Slide 1

A longitudinal study of bone density in reassigned transsexuals R. A. Jones 1, C. G. Schultz 2, B. E. Chatterton 2 1. The Adelaide Private Menopause Clinic, North Adelaide, SA, Australia 2. Nuclear Medicine, PET & Bone Densitometry, Royal Adelaide Hospital, ADELAIDE, SA, Australia Slide 2 Introduction Sex hormones required for attainment of maximal bone density during growth and development maintenance during adult life Hormone withdrawal likely to result in osteoporosis if BMD is low Hypothesis: Hormonally reassigned individuals at increased risk of bone loss during & after treatment Potential for rapid bone loss on removal of phenotypic hormones Hormonally reassigned patients routinely given hormone replacement to: effect the reassignment maintain bone density ? Slide 3 Aim Examine bone density and hormone data prospectively collected in subjects presenting for hormone reassignment Male to female subjects only in this study Subjects sorted into baseline scans of lumbar spine & femur those with serial bone density of lumbar spine and femur Slide 4 Methods - subjects Records of subjects undergoing gender reassignment investigated with DXA scans over a 15 year period Treated with anti-androgen (Cyproterone at doses 50mg to 100mg/day) synthetic oestrogen suitable for HRT after oophorectomy (Premarin at doses from 1.25 to 3.75mg/day+/- oestrogen implant 50 mgm per 5-6/12- ie supra-physiological) Not all subjects underwent surgical reassignment including orchidectomy Slide 5 Methods data collection Data available for analysis in 68 subjects with DXA at least one lumbar spine & femur scans the baseline group Subset of 21 of 68 had serial spine and femur scans spanning up to 10 years Determined mean & standard deviation of age, height, weight, T and Z score Serial DXA group further analysed at each DXA time point using: DXA data GE-Lunar DPX, Expert and Encore scanners Lunar Australian normal ranges used applying normal range of final gender for comparison treatment and sex hormone levels Slide 6 Methods - Analysis Serial group data normalised to baseline values: DXA normalised to baseline scan results expressed as % baseline value baseline scan corresponded closely to commencement of treatment Oestrogen and testosterone levels normalised to mean of upper & lower limits of normal range serial time interval results expressed as % of mean value Data grouped into baseline and 2.5 year wide time intervals (up to 10 years) Statistical tests at each time interval Mean, standard deviation and standard error determined Compared to baseline for each variable with students t-test Slide 7 Baseline results (all subjects) MaleFemale 0.14 1.61 -0.08 1.58 -0.002 1.003 -0.45 1.07 0.49 1.68Z score 0.23 1.58T score Spine 0.54 1.17Z score 0.21 1.17T score Femur 73.5 12.8 (popn 83.7) Weight (kg) 176 8.04 (popn 174.8) Height (cm) 41.3 (18-67.5)Age Average SD Slide 8 Baseline only results Average SD Age41.3 (18-67.5) Height (cm)176 8.04 (popn 174.8) Weight (kg)73.5 12.8 (popn 83.7) Femur T score0.21 1.17 Z score0.54 1.17 Spine T score0.23 1.58 Z score0.49 1.68 Slide 9 Serial group results Average SD Age43.2 (22.9-63.6) Height (cm)174.2 7.2 (popn 174.8) Weight (kg)77.8 11.8 (popn 83.7) Femur T score-0.06 1.27 Z score0.3 1.19 Spine T score-0.45 1.68 Z score-0.18 1.66 Slide 10 MaleFemale -0.65 1.69 -0.96 1.54 -0.34 1.06 -0.74 1.17 -0.18 1.66Z score -0.45 1.68T score Spine 0.3 1.19Z score -0.06 1.27T score Femur 77.8 11.8 (popn 83.7) Weight (kg) 174.2 7.2 (popn 174.8) Height (cm) 43.2 (22.9-63.6)Age Average SD Baseline results (serial group only) Slide 11 Slide 12 Results The serial group not significantly different from baseline only group at the p