Jacobson Alicia R, Whitney Daniel G, Mamdouhi Tania, Janney Carol A, Blaszczak Julie, Ahn Jaimo
From the University of Michigan Medical School, Ann Arbor, MI (Jacobson), the Department of Physical Medicine and Rehabilitation (Whitney), Department of Orthopedic Surgery (Mamdouhi and Ahn), Consulting for Statistics, Computing and Analytics Research (Janney), and Department of Family Medicine (Blaszczak), University of Michigan, Ann Arbor, MI, and the Department of Orthopaedics, Emory University and Grady Health, Atlanta, GA (Ahn).
J Am Acad Orthop Surg. 2024 Dec 24. doi: 10.5435/JAAOS-D-24-00353.
Gender-affirming hormone therapy (GAHT) is a cornerstone of gender-affirming care for transgender and gender diverse (TGD) patients, with a direct biological role on bone metabolism. However, a paucity of data describes how GAHT influences fracture rate over time. The study's primary objective was to describe the 5-year all-cause fracture incidence rate (IR) among TGD patients initiating estrogen-based GAHT (E-GAHT) or testosterone-based GAHT (T-GAHT), compared with TGD patients not using GAHT (non-GAHT).
This retrospective cohort study of TGD adults aged 18 to 65 years used insurance data from the Merative MarketScan Commercial Database (MarketScan) from January 1, 2009, to December 31, 2019. The main outcome was IR (IR with 95% confidence intervals [CIs]) of all-cause fracture after up to 5 years of follow-up. The IR ratio was estimated by comparing E-GAHT and T-GAHT groups with the non-GAHT group. Cox proportional hazards regression models estimated the hazard ratio (HR) of fracture after adjusting for age, comorbidity status using Charlson Comorbidity Index (CCI), recent fractures, and study start year.
Nine thousand six hundred ninety-six TGD adults (E-GAHT [n = 1,131]; T-GAHT [n = 1,046]; non-GAHT [n = 7,519]) were identified using clinical and enrollment criteria. No differences in age (mean age [SD], 33.4 [13.2] years, 30.8 [11.7] years, and 33.2 [13.6] years, respectively) and CCI (percent with CCI = 0 [%CCI = 3+]; 86.7% [2.2%], 84.9% [1.4%], and 85.3% [1.9%]) were observed by group. The fracture IR was 13.9 (95% CI, 9.1 to 18.8) for E-GAHT, 15.3 (95% CI, 10.1 to 20.4) for T-GAHT, and 19.2 (95% CI, 16.9 to 21.4) for non-GAHT. Compared with non-GAHT, the crude IR ratio and fully adjusted HR was 0.73 (95% CI, 0.51 to 1.04) and 0.71 (95% CI, 0.49 to 1.02), respectively, for E-GAHT and 0.80 (95% CI, 0.56 to 1.14) and 0.78 (95% CI, 0.55 to 1.12), respectively, for T-GAHT.
Based on United States commercial claims data, the use of GAHT was not associated with 5-year all-cause fracture IR.
III.
性别肯定激素疗法（GAHT）是跨性别和性别多样化（TGD）患者性别肯定治疗的基石，对骨代谢具有直接的生物学作用。然而，关于GAHT如何随时间影响骨折发生率的数据很少。该研究的主要目的是描述开始接受基于雌激素的GAHT（E-GAHT）或基于睾酮的GAHT（T-GAHT）的TGD患者与未使用GAHT（非GAHT）的TGD患者相比，5年全因骨折发病率（IR）。
这项针对18至65岁TGD成年人的回顾性队列研究使用了2009年1月1日至2019年12月31日来自默克多市场扫描商业数据库（MarketScan）的保险数据。主要结局是随访长达5年后全因骨折的IR（带有95%置信区间[CI]的IR）。通过将E-GAHT组和T-GAHT组与非GAHT组进行比较来估计IR比率。Cox比例风险回归模型在调整年龄、使用查尔森合并症指数（CCI）评估的合并症状态、近期骨折和研究起始年份后估计骨折的风险比（HR）。
根据临床和纳入标准确定了9696名TGD成年人（E-GAHT组[n = 1131]；T-GAHT组[n = 1046]；非GAHT组[n = 7519]）。各组之间在年龄（平均年龄[标准差]，分别为33.4[13.2]岁、30.8[11.7]岁和33.2[13.6]岁）和CCI（CCI = 0的百分比[CCI = 3+]；分别为86.7%[2.2%]、84.9%[1.4%]和85.3%[1.9%]）方面未观察到差异。E-GAHT组的骨折IR为13.9（95%CI，9.1至18.8），T-GAHT组为15.3（95%CI，10.1至20.4），非GAHT组为19.2（95%CI，16.9至21.4）。与非GAHT相比，E-GAHT的粗IR比率和完全调整后的HR分别为0.73（95%CI，0.51至1.04）和0.71（95%CI，0.49至1.02），T-GAHT分别为0.80（95%CI，0.56至1.14）和0.78（95%CI，0.55至1.12）。
基于美国商业索赔数据，GAHT的使用与5年全因骨折IR无关。
III级。
