Fracture risk assessment in an Italian group of transgender women after gender-confirming surgery

Motta, Giovanna; Marinelli, Lorenzo; Barale, Marco; Brustio, Paolo Riccardo; Manieri, C.; Ghigo, Ezio; Procopio, Massimo; Lanfranco, Fabio

doi:10.1007/s00774-020-01127-9

Cited by 19 publications

(20 citation statements)

References 25 publications

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“…Another cross-sectional study showed that the 10-year fracture risk was in the low-risk range on average according to DeFRA (adapted version of FRAX score based on Italian epidemiological studies) 63 and only one out of seven transwomen in this study showed an intermediate to high 10-year fracture risk but none of the patients had fragility fractures.…”

Section: Bone Health In Transwomenmentioning

confidence: 59%

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Bone health in transgender people: a narrative review

Giacomelli

Meriggiola

2022

Therapeutic Advances in Endocrinology

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Bone health in transmen and transwomen is an important issue that needs to be evaluated by clinicians. Prior to gender-affirming hormone treatment (GAHT), transwomen have lower bone mineral density (BMD) and a higher prevalence of osteopenia than cismen probably related to external factors, such as hypovitaminosis D and less physical activities. Gonadotropin-releasing hormone (GnRH) analogues in transgender youth may cause bone loss; however, the addition of GAHT restores or at least improves BMD in both transboys and transgirls. The maintenance or increase in BMD shown in short-term longitudinal studies emphasizes that GAHT does not have a negative effect on BMD in adult transwomen and transmen. Gonadectomy is not a risk factor if GAHT is taken correctly. The prevalence of fractures in the transgender population seems to be the same as in the general population but more studies are required on this aspect. To evaluate the risk of osteoporosis, it is mandatory to define the most appropriate reference group not only taking into consideration the medical aspects but also in respect of the selected gender identity of each person.

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Section: Bone Health In Transwomenmentioning

confidence: 59%

“…Current literature shows that low bone mass (Z-score that matches gender assigned at birth) has been observed in 12.9–40% of transwomen during GAHT and is related to lower basal BMD, lower lean body mass, lower estradiol levels and lower compliance to GAHT. 49 , 50 , 59 , 62 , 63 …”

Section: Bone Health In Transwomenmentioning

confidence: 99%

Bone health in transgender people: a narrative review

Giacomelli

Meriggiola

2022

Therapeutic Advances in Endocrinology

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“…Intermediate‐to‐high fracture risk was found in 14% of the sample. A high percentage of hypovitaminosis D was seen (93%) [80]. From a nationwide cohort study in the Netherlands with 1.089 trans women aged <50 (mean 38

\pm

9) and 934 women aged

\ge

50 (mean 60

\pm

8) using GAHT for a median of 8 and 19 years, respectively, the fracture risk was higher in older trans women, compared to age‐matched reference cis men (OR 1.90).…”

Section: Resultsmentioning

confidence: 99%

Gender‐affirming hormone therapy: An updated literature review with an eye on the future

D'hoore

T’Sjoen

2022

J Intern Med

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“…More prospective data on bone mineral density and fractures in transgender women are awaited. Importantly, a high percentage of low bone mineral density and hypovitaminosis D was found prior to GAHT (97). Therefore, evaluation of bone mineral density and 25OH vitamin D before starting the feminizing treatment may be considered in high-risk individuals (93,94).…”

Section: Bone Healthmentioning

confidence: 99%

“…Therefore, evaluation of bone mineral density and 25OH vitamin D before starting the feminizing treatment may be considered in high-risk individuals (93,94). It is important to recognize that suboptimal medicine compliance in transgender women is associated with low bone mass (97).…”

Section: Bone Healthmentioning

confidence: 99%

MANAGEMENT OF ENDOCRINE DISEASE: Optimal feminizing hormone treatment in transgender people

Glintborg

T’Sjoen

Ravn

et al. 2021

European Journal of Endocrinology

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Transgender women are assigned male at birth, but identify as women. The incidence of gender dysphoria is estimated to be around 1% of the population. Gender dysphoria may be associated with depression and low quality of life, which in most cases improves during gender affirming hormonal treatment (GAHT). Feminizing hormonal treatment for transgender women or gender non-binary people typically includes natural estrogen (estradiol). Additional testosterone-blocking treatment is often needed to ensure suppression of the pituitary gonadal axis and may include cyproterone acetate, a gonadotropin releasing hormone agonist (GnRH-a) or spironolactone. The health risks of cyproterone acetate as anti-androgen treatment are debated and randomized protocols with other anti-androgen treatments are requested. Orchiectomy is performed in some transgender women after various duration of GAHT. Currently, natural progesterone is not recommended as part of GAHT due to limited knowledge on the balance between risks and benefits. In the present article we discuss evidence regarding established and upcoming feminizing treatment for adult transgender women or for gender non-binary people seeking feminization. Data on study populations with transgender women are put into a wider context of literature regarding effects of sex steroid hormones in cisgender study populations. Relevant follow up and monitoring during feminizing treatment is debated. The review has special focus on the pharmacotherapy of feminizing hormonal therapy.

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Fracture risk assessment in an Italian group of transgender women after gender-confirming surgery

Cited by 19 publications

References 25 publications

Bone health in transgender people: a narrative review

Bone health in transgender people: a narrative review

Gender‐affirming hormone therapy: An updated literature review with an eye on the future

MANAGEMENT OF ENDOCRINE DISEASE: Optimal feminizing hormone treatment in transgender people

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