12480 REMS Technology For The Bone Health Assessment After Hormonal Therapy In Transgender Subjects
Authors: Anna Lombardi Fiorella , Russo Antonino , Pisani Paola , Stomaci Chiara , Conversano Francesco , Franchini Roberto , Di Paola Marco , Racanelli Vito , Casciaro Sergio 
Published: October 2024

Abstract
Disclosure: F.A. Lombardi*: None. A. Russo: None. P. Pisani*: None. C. Stomaci*: None. F. Conversano*: None. R. Franchini*: None. M. Di Paola*: None. V. Racanelli*: None. S. Casciaro: None.
Introduction: Sex steroid hormones play crucial roles in bone metabolism and the musculoskeletal system. These hormones interact with specific nuclear receptors, such as estrogen and androgen receptors, which are expressed in bone tissue. This interaction regulates the ongoing process of bone remodeling and induces positive effects on bone health.In this regard, it is crucial to examine the long-term impact of gender affirming hormone therapy (GAHT) on bone metabolism. Radiofrequency Echographic Multi-spectrometry (REMS) is a radiation-free technology for assessing bone mineral density (BMD) and fracture risk prediction by the analysis of the reference axial sites: lumbar spine (LS) and femoral neck (FN). REMS has been widely validated in comparison with Dual Energy X-ray Absorptiometry (DXA), showing good accuracy and precision (&gt;90%), thereby representing a valid technology to monitor bone health status (BHS) in a short-term period. In this context, the goal of this preliminary clinical study was to track the bone health of transgender subjects for one year after starting treatment, using REMS, in order to comprehend the effects of GAHT on BHS. Methods: 7 transgender patients were recruited at Endocrinology Unit of Internal Medicine Department of Santa Chiara Hospital Trento (Italy). Among them were 4 individuals assigned male at birth (AMAB) undergoing therapy with oestradiol valerate 2 g/day and cyproterone acetate 25 mg/day, as well as 3 individuals assigned female at birth (AFAB) undergoing therapy with testosterone 25 mg/day. Before starting GAHT, patients underwent LS-DXA scan, followed by monitoring of BHS by REMS technology after 12 months from the start of treatment. Results: The results show an increase of T-score values in AMAB (-0,3 ± 0,3 REMS vs -1,8 ± 1,8 DXA) after estrogen treatment starting, and no effect on bone in AFAB subjects after GAHT (0.5 ± 0.4 REMS vs 0.9 ± 0.4 DXA); this is due to:-the protective effect of estrogen therapy in AMAB subjects against bone loss;-the combined effect of the decrease of estrogen together with the increase of testosterone in AFAB ones. Conclusions In summary, these initial findings indicate that REMS could be appropriate for monitoring the bone health status of these individuals, confirming the anticipated beneficial effects of estrogen therapy on bone loss in AMAB individuals. The limitation of the study is the lack of REMS data at the beginning of the treatment, but the possibility of carrying out the technique in subsequent evaluation times will allow us to evaluate the change in bone mass during hormonal reaffirmation therapy and compare it with the progress of the measurements obtained with DXA data ones.
Presentation: 6/2/2024