Background: There currently is a paucity of literature regarding the risks gender-affirming hormone therapy (GAHT) presents in the transgender population. Understanding the effect of GAHT on transgender bone health and fracture risk is essential. The purpose of this study is to analyze the prevalence and locations of fractures in trans compared to cis patients while assessing the comorbidities present that may affect fracture risk. 

Methods: A retrospective analysis of fractures from 01/01/2020 to 01/01/2021 was performed with chart review being utilized to identify trans patients. The prevalence and anatomic locations of fractures in trans patients were then compared to that of cis patients. Comorbidities of both populations and assessment of bone mineral density with Dual-Energy X-ray Absorptiometry (DXA) scans in trans patients was also recorded. 

Results: The transgender population experienced more shoulder and upper arm fractures (p=0.004) and less lumbar spine fractures (p=.009). There was no difference in the anatomic distribution of other fractures. The number of fractures per individual in both cohorts was similar (p=.984). The prevalence of hypertension and depression was higher in the trans population (p<.001). Osteoporosis was lower in prevalence in the transgender population (p<.001). 

Conclusion: Fracture prevalence and anatomical location do not seem to be significantly different between the trans and cisgender populations. However, longitudinal prospective studies are needed to better understand the impact of GAHT on fracture risk among transgender patients. An emphasis on adequate charting for gender identity disorders and DXA scans is important for medical management in patients receiving GAHT.

A retrospective analysis of fractures in the transgender population 

 Orthopaedic Surgery

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A retrospective analysis of fractures in the transgender population

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