Background/Knowledge Gap: The size of the transgender community is increasing exponentially as it is becoming more recognized and accepted in the United States, as well as around the globe. There currently is a paucity of literature regarding the risks long-term hormone replacement therapy (HRT) presents in this population, especially in bone health. Fully understanding the risks and benefits of HRT in the transgender population is essential to determine the impact of this treatment on transgender bone health and fracture risk. The objective of this study was to characterize the prevalence, anatomical locations, and characteristics of fractures in the transgender population undergoing HRT relative to the general population at a single institution. This project also sought to better describe comorbidities experienced by the transgender population and other factors that could affect fracture risk in this population. Methods/Design: A retrospective analysis of fractures at a single institution from 01/01/2020 to 01/01/2021 was performed. The HERON system was used to collect data on all fractures in the population. Chart review was utilized to identify all transgender individuals undergoing HRT. The prevalence, anatomical location, and characteristics of the fractures in this cohort were then compared to fracture characteristics in the general population. Comorbidities of the populations and medical management with Dual-Energy X-ray Absorptiometry (DXA) scans were also recorded. Results/Findings: The prevalence, anatomical locations, and characteristics of fractures in the transgender population highly paralleled that of the general population. It was noted that transgender individuals experienced a high percentage of upper arm and shoulder fractures, and a lower percentage of lumbar vertebral fractures. The rate of depression was higher in the transgender population relative to the general population. No patients in the transgender population had been diagnosed with osteoporosis, but only one received a DXA scan.

Conclusion/Implications: Overall, it can be concluded that fracture location and characteristics do not seem to be altered in the transgender population. An emphasis needs to be placed on the importance of adequate charting for gender identity disorders and proper medical management with DXA scans in patients undergoing HRT. Additionally, future research should be focused on prospective studies to continue to elucidate fracture risk, as well as the effects of HRT on bone health in the transgender population.

References

Safer, J.D., et al., Barriers to healthcare for transgender individuals. Curr Opin Endocrinol Diabetes Obes, 2016. 23(2): p. 168-71.

Ramsey, D.C., et al., Orthopaedic Care of the Transgender Patient. J Bone Joint Surg Am, 2021. 103(3): p. 274-281.

Wiepjes, C.M., et al., Fracture Risk in Trans Women and Trans Men Using Long-Term Gender-Affirming Hormonal Treatment: A Nationwide Cohort Study. J Bone Miner Res, 2020. 35(1): p. 64-70.

Foer, D., et al., Challenges with Accuracy of Gender Fields in Identifying Transgender Patients in Electronic Health Records. J Gen Intern Med, 2020. 35(12): p. 3724-3725.

Walcott, Q., et al., DXA Scan Variants in Transgender Patients. J Clin Densitom, 2022