Five-Year Fracture Rate for Transgender and Gender Diverse Patients on Gender-Affirming Hormone Therapy.

The study identified 9,696 TGD adults across three groups with similar baseline age and comorbidity profiles.

• E-GAHT group: n = 1,131; T-GAHT group: n = 1,046; non-GAHT group: n = 7,519
• Mean age (SD) was 33.4 (13.2) years for E-GAHT, 30.8 (11.7) years for T-GAHT, and 33.2 (13.6) years for non-GAHT
• Percent with CCI = 0 was 86.7%, 84.9%, and 85.3% respectively; percent with CCI = 3+ was 2.2%, 1.4%, and 1.9% respectively
• No statistically significant differences in age or comorbidity status were observed across groups
• Data were drawn from the Merative MarketScan Commercial Database from January 1, 2009, to December 31, 2019

The 5-year all-cause fracture incidence rate was numerically lower in both GAHT groups compared with the non-GAHT group.

• Fracture IR per 1,000 person-years was 13.9 (95% CI, 9.1 to 18.8) for E-GAHT
• Fracture IR was 15.3 (95% CI, 10.1 to 20.4) for T-GAHT
• Fracture IR was 19.2 (95% CI, 16.9 to 21.4) for non-GAHT
• The non-GAHT group had the highest point estimate for fracture IR of the three groups

Estrogen-based GAHT was not significantly associated with reduced fracture risk compared with non-GAHT after adjustment.

• Crude IR ratio for E-GAHT vs. non-GAHT was 0.73 (95% CI, 0.51 to 1.04)
• Fully adjusted HR for E-GAHT vs. non-GAHT was 0.71 (95% CI, 0.49 to 1.02)
• Confidence intervals for both the crude and adjusted estimates crossed 1.0, indicating no statistically significant difference
• Cox proportional hazards regression models adjusted for age, comorbidity status (CCI), recent fractures, and study start year

Testosterone-based GAHT was not significantly associated with reduced fracture risk compared with non-GAHT after adjustment.

• Crude IR ratio for T-GAHT vs. non-GAHT was 0.80 (95% CI, 0.56 to 1.14)
• Fully adjusted HR for T-GAHT vs. non-GAHT was 0.78 (95% CI, 0.55 to 1.12)
• Confidence intervals for both the crude and adjusted estimates crossed 1.0, indicating no statistically significant difference
• Adjustment covariates included age, Charlson Comorbidity Index, recent fractures, and study start year

The study was a retrospective cohort design using insurance claims data restricted to commercially insured TGD adults aged 18 to 65 years.

• Data source was the Merative MarketScan Commercial Database covering January 1, 2009, to December 31, 2019
• Participants were identified using clinical and enrollment criteria and followed for up to 5 years
• The primary outcome was incidence rate of all-cause fracture reported with 95% confidence intervals
• Study evidence level was rated III (retrospective cohort study)
• The study population was limited to commercially insured patients aged 18 to 65, which may limit generalizability