{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T21:25:36Z","timestamp":1783113936920,"version":"3.54.6"},"reference-count":22,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2024,2,1]],"date-time":"2024-02-01T00:00:00Z","timestamp":1706745600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2024,2,1]],"date-time":"2024-02-01T00:00:00Z","timestamp":1706745600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Case Reports"],"published-print":{"date-parts":[[2024,2]]},"abstract":"<jats:title>Key Clinical Message<\/jats:title>\n                  <jats:p>\n                    For diagnosis of osteoporosis, a\n                    <jats:italic>T<\/jats:italic>\n                    \u2010score of \u2264\u22122.5 is recommended for all transgender and gender\u2010diverse patients aged 50\u2009years or older, regardless of hormonal status. This case series presents 3 transgender individuals younger than 50\u2009years undergoing gender\u2010affirming hormone therapy (GAHT) who had DXA scores suggestive of osteoporosis. We highlight possible discrepancies in DXA scan interpretations, especially in forearm bone mineral density measurements. We present the baseline (prior to beginning GAHT), 6\u2010month, and 1\u2010year follow\u2010up DXA data along with pertinent labs to include 25\u2010OH vitamin D, calcium, and alkaline phosphatase, for 2 transgender males (assigned female at birth) and 1 transgender female (assigned male at birth) undergoing GAHT who had low\n                    <jats:italic>Z<\/jats:italic>\n                    \u2010scores and\n                    <jats:italic>T<\/jats:italic>\n                    \u2010scores suggestive of osteoporosis. Multiple studies have analyzed the BMD data of individuals taking GAHT over time, which identify possible causes for low baseline\n                    <jats:italic>Z<\/jats:italic>\n                    \u2010scores for transgender females, but less so for transgender males. Other than positional statements, guidelines remain unclear regarding diagnostic approaches to osteoporosis and low\n                    <jats:italic>Z<\/jats:italic>\n                    \u2010scores in transgender individuals who are premenopausal or under 50\u2009years of age. This case series addresses discrepancies in interpretation that may be encountered by clinicians with baseline and follow\u2010up DXAs, especially involving the forearm, during the course of GAHT. This highlights the importance of establishing clearer guidelines for the diagnosis and treatment of osteoporosis and low BMD for chronological age in the transgender population.\n                  <\/jats:p>","DOI":"10.1002\/ccr3.8451","type":"journal-article","created":{"date-parts":[[2024,2,1]],"date-time":"2024-02-01T22:45:52Z","timestamp":1706827552000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Three cases highlighting possible discrepancies in the interpretation of transgender\n                    <scp>DXA<\/scp>\n                    scores"],"prefix":"10.1002","volume":"12","author":[{"given":"Sebastian C.","family":"De\u00a0La\u00a0Torre","sequence":"first","affiliation":[{"name":"Division of Endocrinology, Department of Medicine Walter Reed National Military Medical Center  Bethesda Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cassandra M.","family":"Godar","sequence":"additional","affiliation":[{"name":"Division of Endocrinology, Department of Medicine Walter Reed National Military Medical Center  Bethesda Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5614-6402","authenticated-orcid":false,"given":"Mohamed K. 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