Bone geometry and trabecular bone score in transgender people before and after short- and long-term hormonal treatment

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Abstract

Background: Gender-affirming hormonal treatment (HT) in adult transgender people influences bone mineral density (BMD). Besides BMD, bone geometry and trabecular bone score are associated with fracture risk. However, it is not known whether bone geometry and TBS changes during HT. Purpose: To investigate the bone geometry and TBS in adult transgender people at different time points, up to 25 years, of HT. Methods: A total of 535 trans women and 473 trans men were included, who were divided into three groups at time of their DXA: 20–29 years, 30–39 years, and 40–59 years. Subsequently, each group was divided into different HT durations: baseline, or after 5, 15, or 25 years of HT. Hip structure analysis was performed to measure subperiosteal width, endocortical diameter, average cortical thickness, and section modulus. TBS was calculated based on lumbar spine DXA images. Results: In trans women in all age groups and in young trans men, no differences were observed in periosteal width, endocortical diameter, average cortical thickness, and section modulus for different durations of HT. In trans men aged 40–59 years, subperiosteal width, endocortical diameter, and section modulus were slightly higher in the groups who were using HT compared to the (peri- or postmenopausal) baseline group. In younger trans women, TBS tended to be higher in those using HT compared to the baseline groups, and in older trans women TBS was higher in those using HT for 25 years versus baseline (+0.04, 95%CI +0.00; +0.08). In younger trans men, TBS tended to be lower in those who used HT compared to the baseline groups, and in older trans men TBS was lower in those using 5 years HT versus baseline (−0.05, 95%CI −0.08; −0.01). Conclusion: No differences in cortical bone geometry parameters were found during different HT-durations. TBS increased in trans women and decreased in trans men, indicating that estrogens have positive effects on TBS. These data may be helpful in determining what sex reference values for calculating T-scores and Z-scores in adult transgender people should be used.
Original languageEnglish
Pages (from-to)280-286
JournalBone
Volume127
Early online date1 Jul 2019
DOIs
Publication statusPublished - 2019

Cite this

@article{76f43cc4d8774399b39ea14a65e807a5,
title = "Bone geometry and trabecular bone score in transgender people before and after short- and long-term hormonal treatment",
abstract = "Background: Gender-affirming hormonal treatment (HT) in adult transgender people influences bone mineral density (BMD). Besides BMD, bone geometry and trabecular bone score are associated with fracture risk. However, it is not known whether bone geometry and TBS changes during HT. Purpose: To investigate the bone geometry and TBS in adult transgender people at different time points, up to 25 years, of HT. Methods: A total of 535 trans women and 473 trans men were included, who were divided into three groups at time of their DXA: 20–29 years, 30–39 years, and 40–59 years. Subsequently, each group was divided into different HT durations: baseline, or after 5, 15, or 25 years of HT. Hip structure analysis was performed to measure subperiosteal width, endocortical diameter, average cortical thickness, and section modulus. TBS was calculated based on lumbar spine DXA images. Results: In trans women in all age groups and in young trans men, no differences were observed in periosteal width, endocortical diameter, average cortical thickness, and section modulus for different durations of HT. In trans men aged 40–59 years, subperiosteal width, endocortical diameter, and section modulus were slightly higher in the groups who were using HT compared to the (peri- or postmenopausal) baseline group. In younger trans women, TBS tended to be higher in those using HT compared to the baseline groups, and in older trans women TBS was higher in those using HT for 25 years versus baseline (+0.04, 95{\%}CI +0.00; +0.08). In younger trans men, TBS tended to be lower in those who used HT compared to the baseline groups, and in older trans men TBS was lower in those using 5 years HT versus baseline (−0.05, 95{\%}CI −0.08; −0.01). Conclusion: No differences in cortical bone geometry parameters were found during different HT-durations. TBS increased in trans women and decreased in trans men, indicating that estrogens have positive effects on TBS. These data may be helpful in determining what sex reference values for calculating T-scores and Z-scores in adult transgender people should be used.",
author = "Wiepjes, {Chantal M.} and Vlot, {Mariska C.} and {de Blok}, {Christel J. M.} and Nota, {Nienke M.} and {de Jongh}, {Renate T.} and {den Heijer}, Martin",
note = "Copyright {\circledC} 2019. Published by Elsevier Inc.",
year = "2019",
doi = "10.1016/j.bone.2019.06.029",
language = "English",
volume = "127",
pages = "280--286",
journal = "Bone",
issn = "8756-3282",
publisher = "Elsevier Inc.",

}

TY - JOUR

T1 - Bone geometry and trabecular bone score in transgender people before and after short- and long-term hormonal treatment

AU - Wiepjes, Chantal M.

AU - Vlot, Mariska C.

AU - de Blok, Christel J. M.

AU - Nota, Nienke M.

AU - de Jongh, Renate T.

AU - den Heijer, Martin

N1 - Copyright © 2019. Published by Elsevier Inc.

PY - 2019

Y1 - 2019

N2 - Background: Gender-affirming hormonal treatment (HT) in adult transgender people influences bone mineral density (BMD). Besides BMD, bone geometry and trabecular bone score are associated with fracture risk. However, it is not known whether bone geometry and TBS changes during HT. Purpose: To investigate the bone geometry and TBS in adult transgender people at different time points, up to 25 years, of HT. Methods: A total of 535 trans women and 473 trans men were included, who were divided into three groups at time of their DXA: 20–29 years, 30–39 years, and 40–59 years. Subsequently, each group was divided into different HT durations: baseline, or after 5, 15, or 25 years of HT. Hip structure analysis was performed to measure subperiosteal width, endocortical diameter, average cortical thickness, and section modulus. TBS was calculated based on lumbar spine DXA images. Results: In trans women in all age groups and in young trans men, no differences were observed in periosteal width, endocortical diameter, average cortical thickness, and section modulus for different durations of HT. In trans men aged 40–59 years, subperiosteal width, endocortical diameter, and section modulus were slightly higher in the groups who were using HT compared to the (peri- or postmenopausal) baseline group. In younger trans women, TBS tended to be higher in those using HT compared to the baseline groups, and in older trans women TBS was higher in those using HT for 25 years versus baseline (+0.04, 95%CI +0.00; +0.08). In younger trans men, TBS tended to be lower in those who used HT compared to the baseline groups, and in older trans men TBS was lower in those using 5 years HT versus baseline (−0.05, 95%CI −0.08; −0.01). Conclusion: No differences in cortical bone geometry parameters were found during different HT-durations. TBS increased in trans women and decreased in trans men, indicating that estrogens have positive effects on TBS. These data may be helpful in determining what sex reference values for calculating T-scores and Z-scores in adult transgender people should be used.

AB - Background: Gender-affirming hormonal treatment (HT) in adult transgender people influences bone mineral density (BMD). Besides BMD, bone geometry and trabecular bone score are associated with fracture risk. However, it is not known whether bone geometry and TBS changes during HT. Purpose: To investigate the bone geometry and TBS in adult transgender people at different time points, up to 25 years, of HT. Methods: A total of 535 trans women and 473 trans men were included, who were divided into three groups at time of their DXA: 20–29 years, 30–39 years, and 40–59 years. Subsequently, each group was divided into different HT durations: baseline, or after 5, 15, or 25 years of HT. Hip structure analysis was performed to measure subperiosteal width, endocortical diameter, average cortical thickness, and section modulus. TBS was calculated based on lumbar spine DXA images. Results: In trans women in all age groups and in young trans men, no differences were observed in periosteal width, endocortical diameter, average cortical thickness, and section modulus for different durations of HT. In trans men aged 40–59 years, subperiosteal width, endocortical diameter, and section modulus were slightly higher in the groups who were using HT compared to the (peri- or postmenopausal) baseline group. In younger trans women, TBS tended to be higher in those using HT compared to the baseline groups, and in older trans women TBS was higher in those using HT for 25 years versus baseline (+0.04, 95%CI +0.00; +0.08). In younger trans men, TBS tended to be lower in those who used HT compared to the baseline groups, and in older trans men TBS was lower in those using 5 years HT versus baseline (−0.05, 95%CI −0.08; −0.01). Conclusion: No differences in cortical bone geometry parameters were found during different HT-durations. TBS increased in trans women and decreased in trans men, indicating that estrogens have positive effects on TBS. These data may be helpful in determining what sex reference values for calculating T-scores and Z-scores in adult transgender people should be used.

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U2 - 10.1016/j.bone.2019.06.029

DO - 10.1016/j.bone.2019.06.029

M3 - Article

VL - 127

SP - 280

EP - 286

JO - Bone

JF - Bone

SN - 8756-3282

ER -