Gender diverse adolescents have low pretreatment bone mineral density (BMD), with variable changes in BMD after initiation of gender-affirming treatment. We aimed to assess factors associated with low BMD in gender diverse youth. Sixty-four patients were included in our analysis (73% assigned male at birth). Subtotal whole-body BMD Z-scores were low in 30% of patients, and total lumbar spine BMD Z-scores low in 14%. There was a positive association with body mass index, and no association with vitamin D level. Male sex assigned at birth was associated with lower pretreatment BMD, with lower average BMD Z-scores compared to previous studies.
Get full access to this article
View all access options for this article.
References
1.
SaggeseG, BertelloniS, BaroncelliGI. Sex steroids and the acquisition of bone mass. Horm Res. 1997; 48(Suppl. 5):65–71.
2.
LeeJY, FinlaysonC, Olson-KennedyJ, et al.Low bone mineral density in early pubertal transgender/gender diverse youth: findings from the trans youth care study. J Endocr Soc. 2020; 4:bvaa065.
3.
KlinkD, CarisM, HeijboerA, et al.Bone mass in young adulthood following gonadotropin-releasing hormone analog treatment and cross-sex hormone treatment in adolescents with gender dysphoria. J Clin Endocrinol Metab. 2015; 100:E270–E275.
4.
StoffersIE, de VriesMC, HannemaSE. Physical changes, laboratory parameters, and bone mineral density during testosterone treatment in adolescents with gender dysphoria. J Sex Med. 2019; 16:1459–1468.
5.
VlotMC, KlinkDT, den HeijerM, et al.Effect of pubertal suppression and cross-sex hormone therapy on bone turnover markers and bone mineral apparent density (BMAD) in transgender adolescents. Bone. 2017; 95:11–19.
6.
SchagenSEE, WoutersFM, Cohen-KettenisPT, et al.Bone development in transgender adolescents treated with GnRH analogues and subsequent gender-affirming hormones. J Clin Endocrinol Metab. 2020; 105:e4252–e4263.
7.
WiepjesCM, de JonghRT, de BlokCJ, et al.Bone safety during the first ten years of gender-affirming hormonal treatment in transwomen and transmen. J Bone Miner Res. 2019; 34:447–454.
8.
Van CaenegemE, TaesY, WierckxK, et al.Low bone mass is prevalent in male-to-female transsexual persons before the start of cross-sex hormonal therapy and gonadectomy. Bone. 2013; 54:92–97.
9.
FigheraTM, da SilvaE, LindenauJD, et al.Impact of cross-sex hormone therapy on bone mineral density and body composition in transwomen. Clin Endocrinol (Oxf). 2018; 88:856–862.
10.
WiepjesCM, VlotMC, KlaverM, et al.Bone mineral density increases in trans persons after 1 year of hormonal treatment: a multicenter prospective observational study. J Bone Miner Res. 2017; 32:1252–1260.
11.
Van CaenegemE, WierckxK, TaesY, et al.Body composition, bone turnover, and bone mass in trans men during testosterone treatment: 1-year follow-up data from a prospective case-controlled study (ENIGI). Eur J Endocrinol. 2015; 172:163–171.
12.
Singh-OspinaN, MarakaS, Rodriguez-GutierrezR, et al.Effect of sex steroids on the bone health of transgender individuals: a systematic review and meta-analysis. J Clin Endocrinol Metab. 2017; 102:3904–3913.
13.
DobrolińskaM, van der TuukK, VinkP, et al.Bone mineral density in transgender individuals after gonadectomy and long-term gender-affirming hormonal treatment. J Sex Med. 2019; 16:1469–1477.
14.
Delgado-RuizR, SwansonP, RomanosG. Systematic review of the long-term effects of transgender hormone therapy on bone markers and bone mineral density and their potential effects in implant therapy. J Clin Med. 2019; 8:784.
15.
BroulikPD, UrbánekV, LibanskýP. Eighteen-year effect of androgen therapy on bone mineral density in trans(gender) men. Horm Metab Res. 2018; 50:133–137.
16.
JonesBA, HaycraftE, BoumanWP, et al.The levels and predictors of physical activity engagement within the treatment-seeking transgender population: a matched control study. J Phys Act Health. 2018; 15:99–107.
17.
ConnollyMD, ZervosMJ, BaroneCJ, 2nd, et al. The mental health of transgender youth: advances in understanding. J Adolesc Health. 2016; 59:489–495.
18.
HembreeWC, Cohen-KettenisPT, GoorenL, et al.Endocrine treatment of gender-dysphoric/gender-incongruent persons: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2017; 102:3869–3903.
19.
KhalatbariH, BinkovitzLA, ParisiMT. Dual-energy X-ray absorptiometry bone densitometry in pediatrics: a practical review and update. Pediatr Radiol. 2021; 51:25–39.
20.
ShuhartCR, YeapSS, AndersonPA, et al.Executive summary of the 2019 ISCD position development conference on monitoring treatment, DXA cross-calibration and least significant change, spinal cord injury, peri-prosthetic and orthopedic bone health, transgender medicine, and pediatrics. J Clin Densitom. 2019; 22:453–471.
21.
GoldenNH, Abrams SA; Committee onNutrition. Optimizing bone health in children and adolescents. Pediatrics. 2014; 134:e1229–e1243.
