Samantha Roberge , Taylor Roberge , Sarah Corathers , Nat Nasomyont
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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.</p><p><em>Results:</em> 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, <em>p</em> = 0.965). Baseline aBMD Z-scores significantly correlated with age at the first aBMD assessment (adjusted R<sup>2</sup> 0.124, <em>p</em> = 0.02) with combined modeling including age at first aBMD assessment and BMI Z-score being most significant (adjusted R<sup>2</sup> 0.21, <em>p</em> = 0.008). Only BMI Z-scores were positively associated with the aBMD-velocity Z-scores (adjusted R<sup>2</sup> 0.255, <em>p</em> = 0.046).</p><p><em>Conclusions:</em> 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.</p></div>","PeriodicalId":50240,"journal":{"name":"Journal of Clinical Densitometry","volume":null,"pages":null},"PeriodicalIF":1.7000,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Determinants of bone mass accrual in transgender and gender diverse youth undergoing pubertal suppression therapy\",\"authors\":\"Samantha Roberge , Taylor Roberge , Sarah Corathers , Nat Nasomyont\",\"doi\":\"10.1016/j.jocd.2024.101505\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><p><em>Introduction/Background:</em> 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.</p><p><em>Methodology:</em> 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.</p><p><em>Results:</em> 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, <em>p</em> = 0.965). Baseline aBMD Z-scores significantly correlated with age at the first aBMD assessment (adjusted R<sup>2</sup> 0.124, <em>p</em> = 0.02) with combined modeling including age at first aBMD assessment and BMI Z-score being most significant (adjusted R<sup>2</sup> 0.21, <em>p</em> = 0.008). Only BMI Z-scores were positively associated with the aBMD-velocity Z-scores (adjusted R<sup>2</sup> 0.255, <em>p</em> = 0.046).</p><p><em>Conclusions:</em> 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. 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引用次数: 0
摘要
导言/背景：针对不同性别和变性（GDTG）青年的性别确认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，抑制青春期可能会影响骨骼健康。以往的研究表明，在抑制青春期发育期间，平均骨矿物质密度（aBMD）Z-score 会下降。然而，GnRHa治疗期间的骨量累积率及其决定因素尚不清楚：本研究对 2011 年 1 月 1 日至 2022 年 12 月 12 日期间在辛辛那提儿童医院医疗中心开始接受 GnRHa 单一疗法后 6 个月内进行 aBMD 评估的 GDTG 青少年进行了回顾性病历审查。对于进行了随访 aBMD 评估的个体，我们利用儿童骨矿物质密度研究（Bone Mineral Density in Childhood Study）的参考数据计算了他们的 aBMD 速度并生成了 Z 分数。我们使用多元线性回归模型评估了基线身高调整后 aBMD 和 aBMD 速度 Z 值的决定因素：36名参与者（36%出生时为女性（AFAB），首次进行aBMD评估的平均年龄为12 ± 1.1岁）的基线身高调整aBMD Z分数为-0.053 ± 0.79。在 16 名进行了后续 aBMD 评估的参与者中，平均 aBMD 速度 Z 值为 -0.42 ± 1.13（AFAB 为 -0.27 ± 0.79，而出生时被分配的男性为 -0.52 ± 1.32，p = 0.965）。基线 aBMD Z scores 与首次 aBMD 评估时的年龄显著相关（调整后 R2 0.124，p = 0.02），包括首次 aBMD 评估时的年龄和 BMI Z scores 在内的组合模型最为显著（调整后 R2 0.21，p = 0.008）。只有体重指数 Z 值与 aBMD-速度 Z 值呈正相关（调整后 R2 0.255，p = 0.046）：结论：接受 GnRHa 治疗的 GDTG 青少年的 aBMD 速度 Z 值似乎低于平均水平。较低的体重指数 Z 值是较低的基线身高调整后 aBMD 和 aBMD 速度 Z 值的决定因素。在以往研究的基础上，我们的研究强调了 aBMD 速度是监测广东青少年骨健康的一种新技术。
Determinants of bone mass accrual in transgender and gender diverse youth undergoing pubertal suppression therapy
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.
Methodology: 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.
Results: 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 R2 0.124, p = 0.02) with combined modeling including age at first aBMD assessment and BMI Z-score being most significant (adjusted R2 0.21, p = 0.008). Only BMI Z-scores were positively associated with the aBMD-velocity Z-scores (adjusted R2 0.255, p = 0.046).
Conclusions: 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.
期刊介绍：
The Journal is committed to serving ISCD''s mission - the education of heterogenous physician specialties and technologists who are involved in the clinical assessment of skeletal health. The focus of JCD is bone mass measurement, including epidemiology of bone mass, how drugs and diseases alter bone mass, new techniques and quality assurance in bone mass imaging technologies, and bone mass health/economics.
Combining high quality research and review articles with sound, practice-oriented advice, JCD meets the diverse diagnostic and management needs of radiologists, endocrinologists, nephrologists, rheumatologists, gynecologists, family physicians, internists, and technologists whose patients require diagnostic clinical densitometry for therapeutic management.
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