Wiepjes CM, de Blok CJM, Staphorsius AS, et al. - In the present study, the researchers sought to compare the incidence of fracture in transgender people utilizing long-term hormonal treatment (HT) with an age-matched reference population. For this nationwide cohort study, all adult transgender people who began HT before 2016 at the gender-identity clinic were involved and were connected to a random population-based sample of 5 age-matched reference men and 5 age-matched reference women per person. In total, 1,089 trans women aged < 50 years (mean 38 ± 9 years) and 934 trans women aged ≥ 50 years (mean 60 ± 8 years) using HT for median 8 (interquartile range [IQR] 3–16) and 19 (IQR 11–29) years, respectively, were involved. A total of 2.4% of the trans women aged < 50 years had a fracture, while 3.0% and 1.6% of the age-matched reference men and women, respectively, encountered a fracture. In trans women aged ≥ 50 years, in contrast with 2.4% and 4.2% of the age-matched reference men and women, 4.4% encountered a fracture. Compared with age-matched reference men, fracture risk was higher in older trans women. In young trans women, the risk of fracture tended to be increased vs age-matched reference women. The risk of fracture in young trans men has not been increased.