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内分泌学会のレビュー：ホルモン使用中の骨密度の短期的変化は小さいが、骨折のデータはほとんどない

トランスジェンダーの人々の骨の健康に対する性ステロイドの影響：系統的レビューとメタ解析

系統的レビューとエビデンスレビュー性別適合ホルモン療法
Authors
Naykky Singh-Ospina, Spyridoula Maraka, Rene Rodriguez-Gutierrez, Caroline Davidge-Pitts, Todd B. Nippoldt, Larry J. Prokop, Mohammad Hassan Murad
Journal
The Journal of Clinical Endocrinology & Metabolism
Year
2017
Source
https://doi.org/10.1210/jc.2017-01642

Summary

This review was one of the evidence reviews behind the Endocrine Society's 2017 guideline on treating gender dysphoria (distress about one's sex). The Mayo Clinic team combined 13 studies (639 people, mostly adults) that measured bone density before and after cross-sex hormones. Testosterone in females made no measurable difference to spine or hip bone density over one to two years. Estrogen in males slightly raised spine bone density. Only one study looked at broken bones (none in a year), and only one looked at teenagers given puberty blockers (drugs that pause puberty) and then hormones. That study found males had lower spine bone density at age 22 than before treatment. The authors said the effect on the risk of broken bones is uncertain. The review is reassuring about short-term bone density in adults, but cannot show long-term safety, fracture risk, or safety for teenagers.

Key findings

  • このレビューは、639人（男性として生まれた392人、女性として生まれた247人）を対象とした13件の研究を統合しました。
  • テストステロンを使う女性では、腰椎と股関節の骨密度は、1年後も2年後も測定可能な変化はありませんでした。
  • エストロゲンを使う男性では、腰椎の骨密度は、1年後にわずかに、2年後にもう少し上がりました。
  • 骨折を調べたのは、男性53人と女性53人の1件の研究だけで、12か月間で骨折は見つかりませんでした。
  • 思春期ブロッカーに続いてホルモンを受けた10代を対象としたのは1件の研究だけで、男性では22歳での脊椎の骨密度が治療前より低かったことが分かりました。
  • 著者らは、エビデンスの大半は、誤解を招くリスクが中程度の研究に由来し、骨折リスクへの影響は不確かだと述べました。
  • このレビューは、内分泌学会の2017年のガイドラインを支えるために、その専門家と作った計画を用いて、同学会のために行われました。

Abstract

BACKGROUND: The impact of sex steroids on bone health in transgender individuals is unclear.

METHODS: A comprehensive search of several databases to 7 April 2015 was conducted for studies evaluating bone health in transgender individuals receiving sex steroids. Pairs of reviewers selected and appraised studies. A random effects model was used to pool weighted mean differences and 95% confidence intervals (CIs).

RESULTS: Thirteen studies evaluating 639 transgender individuals were identified [392 male-to-female (MTF), 247 female-to-male (FTM)]. In FTM individuals and compared with baseline values before initiation of masculinizing hormone therapy, there was no statistically significant difference in the lumbar spine, femoral neck, or total hip bone mineral density (BMD) when assessed at 12 and 24 months. In MTF individuals and compared with baseline values before initiation of feminizing hormone therapy, there was a statistically significant increase in lumbar spine BMD at 12 months (0.04 g/cm2; 95% CI, 0.03 to 0.06 g/cm2) and 24 months (0.06 g/cm2; 95% CI, 0.04 to 0.08 g/cm2). Fracture rates were evaluated in a single cohort of 53 MTF and 53 FTM individuals, with no events at 12 months. The body of evidence is derived mostly from observational studies at moderate risk of bias.

CONCLUSION: In FTM individuals, masculinizing hormone therapy was not associated with significant changes in BMD, whereas in MTF individuals feminizing hormone therapy was associated with an increase in BMD at the lumbar spine. The impact of these BMD changes on patient-important outcomes such as fracture risk is uncertain.

Conclusion

In FTM individuals, masculinizing hormone therapy was not associated with significant changes in BMD, whereas in MTF individuals feminizing hormone therapy was associated with an increase in BMD at the lumbar spine. The impact of these BMD changes on patient-important outcomes such as fracture risk is uncertain.