Impact of reference gender on bone mineral density and fracture risk assessment in transgender adults
Authors' conclusion
The choice of reference gender significantly influences densitometric interpretation in young transgender adults. Until further evidence becomes available, calculating Z-scores using both male and female reference databases is advisable. Early preventive interventions remain essential to preserve bone health.
Study context
- Population
- Transgender adults aged 18–43 years before gender-affirming hormone therapy (GAHT), Hospitals of Padua and Brescia (Italy)
- Participants
- 249 adults
- Exposure
- Male vs female reference databases for Z-scores and FRAX
- AFABn = 153
- Assigned male at birth (AMAB)n = 96
- Outcome
- Impact of the gender reference database (male or female) on BMD and fracture risk assessment
Methodological detailstwo-centre
- Two-centre
Main finding
As reported in the abstract
Z-score difference between reference databases
Mean ΔZ across skeletal sites
0.4-0.6 SD
Low bone mineral density (BMD) for age in AMAB, male references
27.1%
Observational data: associations, not effects.
Further findings
- BMI and 25(OH)D independent predictors of BMD and Z-scores in AMAB
Original publication
Impact of reference gender on bone mineral density and fracture risk assessment in transgender adults. Osteoporos Int. Published 30 April 2026. doi:10.
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