Musculoskeletal changes occur with gender-affirming hormonal therapy (GAHT) and gender-affirming surgery (GAS) used in the care of transgender adolescents and adults. Survey results have shown that orthopaedic surgeons desire to care for transgender individuals but express concern over a knowledge deficit. This article reviews the physiology and pathophysiology that may occur with GAHT and GAS. Transgender women have lower bone mineral density (BMD) prior to GAHT than cisgender men. Limited fracture data would suggest that transgender women >50 years of age have fracture rates similar to those of cisgender women. Transgender men have normal BMD prior to GAHT and are not at an increased risk for fracture compared with cisgender women. The use of puberty-blocking medications in the care of transgender youth does result in a decline in BMD, which returns to baseline with GAHT, but the effect of delaying puberty on maximal BMD and the lifetime fracture risk are unknown. At present, dual x-ray absorptiometry (DXA) is used to measure BMD and assess fracture risk. Attention should be paid to using the appropriate reference group in the interpretation of DXA for transgender individuals. Promote musculoskeletal health by ensuring appropriate calcium, vitamin D, weight-bearing activity, and a healthy lifestyle. Adherence to GAHT needs to be encouraged to avoid bone loss. Data with regard to therapy for osteoporosis in transgender patients have been lacking, but, at present, use of available therapies is expected to be effective. Information with regard to differences in other musculoskeletal health issues such as joint injuries has been lacking in transgender individuals.

中文翻译：

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性别在跨性别骨骼和其他肌肉骨骼健康中的作用。


在跨性别青少年和成人的护理中使用的性别肯定激素疗法 (GAHT) 和性别肯定手术 (GAS) 会导致肌肉骨骼变化。调查结果显示，骨科医生希望照顾跨性别者，但对知识匮乏表示担忧。本文综述了 GAHT 和 GAS 可能发生的生理学和病理生理学。跨性别女性在 GAHT 之前的骨矿物质密度 (BMD) 低于顺性别男性。有限的骨折数据表明，50 岁以上的跨性别女性的骨折率与顺性别女性相似。跨性别男性在 GAHT 之前骨密度正常，与顺性别女性相比，骨折风险并不增加。在跨性别青少年的护理中使用青春期阻断药物确实会导致 BMD 下降，并通过 GAHT 恢复到基线，但延迟青春期对最大 BMD 和终生骨折风险的影响尚不清楚。目前，双X射线吸收仪（DXA）用于测量BMD和评估骨折风险。在对跨性别者进行 DXA 解释时应注意使用适当的参考组。通过确保适当的钙、维生素 D、负重活动和健康的生活方式来促进肌肉骨骼健康。需要鼓励遵守 GAHT 以避免骨质流失。关于跨性别患者骨质疏松症治疗的数据一直缺乏，但目前，使用现有的疗法预计是有效的。关于跨性别者其他肌肉骨骼健康问题（例如关节损伤）差异的信息一直缺乏。