Pubertal suppression has been flagged as a time of skeletal vulnerability among transgender and gender-diverse adolescents.A meta-analysis linked puberty blocker use to temporary lumbar spine z-score drops, which partially recovered after gender-affirming hormone therapy.Absolute bone mineral density was stable during puberty suppression and modestly increased with gender-affirming hormone therapy.
Bone growth among transgender and gender-diverse adolescents slowed compared with peers during pubertal suppression, but partially recovered after starting gender-affirming hormone therapy, a systematic review and meta-analysis showed.
Across 10 longitudinal studies involving 751 adolescents, absolute bone mineral density (BMD) remained stable during gonadotropin-releasing hormone agonist (GnRHa) therapy over mean durations up to 38.4 months. However, lumbar spine BMD z-scores dropped significantly compared with sex-assigned-at-birth normative references:Assigned female at birth (AFAB) z-score change: -0.97 (95% CI -1.09 to -0.85)Assigned male at birth (AMAB) z-score change: -0.73 (95% CI -0.93 to -0.53)
Partial z-score recovery followed gender-affirming hormone therapy during a median treatment duration of 36 months but remained numerically below baseline for AFAB (-0.51, 95% CI -0.69 to -0.34) and AMAB (-0.52, 95% CI -0.82 to -0.21), reported Daniele Tienforti, MD, of the University of L'Aquila in Italy, and colleagues.
