Division of Endocrinology, Cincinnati Children's Hospital Medical Center and Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
Department of Science and Health, University of Cincinnati Clermont College, Batavia, OH, USA.
J Clin Densitom. 2024 Jul-Sep;27(3):101505. doi: 10.1016/j.jocd.2024.101505. Epub 2024 Jun 13.
INTRODUCTION/BACKGROUND: Gender-affirming care for gender diverse and transgender (GDTG) youth includes puberty suppression with gonadotropin-releasing hormone agonists (GnRHa). Puberty is a critical period of bone mass accrual, and pubertal suppression may impact bone health. Previous studies have shown a decrease in areal bone mineral density (aBMD) Z-score while on puberty suppression. However, the rate of bone mass accrual and its determinants during GnRHa therapy are not known.
This is a retrospective chart review of GDTG youth with aBMD assessment within six months of starting GnRHa monotherapy at Cincinnati Children's Hospital Medical Center between 01/2011 and 12/2022. In individuals with follow-up aBMD assessment, we calculated their aBMD velocity and generated Z-scores using reference data from the Bone Mineral Density in Childhood Study. The determinants of baseline height-adjusted aBMD and aBMD velocity Z-scores were assessed with multiple linear regression models.
Thirty-six participants (36% assigned female at birth (AFAB), mean age at first aBMD assessment 12 ± 1.1 years) had baseline height-adjusted aBMD Z-score of -0.053 ± 0.79. Among 16 participants with follow-up aBMD assessment, the mean aBMD velocity Z-score was -0.42 ± 1.13 (-0.27 ± 0.79 in AFAB vs -0.52 ± 1.32 in assigned male at birth, p = 0.965). Baseline aBMD Z-scores significantly correlated with age at the first aBMD assessment (adjusted R 0.124, p = 0.02) with combined modeling including age at first aBMD assessment and BMI Z-score being most significant (adjusted R 0.21, p = 0.008). Only BMI Z-scores were positively associated with the aBMD-velocity Z-scores (adjusted R 0.255, p = 0.046).
GDTG youth undergoing GnRHa therapy appeared to have below-average aBMD velocity Z-scores. A lower BMI Z-score was a determinant of lower baseline height-adjusted aBMD and aBMD velocity Z-scores. Building on previous studies, our study highlights aBMD velocity as a novel technique for bone health surveillance in GDTG youth.
简介/背景：为性别多样化和跨性别（GDTG）青年提供的性别肯定护理包括使用促性腺激素释放激素激动剂（GnRHa）抑制青春期。青春期是骨量积累的关键时期，青春期抑制可能会影响骨骼健康。先前的研究表明，在接受青春期抑制治疗期间，骨矿物质密度（aBMD）Z 分数会下降。然而，GnRHa 治疗期间骨量积累的速度及其决定因素尚不清楚。
这是一项回顾性图表研究，对 2011 年 1 月至 2022 年 12 月期间在辛辛那提儿童医院医疗中心接受 GnRHa 单药治疗后六个月内进行 aBMD 评估的 GDTG 青年进行了研究。在有随访 aBMD 评估的个体中，我们使用来自儿童期骨密度研究的参考数据计算了他们的 aBMD 速度，并生成了 Z 分数。使用多元线性回归模型评估了基线身高校正的 aBMD 和 aBMD 速度 Z 分数的决定因素。
36 名参与者（36%为出生时被指定为女性（AFAB），首次进行 aBMD 评估的平均年龄为 12±1.1 岁）的基线身高校正的 aBMD Z 分数为-0.053±0.79。在 16 名接受随访 aBMD 评估的参与者中，平均 aBMD 速度 Z 分数为-0.42±1.13（AFAB 为-0.27±0.79，出生时被指定为男性为-0.52±1.32，p=0.965）。基线 aBMD Z 分数与首次 aBMD 评估的年龄显著相关（调整后的 R 0.124，p=0.02），包括首次 aBMD 评估年龄和 BMI Z 分数的综合建模最为显著（调整后的 R 0.21，p=0.008）。只有 BMI Z 分数与 aBMD-速度 Z 分数呈正相关（调整后的 R 0.255，p=0.046）。
接受 GnRHa 治疗的 GDTG 青年的 aBMD 速度似乎较低。较低的 BMI Z 分数是基线身高校正的 aBMD 和 aBMD 速度 Z 分数较低的决定因素。在先前研究的基础上，我们的研究强调了 aBMD 速度作为 GDTG 青年骨骼健康监测的一种新方法。
