Evidence map›Paper›PMID 25377496›Full record

Observational studyOsteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA2015

Preservation of volumetric bone density and geometry in trans women during cross-sex hormonal therapy: a prospective observational study.

E Van Caenegem, K Wierckx, Y Taes, T Schreiner, S Vandewalle, K Toye, J-M Kaufman, G T'Sjoen

Abstract readObservational Study
PubMed Publisher
In one paragraph

Observational study in Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 45 papers, 3 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
45citing papers in PubMed, 3 pooled it
4.4field-weighted citation impact, top 6% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

45 citing papers in PubMed, 3 syntheses or guidelines pooled it, 117 citations in OpenAlex.

  1. Pooled it
  2. Pooled it
  3. Pooled it
  4. Gender-Affirming Hormone Treatment Decreases Bone Turnover in Transwomen and Older Transmen.Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research · 2019
    Trial
  5. Review
  6. Review
  7. Observational
  8. Observational
  9. Considerations in Care of the Transgender Orthopedic Patient.Current reviews in musculoskeletal medicine · 2025
    Review
  10. Article
  11. Article
  12. Review
  13. Article
  14. Article
  15. Article
  16. Article
  17. Article
  18. Article
  19. The Impact of Gender-Affirming Hormone Therapy on Physical Performance.The Journal of clinical endocrinology and metabolism · 2024
    Review
  20. Review
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

8 authors at 2 institutions in 2 countries.

E Van CaenegemDepartment of Endocrinology, Ghent University Hospital, De Pintelaan 185, 9000, Ghent, Belgium, eva.vancaenegem@ugent.be.
K Wierckx
Y Taes
T Schreiner
S Vandewalle
K Toye
J-M Kaufman
G T'Sjoen
Ghent University Hospital · BEOslo University Hospital · NO

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

unlabelledAlthough trans women before the start of hormonal therapy have a less bone and muscle mass compared with control men, their bone mass and geometry are preserved during the first 2 years of hormonal therapy, despite of substantial muscle loss, illustrating the major role of estrogen in the male skeleton. PURPOSE: The aim of this study is to examine the evolution of areal and volumetric bone density, geometry, and turnover in trans women undergoing sex steroid changes, during the first 2 years of hormonal therapy.

methodsIn a prospective observational study, we examined 49 trans women (male-to-female) before and after 1 and 2 years of cross-sex hormonal therapy (CSH) in comparison with 49 age-matched control men measuring grip strength (hand dynamometer), areal bone mineral density (aBMD), and total body fat and lean mass using dual X-ray absorptiometry (DXA), bone geometry and volumetric bone mineral density, regional fat, and muscle area at the forearm and calf using peripheral quantitative computed tomography. Standardized treatment regimens were used with oral estradiol valerate, 4 mg daily (or transdermal 17-β estradiol 100 μg/24 h for patients >45 years old), both combined with oral cyproterone acetate 50 mg daily.

resultsPrior to CSH, trans women had lower aBMD at all measured sites (all p < 0.001), smaller cortical bone size (all p < 0.05), and lower muscle mass and strength and lean body mass (all p < 0.05) compared with control men. During CSH, muscle mass and strength decreased and all measures of fat mass increased (all p < 0.001). The aBMD increased at the femoral neck, radius, lumbar spine, and total body; cortical and trabecular bone remained stable and bone turnover markers decreased (all p < 0.05).

conclusionsAlthough trans women, before CSH, have a lower aBMD and cortical bone size compared with control men, their skeletal status is well preserved during CSH treatment, despite of substantial muscle loss.

Indexed as

Absorptiometry, PhotonAdultBody CompositionBone DensityBone RemodelingCase-Control StudiesEstradiolFemaleGender-Affirming ProceduresHumansInsulin-Like Growth Factor ILeptinMaleMiddle AgedMotor ActivityMuscle, Skeletal25-hydroxyvitamin DEstradiolInsulin-Like Growth Factor ILeptinVitamin D

Identifiers

PMID25377496
OpenAlexW2064274788

What OpenQuestion holds

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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.