Osteoporosis and Bone Health in Transgender Persons

Endocrinol Metab Clin North Am. 2019 Jun;48(2):421-427. doi: 10.1016/j.ecl.2019.02.006. Epub 2019 Mar 23.


This review summarizes current studies, systematic reviews, and clinical practice guidelines regarding the screening, diagnosis, and treatment of osteoporosis in transgender persons. Gender-affirming hormone therapy has been shown to maintain or promote acquisition of bone density as measured by dual-energy x-ray absorptiometry. No differences in fracture rates have been seen in trans women or men in short, prospective trials. Trans children and adolescents on gonadotropin-releasing hormone may be at risk for decreasing bone density while not on sex steroid hormone replacement. Screening for osteoporosis should be based on clinical factors. Treatment for osteoporosis follows the same guidelines as cisgender populations.

Keywords: Bone density; Dual-energy x-ray absorptiometry; Gender affirmation; Hormone therapy; Osteoporosis; Transgender.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Bone Density*
  • Hormone Replacement Therapy*
  • Humans
  • Osteoporosis* / diagnostic imaging
  • Osteoporosis* / drug therapy
  • Sex Reassignment Procedures*
  • Transgender Persons*
  • Transsexualism*