{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T21:46:17Z","timestamp":1789076777228,"version":"build-2803163510"},"reference-count":24,"publisher":"Oxford University Press (OUP)","issue":"1111","license":[{"start":{"date-parts":[[2020,4,29]],"date-time":"2020-04-29T00:00:00Z","timestamp":1588118400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,7,1]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives:<\/jats:title>\n                    <jats:p>Transgender individuals submitted to hormone or surgical treatment may have alterations in their bone metabolism as these elements are important players in bone remodeling. We aimed to study bone mineral density (BMD) and body composition in transwomen undergoing cross-sex hormonal treatment (CSHT) from Brazil for over 3 years, comparing them with female and male controls.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>93 individuals (31 transwomen, 31 females and 31 males paired for age and body mass index) were studied for bone mass, and body composition by densitometry (by DXA). Epidemiological and clinical data were collected through direct questioning.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Low bone mass (T score \u22642) was found in 12.9% of transwomen; in 3.2% of females and 3.3% of males. Transwomen individuals had lower spine Z score (0.26 \u00b1 1.42 vs 0.50 \u00b1 1.19) and femur Z score (\u22120.41 \u00b1 0.95 vs 0.29 \u00b1 1.04) than females. They had lower total femur Z score than males (\u22120.41 \u00b1 0.95 vs 0.20 \u00b1 0.83). Lean mass values correlated positively with total femur BMD (\u03c1 = 0.40; 95% confidence interval = 0.009\u20130.68; p = 0.04) and BMD in femoral neck (\u03c1 = 0.48; 95% confidence interval = 0.11\u20130.74; p = 0.01) but neither the type of therapy received nor the time that they were used, impacted bone mass.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Low BMD is found frequently in transwomen and it is correlated with lean body mass.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Advances in knowledge:<\/jats:title>\n                    <jats:p>There are few studies of the effects of hormone therapy on the bones and muscles of transwomen. This study demonstrated that significant changes occur, and that the population studied needs greater care in musculoskeletal health.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1259\/bjr.20190935","type":"journal-article","created":{"date-parts":[[2020,4,17]],"date-time":"2020-04-17T13:33:46Z","timestamp":1587130426000},"source":"Crossref","is-referenced-by-count":18,"title":["Transwomen and bone mineral density: a cross-sectional study in Brazilian population"],"prefix":"10.1093","volume":"93","author":[{"given":"Kadija Rahal","family":"Chrisostomo","sequence":"first","affiliation":[{"name":"Internal Medicine Post Graduate, Clinical Hospital, Federal University of Paran\u00e1 , Curitiba , Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thelma L.","family":"Skare","sequence":"additional","affiliation":[{"name":"Internal Medicine Post Graduate, Clinical Hospital, Federal University of Paran\u00e1 , Curitiba , Brazil"},{"name":"Department of Medicine, Evangelical Mackenzie University , Curitiba, Paran\u00e1 , Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Henrique Rahal","family":"Chrisostomo","sequence":"additional","affiliation":[{"name":"Department of Medicine, Evangelical Mackenzie University , Curitiba, Paran\u00e1 , Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edna J. Litenski","family":"Barbosa","sequence":"additional","affiliation":[{"name":"Department of Medicine, Positivo University , Curitiba, Paran\u00e1 , Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Renato","family":"Nisihara","sequence":"additional","affiliation":[{"name":"Internal Medicine Post Graduate, Clinical Hospital, Federal University of Paran\u00e1 , Curitiba , Brazil"},{"name":"Department of Medicine, Evangelical Mackenzie University , Curitiba, Paran\u00e1 , Brazil"},{"name":"Transgender research and care center, State of Paran\u00e1 , Curitiba , Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2020,4,29]]},"reference":[{"key":"2024050215295083000_b1","doi-asserted-by":"crossref","first-page":"421","DOI":"10.1016\/j.ecl.2019.02.006","article-title":"Osteoporosis and bone health in transgender persons","volume":"48","author":"Stevenson","year":"2019","journal-title":"Endocrinol Metab Clin North Am"},{"key":"2024050215295083000_b2","doi-asserted-by":"crossref","first-page":"92","DOI":"10.1016\/j.bone.2013.01.039","article-title":"Low bone mass is prevalent in male-to-female transsexual persons before the start of cross-sex hormonal therapy and gonadectomy","volume":"54","author":"Van Caenegem","year":"2013","journal-title":"Bone"},{"key":"2024050215295083000_b3","doi-asserted-by":"crossref","first-page":"1016","DOI":"10.1016\/j.bone.2008.09.001","article-title":"Body composition, volumetric and areal bone parameters in male-to-female transsexual persons","volume":"43","author":"Lapauw","year":"2008","journal-title":"Bone"},{"key":"2024050215295083000_b4","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1055\/s-0030-1255074","article-title":"Body composition and bone mineral density in male-to-female transsexuals during cross-sex hormone therapy using gonadotrophin-releasing hormone agonist","volume":"119","author":"Mueller","year":"2011","journal-title":"Exp Clin Endocrinol Diabetes"},{"key":"2024050215295083000_b5","doi-asserted-by":"crossref","first-page":"306","DOI":"10.1016\/j.jocd.2008.11.002","article-title":"Prevalence of low bone mass in relation to estrogen treatment and body composition in male-to-female transsexual persons","volume":"12","author":"T'Sjoen","year":"2009","journal-title":"J Clin Densitom"},{"key":"2024050215295083000_b6","doi-asserted-by":"crossref","first-page":"811","DOI":"10.1046\/j.1365-2265.1998.00614.x","article-title":"The effects of oestrogen exposure on bone mass in male to female transsexuals","volume":"49","author":"Reutrakul","year":"1998","journal-title":"Clin Endocrinol"},{"key":"2024050215295083000_b7","doi-asserted-by":"crossref","first-page":"791","DOI":"10.1007\/s00198-004-1754-7","article-title":"Cortical and trabecular bone mineral density in transsexuals after long-term cross-sex hormonal treatment: a cross-sectional study","volume":"16","author":"Ruetsche","year":"2005","journal-title":"Osteoporos Int"},{"key":"2024050215295083000_b8","doi-asserted-by":"crossref","first-page":"920","DOI":"10.1002\/jbmr.2407","article-title":"Bone density, microstructure and strength in obese and normal weight men and women in younger and older adulthood","volume":"30","author":"Evans","year":"2015","journal-title":"J Bone Miner Res"},{"key":"2024050215295083000_b9","doi-asserted-by":"crossref","first-page":"749","DOI":"10.1002\/jbmr.2747","article-title":"A high amount of local adipose tissue is associated with high cortical porosity and low bone material strength in older women","volume":"31","author":"Sundh","year":"2016","journal-title":"J Bone Miner Res"},{"key":"2024050215295083000_b10","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1007\/s00223-016-0196-5","article-title":"Delineating the relationship between leptin, fat mass, and bone mineral density: a mediation analysis","volume":"100","author":"Ho-Pham","year":"2017","journal-title":"Calcif Tissue Int"},{"key":"2024050215295083000_b11","doi-asserted-by":"crossref","first-page":"546","DOI":"10.1016\/S8756-3282(03)00062-0","article-title":"Peak spine and femoral neck bone mass in young women","volume":"32","author":"Lin","year":"2003","journal-title":"Bone"},{"key":"2024050215295083000_b12","first-page":"1999","article-title":"National health and nutrition examination survey: Analytic guidelines, 1999-2010","author":"Johnson","year":"2013","journal-title":"Vital Health Stat 2"},{"key":"2024050215295083000_b13","first-page":"1","article-title":"Who scientific group on the assessment of osteoporosis at primary health","author":"World Health Organization","year":"2007","journal-title":"World Health"},{"key":"2024050215295083000_b14","doi-asserted-by":"crossref","first-page":"547","DOI":"10.1093\/gerona\/glu010","article-title":"The FNIH sarcopenia project: rationale, study description, conference recommendations, and final estimates","volume":"69","author":"Studenski","year":"2014","journal-title":"J Gerontol A Biol Sci Med Sci"},{"key":"2024050215295083000_b15","doi-asserted-by":"crossref","first-page":"755","DOI":"10.1093\/oxfordjournals.aje.a009520","article-title":"Epidemiology of sarcopenia among the elderly in New Mexico","volume":"147","author":"Baumgartner","year":"1998","journal-title":"Am J Epidemiol"},{"key":"2024050215295083000_b16","doi-asserted-by":"crossref","first-page":"953","DOI":"10.1093\/ajcn\/52.6.953","article-title":"Height-normalized indices of the body's fat-free mass and fat mass: potentially useful indicators of nutritional status","volume":"52","author":"VanItallie","year":"1990","journal-title":"Am J Clin Nutr"},{"key":"2024050215295083000_b17","doi-asserted-by":"crossref","first-page":"856","DOI":"10.1111\/cen.13607","article-title":"Impact of cross-sex hormone therapy on bone mineral density and body composition in transwomen","volume":"88","author":"Fighera","year":"2018","journal-title":"Clin Endocrinol"},{"key":"2024050215295083000_b18","doi-asserted-by":"crossref","DOI":"10.1101\/cshperspect.a031211","article-title":"Regulation of bone metabolism by sex steroids","volume":"8","author":"Khosla","year":"2018","journal-title":"Cold Spring Harb Perspect Med"},{"issue":"2 Supp 1","key":"2024050215295083000_b19","first-page":"84","article-title":"Practical guide to bone health in the spectrum of advanced prostate cancer","volume":"21","author":"Butoescu","year":"2014","journal-title":"Can J Urol"},{"key":"2024050215295083000_b20","doi-asserted-by":"crossref","first-page":"2147","DOI":"10.1210\/jc.2017-02316","article-title":"Proandrogenic and antiandrogenic progestins in transgender youth: differential effects on body composition and bone metabolism","volume":"103","author":"Tack","year":"2018","journal-title":"J Clin Endocrinol Metab"},{"key":"2024050215295083000_b21","doi-asserted-by":"crossref","first-page":"394","DOI":"10.1097\/BOR.0000000000000406","article-title":"Body composition assessment in the prediction of osteoporotic fractures","volume":"29","author":"Hars","year":"2017","journal-title":"Curr Opin Rheumatol"},{"key":"2024050215295083000_b22","doi-asserted-by":"crossref","first-page":"943","DOI":"10.1210\/js.2018-00413","article-title":"Bone mass effects of Cross-Sex hormone therapy in transgender people: updated systematic review and meta-analysis","volume":"3","author":"Fighera","year":"2019","journal-title":"J Endocr Soc"},{"key":"2024050215295083000_b23","first-page":"5","article-title":"QUESTION\u00c1RIO Internacional de ATIVIDADE F\u00cdSICA (IPAQ): ESTUDO de VALIDADE E REPRODUTIBILIDADE no BRASIL","volume":"6","author":"Matsudo","year":"2012","journal-title":"Rev Bras Atividade F\u00edsica Sa\u00fade"},{"key":"2024050215295083000_b24","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1089\/trgh.2015.0008","article-title":"A systematic review of the effects of hormone therapy on psychological functioning and quality of life in transgender individuals","volume":"1","author":"White Hughto","year":"2016","journal-title":"Transgend Health"}],"container-title":["The British Journal of Radiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/bjr\/article-pdf\/93\/1111\/20190935\/57377185\/bjr.20190935.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/bjr\/article-pdf\/93\/1111\/20190935\/57377185\/bjr.20190935.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,2]],"date-time":"2024-05-02T12:59:17Z","timestamp":1714654757000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/bjr\/article\/doi\/10.1259\/bjr.20190935\/7451990"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,4,29]]},"references-count":24,"journal-issue":{"issue":"1111","published-online":{"date-parts":[[2020,4,29]]},"published-print":{"date-parts":[[2020,7,1]]}},"URL":"https:\/\/doi.org\/10.1259\/bjr.20190935","relation":{},"ISSN":["0007-1285","1748-880X"],"issn-type":[{"value":"0007-1285","type":"print"},{"value":"1748-880X","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2020,7,1]]},"published":{"date-parts":[[2020,4,29]]},"article-number":"20190935"}}