Fracture Risk in Trans Women and Trans Men Using Long-Term Gender-Affirming Hormonal Treatment: A Nationwide Cohort Study
Chantal M Wiepjes
Department of Endocrinology, Amsterdam UMC, VU University Medical Center, Amsterdam, the Netherlands
Center of Expertise on Gender Dysphoria, Amsterdam UMC, VU University Medical Center, Amsterdam, the Netherlands
Search for more papers by this authorChristel JM de Blok
Department of Endocrinology, Amsterdam UMC, VU University Medical Center, Amsterdam, the Netherlands
Center of Expertise on Gender Dysphoria, Amsterdam UMC, VU University Medical Center, Amsterdam, the Netherlands
Search for more papers by this authorAnnemieke S Staphorsius
Center of Expertise on Gender Dysphoria, Amsterdam UMC, VU University Medical Center, Amsterdam, the Netherlands
Search for more papers by this authorNienke M Nota
Department of Endocrinology, Amsterdam UMC, VU University Medical Center, Amsterdam, the Netherlands
Center of Expertise on Gender Dysphoria, Amsterdam UMC, VU University Medical Center, Amsterdam, the Netherlands
Search for more papers by this authorMariska C Vlot
Department of Endocrinology, Amsterdam UMC, VU University Medical Center, Amsterdam, the Netherlands
Center of Expertise on Gender Dysphoria, Amsterdam UMC, VU University Medical Center, Amsterdam, the Netherlands
Search for more papers by this authorRenate T de Jongh
Department of Endocrinology, Amsterdam UMC, VU University Medical Center, Amsterdam, the Netherlands
Search for more papers by this authorCorresponding Author
Martin den Heijer
Department of Endocrinology, Amsterdam UMC, VU University Medical Center, Amsterdam, the Netherlands
Center of Expertise on Gender Dysphoria, Amsterdam UMC, VU University Medical Center, Amsterdam, the Netherlands
Address correspondence to: Martin den Heijer, MD, PhD, Department of Internal Medicine, Section Endocrinology, Amsterdam UMC, VU University Medical Center, PO Box 7057, 1007 MB Amsterdam, the Netherlands. E-mail: [email protected]Search for more papers by this authorChantal M Wiepjes
Department of Endocrinology, Amsterdam UMC, VU University Medical Center, Amsterdam, the Netherlands
Center of Expertise on Gender Dysphoria, Amsterdam UMC, VU University Medical Center, Amsterdam, the Netherlands
Search for more papers by this authorChristel JM de Blok
Department of Endocrinology, Amsterdam UMC, VU University Medical Center, Amsterdam, the Netherlands
Center of Expertise on Gender Dysphoria, Amsterdam UMC, VU University Medical Center, Amsterdam, the Netherlands
Search for more papers by this authorAnnemieke S Staphorsius
Center of Expertise on Gender Dysphoria, Amsterdam UMC, VU University Medical Center, Amsterdam, the Netherlands
Search for more papers by this authorNienke M Nota
Department of Endocrinology, Amsterdam UMC, VU University Medical Center, Amsterdam, the Netherlands
Center of Expertise on Gender Dysphoria, Amsterdam UMC, VU University Medical Center, Amsterdam, the Netherlands
Search for more papers by this authorMariska C Vlot
Department of Endocrinology, Amsterdam UMC, VU University Medical Center, Amsterdam, the Netherlands
Center of Expertise on Gender Dysphoria, Amsterdam UMC, VU University Medical Center, Amsterdam, the Netherlands
Search for more papers by this authorRenate T de Jongh
Department of Endocrinology, Amsterdam UMC, VU University Medical Center, Amsterdam, the Netherlands
Search for more papers by this authorCorresponding Author
Martin den Heijer
Department of Endocrinology, Amsterdam UMC, VU University Medical Center, Amsterdam, the Netherlands
Center of Expertise on Gender Dysphoria, Amsterdam UMC, VU University Medical Center, Amsterdam, the Netherlands
Address correspondence to: Martin den Heijer, MD, PhD, Department of Internal Medicine, Section Endocrinology, Amsterdam UMC, VU University Medical Center, PO Box 7057, 1007 MB Amsterdam, the Netherlands. E-mail: [email protected]Search for more papers by this authorABSTRACT
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.
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