The role of DXA bone density scans in the diagnosis and treatment of osteoporosis

Blake, Glen M; Fogelman, Ignac

doi:10.1136/pgmj.2007.057505

Cited by 532Bone health and osteoporosis researchHIV-related health complications and treatmentsMenopause: Health Impacts and Treatments

The role of DXA bone density scans in the diagnosis and treatment of osteoporosis

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Blake, Glen M, Fogelman, Ignac·2007·Postgraduate Medical Journal

DOI 10.1136/pgmj.2007.057505PMC PMC2600106

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Abstract

Dual energy x ray absorptiometry (DXA) scans to measure bone mineral density (BMD) at the spine and hip have an important role in the evaluation of individuals at risk of osteoporosis, and in helping clinicians advise patients about the appropriate use of antifracture treatment. Compared with alternative bone densitometry techniques, hip and spine DXA examinations have a number of advantages that include a consensus that BMD results can be interpreted using the World Health Organization T-score definition of osteoporosis, a proven ability to predict fracture risk, proven effectiveness at targeting antifracture therapies, and the ability to monitor response to treatment. This review discusses the evidence for these and other clinical aspects of DXA scanning, including its role in the new WHO algorithm for treating patients on the basis of their individual fracture risk.

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Diagnosis of osteoporosis primarily relies on assessment of bone mass through bone densitometry (DEXA).
“Currently, the diagnosis of osteoporosis primarily relies on the assessment of bone mass through bone densitometry, also known as dual-energy X-ray absorptiometry (DEXA) [46].”
From Osteoporosis: Molecular Pathology, Diagnostics, and Therapeutics (2023) · cites this paper as [46]

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Nickolas, T. L., Leonard, M. B., & Shane, E. (2008) · Kidney International · doi:10.1038/ki.2008.264 · Cited by 300 · see citing works
Veganism, vegetarianism, bone mineral density, and fracture risk: a systematic review and meta-analysis
Iguacel, I., Miguel-Berges, M. L., Gómez-Bruton, A., Moreno, L. A., & Julián, C. (2019) · Nutrition Reviews · doi:10.1093/nutrit/nuy045 · Cited by 222 · see citing works
“Compared with alternative bone densitometry techniques, FN and LS DXA examinations have a number of advantages, including include a proven ability to predict fracture risk, a consensus for defining osteoporosis through BMD results according to the World Health Organization T-score definition, and the ability to monito…”
Background
Continuous antiretroviral therapy decreases bone mineral density
Grund, B., Peng, G., Gibert, C. L., Hoy, J., Isaksson, R., Shlay, J. C., Martínez, E., Reiss, P., Visnegarwala, F., & Carr, A. D. (2009) · AIDS · doi:10.1097/qad.0b013e32832c1792 · Cited by 212 · see citing works
“This is consistent with studies in the general population, in which the age-related BMD decline varies by scan location and technique, and spine BMD measured by qCT declines faster than BMD by DXA of the spine or hip [34,35].”
Result
Beyond the Definitions of the Phenotypic Complications of Sickle Cell Disease: An Update on Management
Ballas, S. K., Kesen, M. R., Goldberg, M. F., Lutty, G. A., Dampier, C., Osunkwo, I., Wang, W. C., Hoppe, C. C., Hagar, W., Darbari, D. S., et al. (2012) · The Scientific World JOURNAL · doi:10.1100/2012/949535 · Cited by 198 · see citing works
“5 standard deviations (T score) below the peak bone mass typically achieved by a healthy adult between the ages of 18–30 years of age of the same sex and ethnicity [175] (WHO Scientific Group on Prevention and Management of Osteoporosis 2000: Geneva, Switzerland, 2003.”
Background
Diagnosing sarcopenia: Functional perspectives and a new algorithm from the ISarcoPRM
Kara, M., Kaymak, B., Frontera, W. R., Ata, A. M., Ricci, V., Ekiz, T., Chang, K. C., Han, D., Michail, X., Quittan, M., et al. (2021) · Journal of Rehabilitation Medicine · doi:10.2340/16501977-2851 · Cited by 186 · see citing works
“As hip BMD is the most reliable parameter for hip fracture risk, and as spinal BMD should be used for monitoring the treatment of osteoporosis (135), femoral neck and/or spine BMD values ≤ 2.”
Background
Diffuse optical characterization of collagen absorption from 500 to 1700 nm
Sekar, S. K. V., Bargigia, I., Mora, A. D. D., Taroni, P., Ruggeri, A., Tosi, A., Pifferi, A., & Farina, A. (2017) · Journal of Biomedical Optics · doi:10.1117/1.jbo.22.1.015006 · Cited by 170 · see citing works
“Importantly, radius distal is one among the locations considered for bone mineral assessment by DXA scans and is rich of collagen, which can be of interest for diagnosing bone pathologies.(34) Figure 4 depicts the calculated broadband (500 to 1700 nm) weighted spectra of major tissue constituents, namely oxy-hemoglobi…”
Background
Abnormal microarchitecture and reduced stiffness at the radius and tibia in postmenopausal women with fractures
Stein, E. M., Liu, X. S., Nickolas, T. L., Cohen, A., Thomas, V., McMahon, D. J., Zhang, C. A., Yin, P. T., Cosman, F., Nieves, J. W., et al. (2010) · Journal of Bone and Mineral Research · doi:10.1002/jbmr.152 · Cited by 168 · see citing works
“Measurement of areal bone mineral density (aBMD) by dual-energy X-ray absorptiometry (DXA) is a powerful clinical tool and the ‘‘gold standard’’ for identifying those who are at increased risk of incident fracture.((6)) However, since half of all postmenopausal fractures occur in women with BMD values above the”
Background
Advances in bone imaging for osteoporosis
Adams, J. E. (2012) · Nature Reviews Endocrinology · doi:10.1038/nrendo.2012.217 · Cited by 164 · see citing works
Effect of Weight Loss via Severe vs Moderate Energy Restriction on Lean Mass and Body Composition Among Postmenopausal Women With Obesity: The TEMPO Diet Randomized Clinical Trial
Seimon, R. V., Wild-Taylor, A. L., Keating, S. E., McClintock, S., Harper, C., Gibson, A. A., Johnson, N. A., Fernando, H. A., Markovic, T. P., Center, J. R., et al. (2019) · JAMA Network Open · doi:10.1001/jamanetworkopen.2019.13733 · Cited by 152 · see citing works
Relationship of body mass index with main limb fragility fractures in postmenopausal women
Gnudi, S., Sitta, E., & Lisi, L. (2009) · Journal of Bone and Mineral Metabolism · doi:10.1007/s00774-009-0056-8 · Cited by 161 · see citing works
Hormone Replacement Therapy Versus the Combined Oral Contraceptive Pill in Premature Ovarian Failure: A Randomized Controlled Trial of the Effects on Bone Mineral Density
Cartwright, B., Robinson, J., Seed, P. T., Fogelman, I., & RYMER, J. M. (2016) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2015-4063 · Cited by 158 · see citing works
Self-citation
Does Diet-Induced Weight Loss Lead to Bone Loss in Overweight or Obese Adults? A Systematic Review and Meta-Analysis of Clinical Trials
Zibellini, J., Seimon, R. V., Lee, C. M., Gibson, A. A., Hsu, M. S., Shapses, S. A., Nguyen, T. V., & Sainsbury, A. (2015) · Journal of Bone and Mineral Research · doi:10.1002/jbmr.2564 · Cited by 157 · see citing works
“[59, 60] The spine, like the hip, is clinically significant because of its correlation with fracture risk.[60-62] Both of these sites, because of their high trabecular bone content and thus high bone surface area, are highly susceptible to factors that influence bone”
Background
Dual energy X-ray absorptiometry: Pitfalls in measurement and interpretation of bone mineral density
Garg, M., & Kharb, S. (2013) · Indian Journal of Endocrinology and Metabolism · doi:10.4103/2230-8210.109659 · Cited by 156 · see citing works
“The gold‐standard technique for estimation of BMD is the DXA technique because of their reproducibility, large normative data, non‐invasive nature, little time requirement for procedure, and minimal radiation exposure.[12] Presently, in India DXA machines, manufactured by Hologic and Lunar, are available to assess BMD.”
Method
Impaired bone mineral density as a predictor of graft subsidence following minimally invasive transpsoas lateral lumbar interbody fusion
Tempel, Z. J., Gandhoke, G. S., Okonkwo, D. O., & Kanter, A. S. (2015) · European Spine Journal · doi:10.1007/s00586-015-3844-y · Cited by 151 · see citing works
“5) at the femoral neck site have a globally increased fracture risk following minor trauma [27–30].”
BackgroundMethod
Advances in osteoporosis imaging
Bauer, J. S., & Link, T. M. (2009) · European Journal of Radiology · doi:10.1016/j.ejrad.2008.04.064 · Cited by 150 · see citing works
“BMD was the first parameter to quanify bone properties non-invasively, correlates with bone strength nd predicts fracture risk of a patient to some extent [12].”
Dual-energy X-ray Absorptiometry
Jain, R. K., & Vokes, T. (2017) · Journal of Clinical Densitometry · doi:10.1016/j.jocd.2017.06.014 · Cited by 148 · see citing works
Osteoporosis: Molecular Pathology, Diagnostics, and Therapeutics
Adejuyigbe, B., Kallini, J., Chiou, D., & Kallini, J. R. (2023) · International Journal of Molecular Sciences · doi:10.3390/ijms241914583 · Cited by 148 · see citing works
“Currently, the diagnosis of osteoporosis primarily relies on the assessment of bone mass through bone densitometry, also known as dual-energy X-ray absorptiometry (DEXA) [46].”
Diagnostic tests: Bone mineral density: Testing for osteoporosis
Sheu, A., & Diamond, T. (2016) · Australian Prescriber · doi:10.18773/austprescr.2016.020 · Cited by 138 · see citing works
Proton-density fat fraction and simultaneous R2* estimation as an MRI tool for assessment of osteoporosis
Kühn, J., Hernando, D., Meffert, P. J., Reeder, S. B., Hosten, N., Laqua, R., Steveling, A., Ender, S. A., Schröder, H., & Pillich, D. T. (2013) · European Radiology · doi:10.1007/s00330-013-2950-7 · Cited by 131 · see citing works
“According to the World Health Organization (WHO) the t score is the best predictor to determine osteoporosis [5].”
Management of Premenstrual Syndrome
(2016) · BJOG An International Journal of Obstetrics & Gynaecology · doi:10.1111/1471-0528.14260 · Cited by 147 · see citing works
“DEXA is accepted as the gold standard investigation for assessing BMD.(107) DEXA scans every year are considered useful as less frequent scans would delay diagnosis of significant bone loss and subsequent review of GnRH analogue treatment, and more frequent scans may not perceive small changes.”
Background
Variation in Attenuation in L1 Trabecular Bone at Different Tube Voltages: Caution Is Warranted When Screening for Osteoporosis With the Use of Opportunistic CT
Garner, H. W., Paturzo, M. M., Gaudier, G., Pickhardt, P. J., & Wessell, D. E. (2016) · American Journal of Roentgenology · doi:10.2214/ajr.16.16744 · Cited by 112 · see citing works
Bone health in phenylketonuria: a systematic review and meta-analysis
Demirdas, S., Coakley, K. E., Bisschop, P. H. L. T., Hollak, C. E. M., Bosch, A. M., & Singh, R. H. (2015) · Orphanet Journal of Rare Diseases · doi:10.1186/s13023-015-0232-y · Cited by 106 · see citing works
“Studies of bone in patients with PKU primarily report DXA estimates of BMD; however, other techniques such as pQCT, QUS and several X-ray methods used to measure BMD are available and are compared elsewhere [30,31].”
Background
An epidemiological analysis of the incidence of osteoporosis and osteoporosis-related fractures among the Saudi Arabian population
Sadat‐Ali, M., Al-Habdan, I. M., Al-Turki, H. A., & Azam, M. Q. (2012) · Annals of Saudi Medicine · doi:10.5144/0256-4947.2012.637 · Cited by 97 · see citing works
Discovery of potential biomarkers for osteoporosis using LC-MS/MS metabolomic methods
Wang, J., Yan, D., Zhao, A., Hou, X., Zheng, X., Chen, P., Bao, Y.-J., Jia, W., Hu, C., Zhang, Z., et al. (2019) · Osteoporosis International · doi:10.1007/s00198-019-04892-0 · Cited by 91 · see citing works
Perceived Versus Calculated HIV Risk: Implications for Pre-exposure Prophylaxis Uptake in a Randomized Trial of Men Who Have Sex With Men
Blumenthal, J. S., Jain, S., Mulvihill, E., Sun, S., Hanashiro, M., Ellorin, E. E., Graber, S., Haubrich, R., & Morris, S. (2018) · JAIDS Journal of Acquired Immune Deficiency Syndromes · doi:10.1097/qai.0000000000001888 · Cited by 90 · see citing works
“24 – 26 The provision and use of an HIV risk score is hoped to yield similar effects.”
Background
Age-related prevalence of osteoporosis and fragility fractures: real-world data from an Austrian Menopause and Osteoporosis Clinic
Boschitsch, E., Durchschlag, E., & Dimai, H. P. (2017) · Climacteric · doi:10.1080/13697137.2017.1282452 · Cited by 83 · see citing works
Consensus Statement on the Use of Bone Turnover Markers for Short-Term Monitoring of Osteoporosis Treatment in the Asia-Pacific Region
Wu, C., Chang, Y., Chen, C., Lewiecki, E. M., Wüster, C. C., Reid, I. R., Tsai, K., Matsumoto, T., MERCADO-ASIS, L. B., Chan, D., et al. (2019) · Journal of Clinical Densitometry · doi:10.1016/j.jocd.2019.03.004 · Cited by 83 · see citing works
The preoperative Hounsfield unit value at the position of the future screw insertion is a better predictor of screw loosening than other methods
Li, J., Zhang, Z., Xie, T., Song, Z.-T., Song, Y., & Zeng, J. (2022) · European Radiology · doi:10.1007/s00330-022-09157-9 · Cited by 77 · see citing works
“Based on above-mentioned limitations, the predictive performance of DXA in BMD prediction is lower than HU values [6–8, 16, 19, 36], and given that the difference in HU values between nonloosening and loosening patients was highest in the insertional screw position group, we believe that the insertional screw position…”
BackgroundMethodInfluential
Effect of increasing vertebral marrow fat content on BMD measurement, T-Score status and fracture risk prediction by DXA
Blake, G. M., Griffith, J. F., Yeung, D. K. W., Leung, P., & Fogelman, I. (2008) · Bone · doi:10.1016/j.bone.2008.11.003 · Cited by 76 · see citing works
“DXA scans evaluate BMD by measuring the transmission of X-rays through the body at two different photon energies [12].”
BackgroundSelf-citation
Innervation is higher above Bone Remodeling Surfaces and in Cortical Pores in Human Bone: Lessons from patients with primary hyperparathyroidism
Sayilekshmy, M., Hansen, R. B., Delaissé, J., Rolighed, L., Andersen, T. L., & Heegaard, A. (2019) · Scientific Reports · doi:10.1038/s41598-019-41779-w · Cited by 73 · see citing works
Development and clinical application of bioelectrical impedance analysis method for body composition assessment
Son, J. W., Han, B., Bennett, J. P., Heymsfield, S., & Lim, S. (2025) · Obesity Reviews · doi:10.1111/obr.13844 · Cited by 74 · see citing works
“43 However, it also requires a special facility, is relatively expensive, and involves low levels of radiation exposure.”
Epidemiology of Fractures in Diabetes
Starup‐Linde, J., Frost, M., Vestergaard, P., & Abrahamsen, B. (2016) · Calcified Tissue International · doi:10.1007/s00223-016-0175-x · Cited by 71 · see citing works
“BMD measured by dual-energy X-ray absorptiometry (DXA) scan is both diagnostic for osteoporosis and predicts fracture risk [88, 89].”
Method
Trabecular bone score in healthy ageing
Bazzocchi, A., Ponti, F., Diano, D., Amadori, M., Albisinni, U., Battista, G., & Guglielmi, G. (2015) · British Journal of Radiology · doi:10.1259/bjr.20140865 · Cited by 70 · see citing works
Association of serum uric acid levels with osteoporosis and bone turnover markers in a Chinese population
Yan, D., Wang, J., Hou, X., Bao, Y., Zhang, Z., Hu, C., & Jia, W. (2017) · Acta Pharmacologica Sinica · doi:10.1038/aps.2017.165 · Cited by 66 · see citing works
Improved prediction of fracture risk leveraging a genome-wide polygenic risk score
Lu, T., Forgetta, V., Keller‐Baruch, J., Nethander, M., Bennett, D., Forest, M., Bhatnagar, S., Walters, R. G., Lin, K., Chen, Z., et al. (2021) · Genome Medicine · doi:10.1186/s13073-021-00838-6 · Cited by 63 · see citing works
Bone mineral density changes in protease inhibitor-sparing vs. nucleoside reverse transcriptase inhibitor-sparing highly active antiretroviral therapy: data from a randomized trial*
Hansen, A. E., Obel, N., Nielsen, H. I., Pedersen, C. D., & Gerstoft, J. (2010) · HIV Medicine · doi:10.1111/j.1468-1293.2010.00864.x · Cited by 64 · see citing works
Protein and bone health across the lifespan
Dolan, E., & Sale, C. (2018) · Proceedings of The Nutrition Society · doi:10.1017/s0029665118001180 · Cited by 61 · see citing works
Applicability of ToF-SIMS for monitoring compositional changes in bone in a long-term animal model
Henß, A., Rohnke, M., Khassawna, T. E., Govindarajan, P., Schlewitz, G., Heiß, C., & Janek, J. (2013) · Journal of The Royal Society Interface · doi:10.1098/rsif.2013.0332 · Cited by 57 · see citing works
“Clinically, a reduced BMD assessed by X-ray absorptiometry is considered to be the first indicator of osteoporosis [1].”
Background
Cancer Treatment–Induced Bone Loss (CTIBL): State of the Art and Proper Management in Breast Cancer Patients on Endocrine Therapy
Diana, A., Carlino, F., Giunta, E. F., Franzese, E., Guerrera, L. P., Lauro, V. D., Ciardiello, F., Daniele, B., & Orditura, M. (2021) · Current Treatment Options in Oncology · doi:10.1007/s11864-021-00835-2 · Cited by 56 · see citing works
Induction of osteoporosis with its influence on osteoporotic determinants and their interrelationships in rats by DEXA
Heiß, C., Govindarajan, P., Schlewitz, G., Hemdan, N. Y. A., Schliefke, N., Alt, V., Thormann, U., Lips, K. S., Wenisch, S., Langheinrich, A. C., et al. (2012) · Medical Science Monitor · doi:10.12659/msm.882895 · Cited by 51 · see citing works
Utility of DXA for monitoring, technical aspects of DXA BMD measurement and precision testing
CAREY, J. J., & Delaney, M. F. (2017) · Bone · doi:10.1016/j.bone.2017.05.021 · Cited by 51 · see citing works
Falls and Fractures in Diabetes—More than Bone Fragility
Rasmussen, N. H.-H., & Dal, J. (2019) · Current Osteoporosis Reports · doi:10.1007/s11914-019-00513-1 · Cited by 51 · see citing works
Variation in bone mineral density by anatomical site in patients with proximal humeral fractures
Wilson, J., Bonner, T. J., Head, M., Fordham, J. N., Brealey, S., & Rangan, A. (2009) · Journal of Bone and Joint Surgery - British Volume · doi:10.1302/0301-620x.91b6.22346 · Cited by 49 · see citing works
A Prospective Observational Study on Effect of Short-Term Periodic Steroid Premedication on Bone Metabolism in Gastrointestinal Cancer (ESPRESSO-01)
Nakamura, M., Ishiguro, A., Muranaka, T., Fukushima, H., Yuki, S., Ono, K., Murai, T., Matsuda, C., Oba, A., Itaya, K., et al. (2017) · The Oncologist · doi:10.1634/theoncologist.2016-0308 · Cited by 48 · see citing works
DEXA sensitivity analysis in patients with adult spinal deformity
Gupta, A. K., Upadhyaya, S., Patel, A. K., Fogel, H. A., Cha, T., Schwab, J. H., Bono, C. M., & Hershman, S. H. (2019) · The Spine Journal · doi:10.1016/j.spinee.2019.08.011 · Cited by 48 · see citing works
In Vivo, Non-Invasive Characterization of Human Bone by Hybrid Broadband (600-1200 nm) Diffuse Optical and Correlation Spectroscopies
Sekar, S. K. V., Pagliazzi, M., Negredo, E., Martelli, F., Farina, A., Mora, A. D. D., Lindner, C., Farzam, P., Pérez‐Álvarez, N., Puig, J., et al. (2016) · PLoS ONE · doi:10.1371/journal.pone.0168426 · Cited by 47 · see citing works
The Critical Role of Body Composition Assessment in Advancing Research and Clinical Health Risk Assessment across the Lifespan
Bennett, J. P., & Lim, S. K. (2025) · Journal of Obesity & Metabolic Syndrome · doi:10.7570/jomes25010 · Cited by 52 · see citing works
“85 These expanded capabilities position DXA as a key tool in identifying relationships be-tween body composition components and disease outcomes, particularly in research aiming to refine predictive models.”
Dual-Energy X-Ray Absorptiometry
Adams, J. E. (2008) · Springer eBooks · doi:10.1007/978-3-540-68604-0_7 · Cited by 45 · see citing works
“The first DXA scanners were introduced in the late 1980s, and DXA is now the most widely used and available method amongst the techniques applied for quantitative assessment of the skeleton (Blake and Fogelman 2007; Dasher et al. 2010; Guglielmi et al. 2011; Chun 2011), although its availability varies in different co…”
Method
Fourier Transform Infrared Imaging Microspectroscopy and Tissue-Level Mechanical Testing Reveal Intraspecies Variation in Mouse Bone Mineral and Matrix Composition
Courtland, H., Nasser, P. R., Goldstone, A. B., Spevak, L., Boskey, A. L., & Jepsen, K. J. (2008) · Calcified Tissue International · doi:10.1007/s00223-008-9176-8 · Cited by 43 · see citing works
Spatially offset Raman spectroscopy for in vivo bone strength prediction
Shu, C., Chen, K., Lynch, M., Maher, J. R., Awad, H. A., & Berger, A. J. (2018) · Biomedical Optics Express · doi:10.1364/boe.9.004781 · Cited by 42 · see citing works
Automatic multi-parametric quantification of the proximal femur with quantitative computed tomography.
Carballido‐Gamio, J., Bonaretti, S., Saeed, I., Harnish, R. J., Recker, R. R., Burghardt, A. J., Keyak, J. H., Harris, T. B., Khosla, S., & Lang, T. (2015) · Europe PMC (PubMed Central) · doi:10.3978/j.issn.2223-4292.2015.08.02 · Cited by 39 · see citing works
“Areal bone mineral density (aBMD) assessed by dual X-ray absorptiometry (DXA) is the standard clinical parameter for the diagnosis of osteoporosis (4,5).”
Method
A cross-sectional analysis of the association between sleep duration and osteoporosis risk in adults using 2005–2010 NHANES
Lee, C.-L., Tzeng, H.-E., Liu, W.-J., & Tsai, C. (2021) · Scientific Reports · doi:10.1038/s41598-021-88739-x · Cited by 39 · see citing works
“0056 Wrist 1148 (10) 94 (16) 387 (11) 571 (9) 96 (12) 0.”
Wrist bone mineral density utility in diagnosing hip osteoporosis in postmenopausal women
Eftekharsadat, B., Ghavami, M., Toopchizadeh, V., & Akbari, M. G. (2016) · Therapeutic Advances in Endocrinology and Metabolism · doi:10.1177/2042018816658164 · Cited by 38 · see citing works
Dual energy X-ray absorptiometry positioning protocols in assessing body composition: A systematic review of the literature
Shiel, F., Persson, C., Furness, J. W., Simas, V., Pope, R., Climstein, M., Hing, W. A., & Schram, B. L. (2018) · Journal of science and medicine in sport · doi:10.1016/j.jsams.2018.03.005 · Cited by 38 · see citing works
Does Physical Exercise Always Improve Bone Quality in Rats?
Portier, H., Benaîtreau, D., & Pallu, S. (2020) · Life · doi:10.3390/life10100217 · Cited by 38 · see citing works
“Volumetric BMD differs from the areal (2-dimensional) BMD that is obtained using DXA [49–52].”
MethodInfluential
Trends in osteoporosis and mean bone density among type 2 diabetes patients in the US from 2005 to 2014
Xu, Y., & Wu, Q. F. (2021) · Scientific Reports · doi:10.1038/s41598-021-83263-4 · Cited by 38 · see citing works
Osteoporosis Pre-Screening Using Ensemble Machine Learning in Postmenopausal Korean Women
Kwon, Y., Lee, J., Park, J. H., Kim, Y. M., Kim, S. H., Won, Y. J., & Kim, H.-Y. (2022) · Healthcare · doi:10.3390/healthcare10061107 · Cited by 38 · see citing works
“BMDs of the lumbar spine and femur are usually measured, but those of the wrist, finger, or heel may be substituted [21].”
Background
Implications of combined ovariectomy and glucocorticoid (dexamethasone) treatment on mineral, microarchitectural, biomechanical and matrix properties of rat bone
Govindarajan, P., Khassawna, T. E., Kampschulte, M., Böcker, W., Hürter, B., Dürselen, L., Faulenbach, M., & Heiß, C. (2013) · International Journal of Experimental Pathology · doi:10.1111/iep.12038 · Cited by 38 · see citing works
“Z-scores were calculated with the formula, Z-score = [Measured BMD – Age-matched BMD]/Age-matched population SD (Glen and Ignac 2007).”
Method
Risk factors predicting subsequent falls and osteoporotic fractures at 4 years after distal radius fracture—a prospective cohort study
Dewan, N., MacDermid, J. C., Grewal, R. S., & BEATTIE, K. A. (2018) · Archives of Osteoporosis · doi:10.1007/s11657-018-0445-5 · Cited by 36 · see citing works
Association of adiposity indices with bone density and bone turnover in the Chinese population
Wang, J., Yan, D., Hou, X., Chen, P., Sun, Q., Bao, Y., Hu, C., Zhang, Z., & Jia, W. (2017) · Osteoporosis International · doi:10.1007/s00198-017-4081-5 · Cited by 34 · see citing works
MRI-based assessment of proximal femur strength compared to mechanical testing
Rajapakse, C. S., Farid, A. R., Kargilis, D., Jones, B. C., Lee, J., Johncola, A., Batzdorf, A. S., Shetye, S. S., Hast, M. W., & Chang, G. A. (2020) · Bone · doi:10.1016/j.bone.2020.115227 · Cited by 34 · see citing works
“DXA scanners are fairly ubiquitous and provide precise measurements of bone density in short scan times [9].”
Background
Impact of hormone therapy on the bone density of women with premature ovarian insufficiency: A systematic review
Costa, G. P. O., Filho, E. S. F., Simões, R. S., Soares, J. M., Baracat, E. C., & Maciel, G. A. R. (2022) · Maturitas · doi:10.1016/j.maturitas.2022.09.011 · Cited by 34 · see citing works
DXA in Adults and Children
Blake, G. M., Adams, J. E., & Bishop, N. J. (2013) · Primer on the metabolic bone diseases and disorders of mineral metabolism · doi:10.1002/9781118453926.ch30 · Cited by 34 · see citing works
Self-citation
Effect of trabecular architectures on the mechanical response in osteoporotic and healthy human bone
Bregoli, C., Biffi, C. A., Tuissi, A., & Buccino, F. (2024) · Medical & Biological Engineering & Computing · doi:10.1007/s11517-024-03134-8 · Cited by 33 · see citing works
“Currently, DXA scans, already implemented in clinics, provide information on bone density and WHO provides well-established indexes for the definition of osteoporosis (i.e. T-score, z-score) [9, 10].”
BackgroundMethod
Quantitative Radionuclide Studies of Bone
Blake, G. M., Frost, M. L., & Fogelman, I. (2009) · Journal of Nuclear Medicine · doi:10.2967/jnumed.109.063263 · Cited by 33 · see citing works
“Bone densitometry using dual-energy x-ray absorptiometry is another method for monitoring changes in bone remodeling (14,15).”
BackgroundMethodSelf-citation
Association Between Bone Mineral Density and Autoantibodies in Patients With Rheumatoid Arthritis
Amkreutz, J. A. M. P., de Moel, E. C., Theander, L., Willim, M., Heimans, L., Nilsson, J., Karlsson, M. K., Huizinga, T. W. J., Åkesson, K., Jacobsson, L., et al. (2020) · Arthritis & Rheumatology · doi:10.1002/art.41623 · Cited by 33 · see citing works
Intra and Interobserver Reliability and Agreement of Semiquantitative Vertebral Fracture Assessment on Chest Computed Tomography
Buckens, C. F. M., de Jong, P. A., Mol, C. P., Bakker, E. W. P., Stallman, H., Mali, W. P. T. M., van der Graaf, Y., & Verkooijen, H. M. (2013) · PLoS ONE · doi:10.1371/journal.pone.0071204 · Cited by 31 · see citing works
“Subclinical vertebral fractures may precede overt osteoporosis and may predict future fractures, independently of dual-energy X-ray absorptiometry, which is currently the standard modality used to diagnose osteoporosis but has only modest predictive value for future fractures [5].”
Background
Deep Learning-Based Hip X-ray Image Analysis for Predicting Osteoporosis
Feng, S.-W., Lin, S., Chiang, Y.-H., Lu, M.-H., & Chao, Y.-H. (2023) · Applied Sciences · doi:10.3390/app14010133 · Cited by 30 · see citing works
Evaluation of circulating miRNA-208a-3p, miRNA-155–5p and miRNA-637 as potential non-invasive biomarkers and the possible mechanistic insights into pre- and postmenopausal osteoporotic females
Ismail, S. M., El-Boghdady, N. A., Hamoud, H. S., & Shabayek, M. I. (2020) · Archives of Biochemistry and Biophysics · doi:10.1016/j.abb.2020.108331 · Cited by 30 · see citing works
Risk Behavior Not Associated with Self-Perception of PrEP Candidacy: Implications for Designing PrEP Services
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“DXA-determined BMD has been used to define osteoporosis (through the use of T-scores) [142], predicts fracture risk [20, 92], and can monitor response to therapeutic interventions [11, 64].”
Patient-Specific Phantomless Estimation of Bone Mineral Density and Its Effects on Finite Element Analysis Results: A Feasibility Study
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Postmenopausal women with osteopenia and a healed wrist fracture have reduced physical function and quality of life compared to a matched, healthy control group with no fracture
Hakestad, K. A., Nordsletten, L., Torstveit, M. K., & Risberg, M. A. (2014) · BMC Women s Health · doi:10.1186/1472-6874-14-92 · Cited by 28 · see citing works
“The method is exact and reliable [1,27], and the scanned areas were hip, femur neck and trochanter, lumbar spine and total body.”
Method
Magnetic Susceptibility and Fat Content in the Lumbar Spine of Postmenopausal Women With Varying Bone Mineral Density
Guo, Y., Chen, Y., Zhang, X., Mei, Y., Yi, P., Wang, Y., Feng, Q., Tegola, L. L., Guglielmi, G., Zhang, X., et al. (2018) · Journal of Magnetic Resonance Imaging · doi:10.1002/jmri.26279 · Cited by 28 · see citing works
“Bone mineral density (BMD) measured by dual energy x-ray absorptiometry (DXA) is the current standard quantitative indicator of osteoporosis and fracture risk in clinical practice.(6) However, the 2D DXA measurement of BMD is complicated by bone size and surrounding tissues.”
Machine Learning for Opportunistic Screening for Osteoporosis from CT Scans of the Wrist and Forearm
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“The World Health Organization (WHO) and the International Society for Clinical Densitometry (ISCD) have guidelines for the classification of patients aged 50 years or greater with low BMD as osteoporotic or osteopenic based on DEXA BMD T-scores.”
BackgroundInfluential
Cross-Calibration of GE Healthcare Lunar Prodigy and iDXA Dual-Energy X-Ray Densitometers for Bone Mineral Measurements
Saarelainen, J., Hakulinen, M. A., Rikkonen, T., Kröger, H., Tuppurainen, M., Koivumaa-Honkanen, H. T., Honkanen, R., Hujo, M., & Jurvelin, J. S. (2016) · Journal of Osteoporosis · doi:10.1155/2016/1424582 · Cited by 27 · see citing works
“(coefficients of variation, CV% = (SD/mean) × 100%) of the instruments [14].”
Influence of Adolescents' Physical Activity on Bone Mineral Acquisition: A Systematic Review Article.
Zulfarina, M. S., Ahmad, M. S., Aqilah-S.N, Z.-S., Mokhtar, S.-A., Nazrun, S. A., & Naina-Mohamed, I. (2016) · PubMed Central · Cited by 26 · see citing works
Relationship between Body Mass Index and T-Scores of Bone Mineral Density in the Hip and Spine Regions among Older Adults with Diabetes: A Retrospective Review
Hariri, A. F., Almatrafi, M. N., Zamka, A. B., Babaker, A. S., Fallatah, T. M., Althouwaibi, O. H., & Hamdi, A. (2019) · Journal of Obesity · doi:10.1155/2019/9827403 · Cited by 29 · see citing works
Severity of reduced bone mineral density and risk of fractures in long‐term survivors of childhood leukemia and lymphoma undergoing guideline‐recommended surveillance for bone health
Bloomhardt, H. M., Sint, K., Ross, W. L., Rotatori, J. L., Ness, K. D., Robinson, C., Carpenter, T. O., Chow, E. J., & Kadan‐Lottick, N. S. (2019) · Cancer · doi:10.1002/cncr.32512 · Cited by 26 · see citing works
“208 Cancer January 1, 2020 on multiple epidemiological studies.(51) Because of the retrospective nature of our study, DXA surveillance may have occurred before or after a fracture, and we could not conclude causality between low BMD and fracture.”
Background
Patients with abnormal microarchitecture have an increased risk of early complications after spinal fusion surgery
Kim, H. J., Dash, A. S., Cunningham, M. E., Schwab, F. J., Dowdell, J. E., Harrison, J., Zaworski, C., Krez, A. N., Lafage, V., Agarwal, S., et al. (2020) · Bone · doi:10.1016/j.bone.2020.115731 · Cited by 26 · see citing works
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Goff, E., Cohen, A., Shane, E. J., Recker, R. R., Kuhn, G. A., & Müller, R. (2022) · Bone · doi:10.1016/j.bone.2022.116424 · Cited by 26 · see citing works
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Discordance between Hip and Spine Bone Mineral Density: A Point of Care
Yoon, B., & Kim, D. (2021) · Journal of Bone Metabolism · doi:10.11005/jbm.2021.28.4.249 · Cited by 26 · see citing works
“[1] DXA is usually measured at the central bone (hip and spine) and the BMD is determined by the lowest score at 1 of these 2 sites.[1,2] Discordance is defined as a discrepancy in the BMD measurements at the 2 sites, which can pose clinicians with the predicament on how to incorporate BMD measurement when deciding on…”
BackgroundMethod
Automated osteoporosis classification and T -score prediction using hip radiographs via deep learning algorithm
Chen, Y., Chan, W. P., Zhang, H., Tsai, Z.-R., Peng, H.-C., Huang, S.-W., Jang, Y.-C., & Kuo, Y. (2024) · Therapeutic Advances in Musculoskeletal Disease · doi:10.1177/1759720x241237872 · Cited by 25 · see citing works
Imaging Techniques for the Assessment of the Bone Osteoporosis-Induced Variations with Particular Focus on Micro-CT Potential
Molino, G., Montalbano, G., Pontremoli, C., Fiorilli, S., & Vitale‐Brovarone, C. (2020) · Applied Sciences · doi:10.3390/app10248939 · Cited by 25 · see citing works
“In 1994, the WHO also recognised the value of the areal BMD measured by DXA as a reliable parameter for the assessment of bone fracture risk [42].”
Background
Characteristics of Long-Term Femoral Neck Bone Loss in Postmenopausal Women: A 25-Year Follow-Up
Moilanen, A., Kopra, J., Kröger, H., Sund, R., Rikkonen, T., & Sirola, J. P. (2020) · Journal of Bone and Mineral Research · doi:10.1002/jbmr.4444 · Cited by 25 · see citing works
“Hologic anthropometric lumbar spine phantom, European Spine Phantom (ESP), and GE Healthcare Lunar aluminum spine phantom((18,19)) were scanned 10 times during a period of 1 week to calculate the short-term precision error (coefficients of variation, CV% = (standard deviation [SD]/mean) 100%) of the instruments.((20))…”
Method
Systematic Development and Optimization of Teriparatide-Loaded Nanoliposomes Employing Quality by Design Approach for Osteoporosis
Rana, D., Salave, S., Jain, S., Shah, R. P., & Benival, D. M. (2022) · Journal of Pharmaceutical Innovation · doi:10.1007/s12247-022-09663-9 · Cited by 25 · see citing works
“The poor bone strength manifests towards increased proneness of fractures of the spine, hip, forearm, and other skeletal settings ultimately leading to morbidity and mortality [2].”
Background
Time of flight secondary ion mass spectrometry of bone—Impact of sample preparation and measurement conditions
Henß, A., Hild, A., Rohnke, M., Wenisch, S., & Janek, J. (2015) · Biointerphases · doi:10.1116/1.4928211 · Cited by 25 · see citing works
Bone volume–to–total volume ratio measured in trabecular bone by single‐sided NMR devices
Brizi, L., Barbieri, M., Baruffaldi, F., Bortolotti, V., Fersini, C., Liu, H., d’Eurydice, M. N., Obruchkov, S. I., Zong, F., Galvosas, P., et al. (2017) · Magnetic Resonance in Medicine · doi:10.1002/mrm.26697 · Cited by 25 · see citing works
“It uses ionizing radiations and provides a measure of the areal bone mineral density (BMD), but does not provide any information about the microstructure of the bone (3,4), while the strength of trabecular bone to resist fractures depends not only on BMD, but also on the architecture of the trabecular structure.”
Background
Recovery patterns over 4 years after distal radius fracture: Descriptive changes in fracture-specific pain/disability, fall risk factors, bone mineral density, and general health status
Dewan, N., MacDermid, J. C., Grewal, R. S., & BEATTIE, K. A. (2017) · Journal of Hand Therapy · doi:10.1016/j.jht.2017.06.009 · Cited by 25 · see citing works
The role of body composition assessment in obesity and eating disorders
Dalili, D., Bazzocchi, A., Dalili, D. E., Guglielmi, G., & Isaac, A. (2020) · European Journal of Radiology · doi:10.1016/j.ejrad.2020.109227 · Cited by 25 · see citing works
Bone mineral density in healthy adult Indian population: the Chandigarh Urban Bone Epidemiological Study (CUBES)
Aggarwal, A., Pal, R., Bhadada, S. K., Ram, S., Garg, A., Bhansali, A. K., Singh, P., Thakur, J. S., Singh, T., Sachdeva, N. K., et al. (2021) · Archives of Osteoporosis · doi:10.1007/s11657-020-00868-4 · Cited by 25 · see citing works
A systematic review on the correlation between skeletal and jawbone mineral density in osteoporotic subjects
Calciolari, E., Donos, N., Park, J., Petrie, A., & Mardas, N. (2015) · Clinical Oral Implants Research · doi:10.1111/clr.12597 · Cited by 24 · see citing works
“…for measuring BMD and diagnosing osteoporosis for its reproducibility, short scan times, large normative data and very low doses of radiation (Blake and Fogelman 2007), although other techniques such as quantitative ultrasound (QUS), quantitative computed tomography (QCT), peripheral DXA,…”
Osteoporosis detection in postmenopausal women using axial transmission multi-frequency bone ultrasonometer: Clinical findings
Egorov, V., Tatarinov, A. M., Sarvazyan, N., Wood, R., Magidenko, L., Amin, S., Khosla, S., Ruh, R., Ruh, J., & Sarvazyan, A. P. (2013) · Ultrasonics · doi:10.1016/j.ultras.2013.08.017 · Cited by 24 · see citing works
“5 or lower is considered the current ‘‘gold standard’’ in osteoporosis assessment [1,2].”
Quantification of calcium content in bone by using ToF-SIMS–a first approach
Henß, A., Rohnke, M., Knaack, S., Kleine‐Boymann, M., Leichtweiß, T., Schmitz, P., Khassawna, T. E., Gelinsky, M., Heiß, C., & Janek, J. (2013) · Biointerphases · doi:10.1186/1559-4106-8-31 · Cited by 24 · see citing works
“Dual energy X-ray absorptiometry (DEXA) and quantitative computed tomography (Q-CT) are widely used for the clinical diagnosis of osteoporosis [1,2].”
Method
Regional differences in hip bone mineral density levels in Norway: the NOREPOS study
Omsland, T. K., Gjesdal, C. G., Emaus, N., Tell, G. S., & Meyer, H. E. (2008) · Osteoporosis International · doi:10.1007/s00198-008-0699-7 · Cited by 24 · see citing works
“Low bone mineral density (BMD) is widely recognized as a major risk factor for fractures [15].”
Background
Random forest classifiers aid in the detection of incidental osteoblastic osseous metastases in DEXA studies
Mehta, S. D., & Sebro, R. (2019) · International Journal of Computer Assisted Radiology and Surgery · doi:10.1007/s11548-019-01933-1 · Cited by 23 · see citing works

Authors: Blake, G. M., & Fogelman, I.
Affiliations: King's College London (GB)
Corresponding author: Blake, Glen M
ORCID: Blake, Glen M
Venue: Postgraduate Medical Journal
Publisher: Oxford University Press (OUP)
Published: 2007-08-01
Volume: 83
Issue: 982
Pages: 509-517
ISSN: 0032-5473 (ISSN-L)
1469-0756
DOI: 10.1136/pgmj.2007.057505
PMC: PMC2600106
OpenAlex: W2000878199
Cited by: 532
References: 74
Citations by year: 2026: 31 · 2025: 55 · 2024: 56 · 2023: 34 · 2022: 55 · 2021: 54 · 2020: 31 · 2019: 31 · 2018: 33 · 2017: 26 · 2016: 22 · 2015: 16 · 2014: 19 · 2013: 22 · 2012: 13
FWCI: 1.55
Type: journal article
Language: en
Open access: bronze
doi.org
Licence: academic.oup.com/pages/standard-publication-reuse-rights (vor)
Locations: Postgraduate Medical Journal (publishedVersion)
PubMed Central (publishedVersion)
PubMed (publishedVersion)
Research Portal (King's College London) (submittedVersion)
Topics: Health Sciences › Medicine › Orthopedics and Sports Medicine › Bone health and osteoporosis research
Health Sciences › Medicine › Emergency Medicine › HIV-related health complications and treatments
Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Menopause: Health Impacts and Treatments
Keywords: dual-energy X-ray absorptiometry, bone mineral density, osteoporosis diagnosis, fracture risk prediction, treatment response monitoring
MeSH terms: Humans, Osteoporosis, Risk Factors, Absorptiometry, Photon, Bone Density, Risk Assessment, Fractures, Bone

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The role of DXA bone density scans in the diagnosis and treatment of osteoporosis

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