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Preservation of volumetric bone density and geometry in trans women during cross-sex hormonal therapy: a prospective observational study

Eva Van Caenegem, Katrien Wierckx, Youri Taes, Thomas Schreiner UGent, SARA VANDEWALLE, Kaatje Toye UGent, Jean Kaufman UGent and Guy T'Sjoen UGent (2015) OSTEOPOROSIS INTERNATIONAL. 26(1). p.35-47
abstract
Although trans women before the start of hormonal therapy have a less bone and muscle mass compared with control men, their bone mass and geometry are preserved during the first 2 years of hormonal therapy, despite of substantial muscle loss, illustrating the major role of estrogen in the male skeleton. The aim of this study is to examine the evolution of areal and volumetric bone density, geometry, and turnover in trans women undergoing sex steroid changes, during the first 2 years of hormonal therapy. In a prospective observational study, we examined 49 trans women (male-to-female) before and after 1 and 2 years of cross-sex hormonal therapy (CSH) in comparison with 49 age-matched control men measuring grip strength (hand dynamometer), areal bone mineral density (aBMD), and total body fat and lean mass using dual X-ray absorptiometry (DXA), bone geometry and volumetric bone mineral density, regional fat, and muscle area at the forearm and calf using peripheral quantitative computed tomography. Standardized treatment regimens were used with oral estradiol valerate, 4 mg daily (or transdermal 17-beta estradiol 100 mu g/24 h for patients > 45 years old), both combined with oral cyproterone acetate 50 mg daily. Prior to CSH, trans women had lower aBMD at all measured sites (all p < 0.001), smaller cortical bone size (all p < 0.05), and lower muscle mass and strength and lean body mass (all p < 0.05) compared with control men. During CSH, muscle mass and strength decreased and all measures of fat mass increased (all p < 0.001). The aBMD increased at the femoral neck, radius, lumbar spine, and total body; cortical and trabecular bone remained stable and bone turnover markers decreased (all p < 0.05). Although trans women, before CSH, have a lower aBMD and cortical bone size compared with control men, their skeletal status is well preserved during CSH treatment, despite of substantial muscle loss.
Please use this url to cite or link to this publication:
author
organization
year
type
journalArticle (original)
publication status
published
subject
keyword
TO-FEMALE TRANSSEXUALS, Bone transsexual gender dyspohria sex steroids prospective, TERM-FOLLOW-UP, MINERAL DENSITY, PHYSICAL-ACTIVITY, BODY-COMPOSITION, PROSTATE-CANCER, FRACTURE RISK, TURNOVER RATE, VITAMIN-D, MASS
journal title
OSTEOPOROSIS INTERNATIONAL
Osteoporosis Int.
volume
26
issue
1
pages
35 - 47
Web of Science type
Article
Web of Science id
000347689400004
JCR category
ENDOCRINOLOGY & METABOLISM
JCR impact factor
3.445 (2015)
JCR rank
45/131 (2015)
JCR quartile
2 (2015)
ISSN
0937-941X
DOI
10.1007/s00198-014-2805-3
language
English
UGent publication?
yes
classification
A1
copyright statement
I have transferred the copyright for this publication to the publisher
id
6850583
handle
http://hdl.handle.net/1854/LU-6850583
date created
2015-06-26 13:32:29
date last changed
2016-12-19 15:45:52
@article{6850583,
  abstract     = {Although trans women before the start of hormonal therapy have a less bone and muscle mass compared with control men, their bone mass and geometry are preserved during the first 2 years of hormonal therapy, despite of substantial muscle loss, illustrating the major role of estrogen in the male skeleton. 
The aim of this study is to examine the evolution of areal and volumetric bone density, geometry, and turnover in trans women undergoing sex steroid changes, during the first 2 years of hormonal therapy. 
In a prospective observational study, we examined 49 trans women (male-to-female) before and after 1 and 2 years of cross-sex hormonal therapy (CSH) in comparison with 49 age-matched control men measuring grip strength (hand dynamometer), areal bone mineral density (aBMD), and total body fat and lean mass using dual X-ray absorptiometry (DXA), bone geometry and volumetric bone mineral density, regional fat, and muscle area at the forearm and calf using peripheral quantitative computed tomography. Standardized treatment regimens were used with oral estradiol valerate, 4 mg daily (or transdermal 17-beta estradiol 100 mu g/24 h for patients {\textrangle} 45 years old), both combined with oral cyproterone acetate 50 mg daily. 
Prior to CSH, trans women had lower aBMD at all measured sites (all p {\textlangle} 0.001), smaller cortical bone size (all p {\textlangle} 0.05), and lower muscle mass and strength and lean body mass (all p {\textlangle} 0.05) compared with control men. During CSH, muscle mass and strength decreased and all measures of fat mass increased (all p {\textlangle} 0.001). The aBMD increased at the femoral neck, radius, lumbar spine, and total body; cortical and trabecular bone remained stable and bone turnover markers decreased (all p {\textlangle} 0.05). 
Although trans women, before CSH, have a lower aBMD and cortical bone size compared with control men, their skeletal status is well preserved during CSH treatment, despite of substantial muscle loss.},
  author       = {Van Caenegem, Eva and Wierckx, Katrien and Taes, Youri and Schreiner, Thomas and VANDEWALLE, SARA and Toye, Kaatje and Kaufman, Jean and T'Sjoen, Guy},
  issn         = {0937-941X},
  journal      = {OSTEOPOROSIS INTERNATIONAL},
  keyword      = {TO-FEMALE TRANSSEXUALS,Bone transsexual gender dyspohria sex steroids prospective,TERM-FOLLOW-UP,MINERAL DENSITY,PHYSICAL-ACTIVITY,BODY-COMPOSITION,PROSTATE-CANCER,FRACTURE RISK,TURNOVER RATE,VITAMIN-D,MASS},
  language     = {eng},
  number       = {1},
  pages        = {35--47},
  title        = {Preservation of volumetric bone density and geometry in trans women during cross-sex hormonal therapy: a prospective observational study},
  url          = {http://dx.doi.org/10.1007/s00198-014-2805-3},
  volume       = {26},
  year         = {2015},
}

Chicago
Van Caenegem, Eva, Katrien Wierckx, Youri Taes, Thomas Schreiner, Sara Vandewalle, Kaatje Toye, Jean Kaufman, and Guy T’Sjoen. 2015. “Preservation of Volumetric Bone Density and Geometry in Trans Women During Cross-sex Hormonal Therapy: a Prospective Observational Study.” Osteoporosis International 26 (1): 35–47.
APA
Van Caenegem, E., Wierckx, K., Taes, Y., Schreiner, T., Vandewalle, S., Toye, K., Kaufman, J., et al. (2015). Preservation of volumetric bone density and geometry in trans women during cross-sex hormonal therapy: a prospective observational study. OSTEOPOROSIS INTERNATIONAL, 26(1), 35–47.
Vancouver
1.
Van Caenegem E, Wierckx K, Taes Y, Schreiner T, Vandewalle S, Toye K, et al. Preservation of volumetric bone density and geometry in trans women during cross-sex hormonal therapy: a prospective observational study. OSTEOPOROSIS INTERNATIONAL. 2015;26(1):35–47.
MLA
Van Caenegem, Eva, Katrien Wierckx, Youri Taes, et al. “Preservation of Volumetric Bone Density and Geometry in Trans Women During Cross-sex Hormonal Therapy: a Prospective Observational Study.” OSTEOPOROSIS INTERNATIONAL 26.1 (2015): 35–47. Print.