Division of Endocrinology and Metabolism, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.
Division of Endocrinology, Diabetes and Hypertension, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.
J Clin Densitom. 2019 Oct-Dec;22(4):544-553. doi: 10.1016/j.jocd.2019.07.004. Epub 2019 Jul 10.
The indications for initial and follow-up bone mineral density (BMD) in transgender and gender nonconforming (TGNC) individuals are poorly defined, and the choice of which gender database to use to calculate Z-scores is unclear. Herein, the findings of the Task Force are presented after a detailed review of the literature. As long as a TGNC individual is on standard gender-affirming hormone treatment, BMD should remain stable to increasing, so there is no indication to monitor for bone loss or osteoporosis strictly on the basis of TGNC status. TGNC individuals who experience substantial periods of hypogonadism (>1 yr) might experience bone loss or failure of bone accrual during that time, and should be considered for baseline measurement of BMD. To the extent that this hypogonadism continues over time, follow-up measurements can be appropriate. TGNC individuals who have adequate levels of endogenous or exogenous sex steroids can, of course, suffer from other illnesses that can cause osteoporosis and bone loss, such as hyperparathyroidism and steroid use; they should have measurement of BMD as would be done in the cisgender population. There are no data that TGNC individuals have a fracture risk different from that of cisgender individuals, nor any data to suggest that BMD predicts their fracture risk less well than in the cisgender population. The Z-score in transgender individuals should be calculated using the reference data (mean and standard deviation) of the gender conforming with the individual's gender identity. In gender nonconforming individuals, the reference data for the sex recorded at birth should be used. If the referring provider or the individual requests, a set of "male" and "female" Z-scores can be provided, calculating the Z-score against male and female reference data, respectively.
跨性别和性别不一致（TGNC）个体初始和随访骨密度（BMD）的适应证定义不明确，用于计算 Z 评分的性别数据库选择也不清楚。在此，在详细审查文献后提出了工作组的发现。只要 TGNC 个体正在接受标准的性别肯定激素治疗，BMD 就应该保持稳定或增加，因此，没有必要仅仅根据 TGNC 状态监测骨丢失或骨质疏松症。经历大量性腺功能减退（> 1 年）的 TGNC 个体在此期间可能会经历骨丢失或骨积累失败，应考虑进行 BMD 的基线测量。如果这种性腺功能减退持续存在，则可以进行随访测量。具有足够内源性或外源性性激素水平的 TGNC 个体当然可能会患上其他导致骨质疏松症和骨丢失的疾病，例如甲状旁腺功能亢进和类固醇使用；他们应该像 cisgender 人群一样进行 BMD 测量。没有数据表明 TGNC 个体的骨折风险与 cisgender 个体不同，也没有数据表明 BMD 对他们的骨折风险预测不如 cisgender 人群。 transgender 个体的 Z 评分应使用与个体性别认同相符的性别参考数据（平均值和标准差）计算。在性别不一致的个体中，应使用出生时记录的性别的参考数据。如果参考提供者或个体要求，可以提供一组“男性”和“女性”Z 评分，分别针对男性和女性参考数据计算 Z 评分。
