Resumen del estudio
Bone growth among transgender and gender-diverse adolescents slowed compared with peers during pubertal suppression, but partially recovered after starting gender-affirming hormone therapy, a systematic review and meta-analysis showed.
Across 10 longitudinal studies involving 751 adolescents, absolute bone mineral density (BMD) remained stable during gonadotropin-releasing hormone agonist (GnRHa) therapy over mean durations up to 38.4 months. However, lumbar spine BMD z-scores dropped significantly compared with sex-assigned-at-birth normative references:
- Assigned female at birth (AFAB) z-score change: -0.97 (95% CI -1.09 to -0.85)
- Assigned male at birth (AMAB) z-score change: -0.73 (95% CI -0.93 to -0.53)
Recuperación parcial
Partial z-score recovery followed gender-affirming hormone therapy during a median treatment duration of 36 months but remained numerically below baseline for AFAB (-0.51, 95% CI -0.69 to -0.34) and AMAB (-0.52, 95% CI -0.82 to -0.21), reported Daniele Tienforti, MD, of the University of L’Aquila in Italy, and colleagues.
“At follow-up, z-scores remained numerically lower than baseline but were generally not statistically different across most skeletal sites, suggesting at most a modest and uncertain shortfall in catch-up rather than a demonstrated persistent deficit,” the authors wrote in JAMA Pediatrics.
Aumento de la densidad ósea
After gender-affirming hormone therapy (GAHT), absolute BMD increased modestly in AFAB (mean difference 0.09 g/cm2) and AMAB youth (mean difference 0.13 g/cm2), “indicating ongoing bone accrual during GAHT despite residual numerical differences in z-scores,” the authors noted.
“Our results suggest that puberty suppression temporarily slows bone accrual, but this is followed by a clear recovery after gender-affirming hormone therapy is initiated,” Tienforti told MedPage Today.
Riesgos adicionales
Mechanistically, the authors explained that skeletal vulnerability during pubertal suppression “may be compounded by GnRHa-induced reductions in lean mass and increases in fat mass, impairing the muscle-bone unit, a key driver of skeletal development.” Lower baseline BMD has also been observed in some transgender and gender-diverse adolescents, particularly those AMAB, “potentially increasing vulnerability to treatment-related bone changes,” they added.
Importancia de la monitorización
Because adolescence is the primary window for acquiring lifelong bone mass, Tienforti emphasized that monitoring of bone health should be part of routine gender-affirming care throughout treatment.
“Rather than focusing on a single phase of treatment, I think it’s important to view skeletal development as a dynamic process that deserves ongoing attention throughout care,” he noted. Tienforti advised clinicians to focus on modifiable lifestyle factors — such as adequate calcium and vitamin D intake, regular weight-bearing exercise, and structured DXA surveillance — while tailoring treatment timing and duration to each patient.
Limitaciones del estudio
The team acknowledged several limitations, including relatively short follow-up periods across cohorts, lack of parallel cisgender comparator groups, inconsistent adjustment for key confounders, and sparse reporting of bone turnover markers or fracture rates.
“Since peak bone mass is reached in early adulthood, we still need longer-term studies to understand whether bone mineral density continues to recover into adulthood,” Tienforti said.
Nota de descargo de responsabilidad
La información aquà proporcionada es únicamente con fines informativos y no debe considerarse como consejo médico. Se recomienda consultar a un médico para diagnóstico y tratamiento especÃficos.
Fuente: https://www.medpagetoday.com/endocrinology/transgender-medicine/122471
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