Wiepjes CM, de Blok CJM, Staphorsius AS, et al. - In this nationwide cohort study, all adult transgender individuals who started HT former to 2016 at a gender-identity clinic were involved and were associated with a random population-based sample of 5 age-matched reference men and 5 age-matched reference women per person in order to contrast the fracture incidence in transgender people. Using HT for median 8 and 19 years, respectively, a total of 1,089 trans women aged < 50 years and 934 trans women aged ≥ 50 years, 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. Using HT for a median of 9 years, 1,036 trans men were included. Fractures occurred in 1.7% of the trans men, 3.0% and 2.2% of the age-matched reference men and women, respectively. Summing-up, in elderly trans women, in comparison with age-matched reference men, fracture risk was greater. In young trans women, in contrast to age-matched reference women, fracture risk tended to be raised. Moreover, in young trans men, fracture risk was not raised.