The University of Kansas School of Medicine, Kansas City, KS, USA.
The University of Kansas School of Medicine, Kansas City, KS, USA.
J Clin Densitom. 2022 Oct-Dec;25(4):615-621. doi: 10.1016/j.jocd.2022.02.004. Epub 2022 Mar 13.
Transgender and gender non-conforming (TGNC) individuals face numerous barriers to healthcare, which contribute to many health disparities. TGNC persons may choose gender-affirming therapies with surgery and/or hormone replacement therapy (HRT) to manage gender incongruence. Despite the expanding use of HRT, the long-term outcomes on bone health and metabolism, are still relatively unknown in the TGNC population. In 2019, the International Society of Clinical Densitometry (ISCD) released an official position statement on the appropriate use of dual energy x-ray absorptiometry (DXA) to measure bone density in the TGNC population. In this study, we reviewed which "sex" is currently utilized among providers when performing DXA scans to calculate T- and Z-scores for TGNC persons and how this compares to the positions published by the ISCD. A retrospective analysis was performed utilizing HERON queries and subsequent chart review. HERON is a type of Informatics for Integrating Biology and the Bedside software that was utilized to find sets of patients of interest from electronic medical record data while preserving patient privacy through a query interface tool. Project specific sets including patient demographics, medications, gonadectomy, and DXA scan information was created in HERON to make this highly detailed data of specific patients available to the investigators on the platform, as reviewed and retrieved by the Institutional Review Board. The qualitative DXA data obtained from chart review was determined as "correct" or "incorrect" based on positions provided from the ISCD. 10 DXA scans that met inclusion criteria were obtained between 9 TGNC patients. In total, 18 T-scores and Z-scores of the 10 DXAs were reviewed and scored. Based on ISCD positions, 67% of the T-score and Z-scores were calculated incorrectly; using the erroneous "sex" based standard to compare scores. Like DXA scans, many current healthcare standards and protocols are based on a patient's sex or gender, which may cause confusion amongst healthcare personnel who have not received proper training regarding the TGNC population. In this study, 67% of T-scores and Z-scores were calculated incorrectly based on ISCD recommendations. An additional prospective research design is required to determine the consequences of incorrectly calculated DXA scans for TGNC patients. Furthermore, future research is needed to determine HRT's effects on bone mineral density in the TGNC population in the United States.
跨性别和性别不符合（TGNC）个体在获得医疗保健方面面临众多障碍，这导致了许多健康差距。TGNC 个体可能会选择性别肯定疗法，包括手术和/或激素替代疗法（HRT）来管理性别不一致。尽管 HRT 的使用不断扩大，但 TGNC 人群的骨健康和代谢的长期结果仍然相对未知。2019 年，国际临床密度测定学会（ISCD）发布了一份关于使用双能 X 射线吸收法（DXA）测量 TGNC 人群骨密度的适当用途的官方立场声明。在这项研究中，我们回顾了目前提供者在进行 DXA 扫描以计算 TGNC 个体的 T-和 Z-评分时使用的“性别”，以及这与 ISCD 发布的立场相比如何。我们使用 HERON 查询和随后的图表审查进行了回顾性分析。HERON 是一种用于整合生物学和床边的信息学软件，用于通过查询接口工具从电子病历数据中找到感兴趣的患者集，同时通过查询接口工具保护患者隐私。在 HERON 中创建了特定于项目的患者人口统计学、药物、性腺切除术和 DXA 扫描信息集，以便调查人员在平台上查看和检索特定患者的详细数据，同时通过机构审查委员会审查和检索。从图表审查中获得的定性 DXA 数据根据 ISCD 提供的内容确定为“正确”或“不正确”。从 9 名 TGNC 患者中获得了符合纳入标准的 10 次 DXA 扫描。总共审查和评分了 10 次 DXA 中的 18 个 T 评分和 Z 评分。根据 ISCD 立场，67%的 T 评分和 Z 评分计算不正确；使用错误的“性别”标准进行比较。与 DXA 扫描一样，许多当前的医疗保健标准和协议都是基于患者的性别或性别，这可能会导致没有接受过 TGNC 人群适当培训的医疗保健人员感到困惑。在这项研究中，根据 ISCD 建议，67%的 T 评分和 Z 评分计算不正确。需要进行进一步的前瞻性研究设计，以确定不正确计算的 DXA 扫描对 TGNC 患者的后果。此外，需要进一步研究以确定 HRT 对美国 TGNC 人群骨矿物质密度的影响。
