometry (DXA) scan at the start of HT. Follow‐up DXA scans performed after 2, 5, and/or 10 years of HT were used for analyses. The course of BMD of the lumbar spine during the first 10 years of HT was analyzed using multilevel analyses. A total of 711 transwomen (median age 35 years; IQR, 26 to 46 years) and 543 transmen (median age 25 years; IQR, 21 to 34 years) were included. Prior to the start of HT, 21.9% of transwomen and 4.3% of transmen had low BMD for age (Z‐score < –2.0). In transwomen lumbar spine BMD did not change (+0.006; 95% CI, –0.005 to +0.017), but lumbar spine Z‐score increased by +0.22 (95% CI, +0.12 to +0.32) after 10 years of HT. Also in transmen lumbar spine BMD did not change (+0.008; 95% CI, –0.004 to +0.019), but lumbar spine Z‐score increased by +0.34 (95% CI, +0.23 to +0.45) after 10 years of HT. This study showed that HT does not have negative effects on BMD, indicating that regularly assessing BMD during HT is not necessary. However, a high percentage of low BMD was found prior to HT, especially in transwomen. Therefore, evaluation of BMD before start of HT may be considered. © 2018 The Authors. Journal of Bone and Mineral Research Published by Wiley Periodicals, Inc.

show abstract

Effect of Sex Steroids on the Bone Health of Transgender Individuals: A Systematic Review and Meta-Analysis

Cited by 102 publications

References 33 publications

Impact of cross‐sex hormone therapy on bone mineral density and body composition in transwomen

Impact of cross‐sex hormone therapy on bone mineral density and body composition in transwomen

Fracture Risk in Trans Women and Trans Men Using Long-Term Gender-Affirming Hormonal Treatment: A Nationwide Cohort Study

Bone Safety During the First Ten Years of Gender-Affirming Hormonal Treatment in Transwomen and Transmen

Contact Info

Product

Resources

About