Bone mineral density in a sample of Mexican trans women

Keywords: Bone density, body composition, transgender individuals, socioeconomic factors

Abstract

Introduction: Trans people represent a vulnerable group, and their health conditions are poorly understood. A trans woman is a person who at birth has the biological sex of a man, but identifies and expresses herself as feminine. Objectives: to evaluate bone mineral density (BMD) and its associations with health habits and body composition in Mexican trans women (TW). Material and methods: A cross-sectional study was carried out with a convenience sample of thirty trans women, residents of Toluca City, Mexico. Bone mineral density (BMD) was evaluated by densitometry (DXA) and body composition by electrical bio-impedance, using reference values for Mexican-American men. A questionnaire on socio-demographic characteristics, physical activity, health-related habits, and use of gender-affirmative hormone therapy was applied. Results: The mean age of the participants was 28 years (SD = 6.9); 20% of the participants had low BMD. Low socioeconomic status was related to lower BMD in the hip (p = 0.043). The trans women with heavier bodies had a higher BMD in the spine (for weight, p= 0.004; for fat mass, p = 0.047; for fat-free mass, p = 0.004); furthermore, fat-free mass was associated with higher BMD in the hip (p = 0.050). No statistically significant relationships were found with other variables. Conclusions: Trans women had low BMD, which was associated with socioeconomic status and body composition. The findings suggest that trans women represent a vulnerable group and require the design of strategies oriented to health and nutrition problems.

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References

Hembree W, Cohen-Kettenis P, Gooren L, Hannema S, Meyer W, Murad M, et al. Endocrine treatment of gender-dysphoric/gender-incongruent persons: an endocrine society clinical practice guideline. J. Clin. Endoc. Met. 2017; 102(11):3869-3903. DOI: https://doi.org/10.1210/jc.2017-01658

Glen F, Hurrell K. Measuring gender identity. Equality and Human Rights Commission Research report. Manchester; 2012

Kuyper L, Wijsen C. Gender identities and gender dysphoria in the Netherlands. Arch. Sex. Behav. 2014; 43(2):377-385.DOI: https://doi.org/10.1007/s10508-013-0140-y

The Williams Institute. Disponible en: https://williamsinstitute.law.ucla.edu/ Citado: 22-10-2021

Reza A. Osteoporosis. Gac. Med. México. 2016; 152(1):84-89.

Davidge-Pitts C, Clarke B. Transgender bone health. Maturitas. 2019;127:35-42. DOI: https://doi.org/10.1016/j.maturitas. 2019.05.002

Rothman MS, Iwamoto SJ. Bone health in the transgender population. Clin. Rev. Bone. Mine. Metab. 2019; 17(2):77-85. DOI: https://doi.org/10.1007/s12018-019-09261-3

Van-Caenegem E, T'Sjoen G. Bone in trans persons. Curr. Opin. Endocrinol. Diabetes. Obes. 2015; 22(6):459-466. DOI: https://doi.org/10.1097/med.0000000000000202

T'Sjoen G, Weyers S, Taes Y, Lapauw B, Toye K, Goemaere S, et al. Prevalence of low bone mass in relation to estrogen treatment and body composition in male-to-female transsexual persons. J. Clin. Densitom. 2009; 12(3):306-313.

Klaver M, De blok C, Wiepjes C, Nota N, Dekker M, De Mutsert R, et al. Changes in regional body fat, lean body mass and body shape in trans persons using cross-sex hormonal therapy: results from a multicenter prospective study. Eur. J. Endocrinol. 2018; 178(2):163-171. DOI: doi: 10.1530 / EJE-17-0496.

Wiepjes C, Vlot M, De Blok C, Nota N, De Jongh R, Den Heijer M. Bone geometry and trabecular bone score in transgender people before and after short-and long-term hormonal treatment. JBMR. 2019; 127:280-286. DOI: https://doi.org/10.1016/j.bone.2019.06.029

Wierckx K, Mueller S, Weyers S, Van-Caenegem E, Roef G, Heylens G, et al. Long term evaluation of cross sex hormone treatment in transsexual persons. J. Sex. Med. 2012; 9(10):2641-51.DOI: https://doi.org/10.1111/j.1743-6109.2012.02876.x

Gooren L, Giltay E, Bunck M. Long-term treatment of transsexuals with cross-sex hormones: extensive personal experience. Int. J. Clin. Endocrinol. Metab. 2008; 93(1):19-25. DOI: https://doi.org/10.1210/jc.2007-1809

Wiepjes C, De Jongh R, De Blok C, Vlot M, Lips P, Twisk J, et al. Bone safety during the first ten years of gender affirming hormonal treatment in transwomen and transmen. JBMR. 2019; 34(3):447-454. DOI: https://doi.org/10.1002/jbmr.3612

Fighera T, Ziegelmann P, Rasia da Silva T, Spritzer P. Bone mass effects of cross-sex hormone therapy in transgender people: updated systematic review and meta-analysis. JES. 2019; 3(5):943-964. DOI: doi: 10.1210 / js.2018-00413

Organización Mundial de la Salud. Recomendaciones mundiales sobre actividad física para la salud. 2020. Disponible en: https://www.who.int/es/news-room/fact-sheets/detail/physical-activity

American College Health Association. Association-National College Health Assessment II: Reference Group Executive Summary Spring. American College Health Association: Hanover MD; 2013.

Piercy K, Troiano R, Ballard R, Carlson S, Fulton J, Galuska D, et al. The physical activity guidelines for Americans. JAMA. 2018; 320(19):2020-2028. DOI: 10.1001/jama.2018.14854.

Tremblay M, Warburton D, Janssen I, Paterson D, Latimer A, Rhodes R, et al. New Canadian Physical Activity Guidelines. Appl. Physiol. Nutr. Metab. 2011; 36(1):36-46.

Instituto Nacional de Psquiatría Ramón de la Fuente Muñiz. Encuesta Nacional de Consumo de Drogas, Alcohol y Tabaco. Reporte de Alcohol 2016-2017. México: Instituto Nacional de Psquiatría Ramón de la Fuente Muñiz; 2017.

The International Society for Clinical Densitometry. Adult Oficial Positions. ISCD; 2019. Disponible en: https://www.ISCD.org

Gallagher D, Heymsfield S, Heo M, Jebb S, Murgatroyd P, Sakamoto Y. Healthy percentage body fat ranges: an approach for developing guidelines based on body mass index. Am. J. Clin. Nutr. 2000; 72(3):694-701. DOI: https://doi.org/10.1093/ajcn/72.3.694

Tanita. Lectura de la composición corporal 2021 [Disponible en: https://www.tanita.com/es/. Citado el: 23/10/2021.

Lohman T, Roche A, Martorell R. Anthropometric standardization reference manual. Champaign, IL: Human kinetics books; 1988.

WMA. Declaration of Helsinki. Ethical principles for medical research involving human subjects 2013. Disponible en: http://www.wma.net/en/30publications/10policies/b3/index.html.

Van-Caenegem E, Wierckx K, Taes Y, Schreiner T, Vandewalle S, Toye K, et al. Preservation of volumetric bone density and geometry in trans women during cross-sex hormonal therapy: a prospective observational study. Osteoporos. Inter. 2015; 26(1):35-47. DOI: https://doi.org/10.1007/s00198-014-2805-3

Secretaría de Gobernación, Comisión Nacional de los Derechos Humanos. Encuesta sobre Discriminación por motivos de Orientación Sexual e Identidad de Género, 2018. México: Secretaria de Gobernación; 2018.

Cervantes G. Detección de los factores que influyen en la vulnerabilidad de las mujeres transgénero para desarrollar VIH-SIDA. [Tesis de maestría]. Cuernavaca: Instituto Nacional de Salud Pública; 2012.

Fundación Arcoiris A.C. Atención a personas LGBTI en México, la condición en algunos estados del centro del país. México: Fundación Arcoiris A.C.; 2016.

De la Nuez M. Osteoporosis y pobreza. [Tesis de maestría]. Gran Canaria: Universidad de Las Palmas; 2009.

Ortiz Hernández L, Ramos Ibañez N, Pérez Salgado D, Ramírez Aguilar ML. Fundamentos de nutrición para la consulta nutriológica. México: Trillas; 2013.

Caballero M. El derecho a la educación en la medición de pobreza: un análisis complejo. Ed. Hum. 2017; 19(33):386-97. DOI: https://doi.org/10.17081/eduhum.19.33.2651

Centro Nacional de Equidad de Género y Salud Reproductiva. Recursos contra la discriminación y la violencia por identidad sexual, identidad o expresión de género en el contexto de la enfermedad COVID-19. México: Gobierno de México; 2019.

Blanco T. La situación de acceso a derechos de las personas trans en México: problemáticas y propuestas. México: Estados Unidos de America. México; 2019.

Secretaría de Salud. Protocolo para el acceso sin discriminación a la prestación de servicios de atención médica de las poblaciones lésbico, gay, bisexual, transexual, travesti, transgénero e intersexual y guías de atención específica. México: Secretaria de Salud; 2019.

Rodríguez J. El humanismo en la educación médica. Rev. Edu. 2006; 30(1):51-63.

Giner M, Montoya M, Miranda C, Vázquez M, Miranda M, Pérez-Cano R. Influencia de la obesidad sobre la microarquitectura y las propiedades biomecánicas en pacientes con fractura de cadera. Rev. Osteoporos. Met. Miner. 2017; 9(1):20-7. DOI: https://dx.doi.org/10.4321/s1889-836x2017000100004

Basterrechea J, Bonilla N, Borrero L, Bottaro G, Fuentes L. Concepciones sobre transexualidad en estudiantes de Medicina de la Universidad de Carabobo. Salus. 2017; 21(1):10-15.

Published
2023-01-05
How to Cite
Aguilar Martínez, J. R., Lazarevich, I., & Luis Ortiz Hernández, L. (2023). Bone mineral density in a sample of Mexican trans women. Mexican Journal of Medical Research ICSA, 11(21), 48-54. https://doi.org/10.29057/mjmr.v11i21.9648