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The role of DXA bone density scans in the diagnosis and treatment of osteoporosis
Open accessAbstract
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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“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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“The major role of this procedure includes the diagnosis of osteoporosis and the assessment of risk of fracture (Blake & Fogelman, 2007).”
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“Until the mid1980s, bone assessment using DXA scan was used only for research purposes, but came in to clinical practice thereafter (5).”
MethodXi, Z., Xie, Y., Sun, S., Wang, N., Chen, S., Kang, X., & Li, J. (2024) · The Spine Journal · doi:10.1016/j.spinee.2023.12.007 · Cited by 23
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Significant differences in UK and US female bone density reference ranges
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“DXA measurements are interpreted using T-scores and Z-scores, where T-scores express the difference in standard deviation units between a subject's BMD and the mean figure in healthy young adults, while Z-scores express the difference from a healthy age-matched reference population [7].”
MethodSelf-citationCurrent Applications and Selected Technical Details of Dual-Energy X-Ray Absorptiometry
Sawicki, P., Tałałaj, M., Życińska, K., Zgliczyński, W. S., & Wierzba, W. (2021) · Medical Science Monitor · doi:10.12659/msm.930839 · Cited by 22
“Dual-energy X-ray absorptiometry (DXA) is currently a primary radiological technique in the diagnosis of osteoporosis, used for stratifying the risk of osteoporotic fractures by assessing bone mineral density (BMD) [1,2].”
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Quantitative Studies of Bone Using 99mTc-Methylene Diphosphonate Skeletal Plasma Clearance
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“DXA imaging has been described as the “gold standard” for diagnosing osteoporosis as there are many clinical advantages including quantifiable data, fast scan times, low radiation dose, accurate reproducibility and large normative data references (Blake & Fogelman 2007).”
BackgroundRufus-Membere, P. G., Holloway‐Kew, K. L., Díez‐Pérez, A., Kotowicz, M. A., & Pasco, J. A. (2018) · BMJ Open · doi:10.1136/bmjopen-2018-023959 · Cited by 21
“IntrODuCtIOn The most widely used clinical measurement for ascertainment of fracture risk is bone mineral density (BMD) measured by dual-energy X-ray absorptiometry (DXA).(1) However, BMD does not fully explain fracture risk, as the largest absolute number of fragility fractures occur in people without severe deficits…”
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“NHANES III mean BMD data for age groups were converted to T-scores using the formula: T-score = (measured BMD – young adult mean BMD) / young adult population SD [23].”
MethodLow bone mineral density is associated with gray matter volume decrease in UK Biobank
Kalc, P., Dahnke, R., Hoffstaedter, F., & Gaser, C. (2023) · Frontiers in Aging Neuroscience · doi:10.3389/fnagi.2023.1287304 · Cited by 21
“DXA scanning is a state-of-the-art assessment method for diagnosing osteoporosis (Arabi et al., 2007; Blake and Fogelman, 2007).”
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“Currently, DXA is the gold standard for the evaluation of mineral density of the bone because of its reproducibility, large normative data, non-invasive technology and little time required for the procedure [10].”
BackgroundDoes the Severity of Obesity Influence Bone Mineral Density Values in Premenopausal Women?
Hammoud, E., Toumi, H., Jacob, C., Pinti, A., Lespessailles, É., & Hage, R. E. (2019) · Journal of Clinical Densitometry · doi:10.1016/j.jocd.2019.04.006 · Cited by 21
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“Areal bone mineral density (aBMD) derived from dual X-ray absorptiometry (DXA) is the standard clinical parameter for the diagnosis of osteoporosis and assessment of risk of osteoporotic bone fracture (6,7).”
What Is the Effect of High-dose Radiation on Bone in Patients With Sacral Chordoma? A CT Study
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“In routine clinic, no phantoms or DEXA scans are used.”
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Measure What Matters Most in Sarcopenia: Regional vs. Appendicular Muscle Mass?
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“Traditionally, dual energy x-ray absorptiometry (DEXA) or qCT have been used for quantification of bone density (16, 17).”
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“1895 Roentgen a discovers X-rays [18] 1940, Stuart et al. use X-ray shadows for muscle and bone [38]; 1970s, Houns fi eld a and Cormack a develop computed tomography (CT) [39, 40]; 1988, dual-energy X-ray absorptiometry (DXA) approved for clinical use [41].”
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“Z-scores were calculated with the formula Z-score = [measured BMD – age matched BMD]/age-matched population SD [9].”
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“The criterion standard technique for BMD estimation is the DXA technique because of the following: reproducibility, large normative data, non-invasive nature, little time requirement for procedure, and minimal radiation exposure.(26) However, DXA is often inaccurate for diagnosing osteoporosis for many reasons.”
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“While the diagnosis of vertebral compression fractures is based on radiographic examination [15], the diagnosis of osteoporosis should be confirmed by central dual-energy X-ray absorptiometry [16].”
Computational Anatomy in the Study of Bone Structure
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“Although the measurement of spine, hip, and forearm by DXA is the current gold standard for diagnosing osteoporosis,((45)) the population who took the DXA measurement was relatively small (~4000 to 5000 participants) in the UK Biobank.”
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“Compared to the T score measured by DXA, the HU value could better evaluate the cancellous BMD by eliminating the confounding effect caused by osteosclerosis and osteophyte formation in the natural degenerative process [13, 49].”
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Fatigue-caused damage in trabecular bone from clinical, morphological and mechanical perspectives
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Quality assurance of imaging techniques used in the clinical management of osteoporosis
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“5 SD [29].”
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“Dual-energy X-ray absorptiometry (DXA) is recognized as the reference method to measure bone mineral density (BMD) accurately and reproducibly [ 1 ].”
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“9 In cases of patients with osteophytes, cortical bone thickening, and aortic stenosis, DXA is inaccurate and unreliable.”
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“DEXA is the gold standard technology for measuring BMD as it is recommended by some guidelines, because of the low radiation, short time required, and affordable [52].”
BackgroundGenetic Polymorphism of miR-196a-2 is Associated with Bone Mineral Density (BMD)
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“However, in patients with known spinal pathology, DXA may be inaccurate due to artifact from both underlying spinal abnormalities and technical difficulty in demarcating individual vertebra in spines with substantial curvature [14, 15].”
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“However, over the years, dual energy X-ray absorptiometry (DXA) is considered as gold standard for measurement of bone mass and used in both clinical as well as research studies.[33] The three DXA manufacturers are Hologic Inc.”
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“5 However, in the absence of DXA diagnosis, a reliable mean is needed to screen for osteoporosis in the elderly.”
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“DXA provides a body composition model that includes fat, bone mineral density, and lean mass [45, 46], but even though it is a reference method for measuring total skeletal muscle mass, it cannot evaluate an individual muscle or assess muscle quality [7, 47].”
BackgroundCherif, R., Vico, L., Laroche, N., Sakly, M., Attia, N., & Lavet, C. (2017) · Journal of Bone and Mineral Metabolism · doi:10.1007/s00774-017-0813-z · Cited by 14
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“Dual X-ray absorptiometry is the standard technique used to measure bone mineral density (BMD) revealing OP and therefore fracture risk (7), though not the sole indicator of OP.”
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Olson, L. E., & Mohan, S. (2011) · American Journal of Medical Genetics Part A · doi:10.1002/ajmg.a.34203 · Cited by 14
“DXA uses the attenuation of low and high energy X-ray beams to calculate body composition; it has been shown to be accurate compared to chemicalmethods andhighlyprecise [Mazess et al., 1990; Svendsen et al., 1993; Iida-Klein et al., 2003].”
InfluentialYoon, B., Kang, H. W., Kim, S. M., & Koh, Y. D. (2022) · Journal of Bone Metabolism · doi:10.11005/jbm.2022.29.1.43 · Cited by 13
“[1,2] The International Society for Clinical Densitometry (ISCD) has recommended that BMD should be measured for the purpose of diagnosing osteoporosis at 2 preferred skeletal sites, the hip and lumbar spine.[3,4] ISCD also recommended osteoporosis would be diagnosed on the basis of the lowest T-score for BMD found at…”
BackgroundBernatz, J. T., Pumford, A., Goh, B. C. K., Pinter, Z. W., Mikula, A. L., Michalopoulos, G. D., Bydon, M., Huddleston, P. M., Nassr, A. N., Freedman, B. A., et al. (2024) · Clinical Spine Surgery A Spine Publication · doi:10.1097/bsd.0000000000001623 · Cited by 13
Sensing the future: A review on emerging technologies for assessing and monitoring bone health
Naik, A., Kale, A., & Rajwade, J. M. (2024) · Biomaterials Advances · doi:10.1016/j.bioadv.2024.214008 · Cited by 14
Ramkumar, S., & Malathi, R. (2018) · Asian Pacific Journal of Cancer Prevention · doi:10.31557/apjcp.2018.19.12.3517 · Cited by 13
“The influences of these diseases enlarge the fractures risk, fragility and depressing mechanical force on sustaining normal body actions (Blake et al., 2007).”
BackgroundPresbítero-Espinosa, G., Gutiérrez, D., Lemus-Martínez, W. R., Vílchez‐Cavazos, F., García, P., & Arizmendi-Morquecho, A. M. (2021) · Applied Sciences · doi:10.3390/app11125479 · Cited by 13
Liu, J., Liao, J., Li, W., Chen, X., Feng, J., Yao, L., Huang, P.-H., Su, Z., Lü, H., Liao, Y., et al. (2022) · Frontiers in Endocrinology · doi:10.3389/fendo.2022.801930 · Cited by 13
Non-local means filter denoising for DEXA images
Al–antari, M. A., Al‐masni, M. A., Metwally, M. K., Hussain, D., Valarezo, E., Rivera, P., Gi, G., Park, J. M., Kim, T. Y., Park, S.-J., et al. (2017) · Annual International Conference of the IEEE Engineering in Medicine and Biology Society (EMBC) · doi:10.1109/embc.2017.8036889 · Cited by 13
“For instance, DEXA is especially useful for menopausal women who exhibit high probability of bone fractures and for patients who are over 50 years old and more exposed to disability and mortality due to bone problems [2], [3], [4].”
BackgroundOberkircher, L., Krüger, A., Hörth, D., Hack, J., Ruchholtz, S., Fleege, C., Rauschmann, M., & Arabmotlagh, M. (2017) · The Spine Journal · doi:10.1016/j.spinee.2017.10.068 · Cited by 13
Regulatory Perspectives in Pharmacometric Models of Osteoporosis
Madrasi, K. J., Li, F., Kim, M., Samant, S., Voss, S. D., Kehoe, T. E., Bashaw, E. D., Ahn, H. Y., Wang, Y., Florian, J., et al. (2018) · The Journal of Clinical Pharmacology · doi:10.1002/jcph.1071 · Cited by 13
Empirical Functions for Conversion of Femur Areal and Volumetric Bone Mineral Density
Luo, Y. (2018) · Journal of Medical and Biological Engineering · doi:10.1007/s40846-018-0394-x · Cited by 13
Bortone, I., Trotta, G. F., Cascarano, G. D., Regina, P., Brunetti, A., Feudis, I. D., Buongiorno, D., Loconsole, C., & Bevilacqua, V. (2018) · International Joint Conference on Neural Networks (IJCNN) · doi:10.1109/ijcnn.2018.8489205 · Cited by 13
“Bone Mineral Density (BMD) measurement techniques were introduced in the last 20 years, and, currently, Dualenergy X-ray Absorptiometry (DXA) measurement is the standard procedure in evaluating patients at risk for osteoporosis [7].”
BackgroundJiang, F., Li, X., Liu, L., Xie, Z., Wu, X., & Wang, Y. (2024) · BioScience Trends · doi:10.5582/bst.2023.01327 · Cited by 12
Özden, S., & Çiçek, O. (2024) · Journal of Clinical Medicine · doi:10.3390/jcm13237334 · Cited by 12
“Various methods, such as micro ‐ computed tomography (micro ‐ CT) [38], magnetic resonance imaging (MRI) [39], histomorphometry [40], dual ‐ energy X ‐ ray absorptiometry (DEXA) [41], intensity features [42], and finite element analysis (FEA) [43], are utilized for evaluating trabecular bone.”
Denoising images of dual energy X-ray absorptiometry using non-local means filters
Al–antari, M. A., Al‐masni, M. A., Metwally, M. K., Hussain, D., Park, S.-J., Shin, J.-S., Han, S., & Kim, T. (2018) · Journal of X-Ray Science and Technology · doi:10.3233/xst-17341 · Cited by 12
“Based on this pair of images, a DXA imaging system is able to distinguish between bone and tissue regions [3].”
Zhou, Y., Wu, K., Shen, H., Zhang, J., Deng, H., & Zhao, L. (2019) · Scientific Reports · doi:10.1038/s41598-019-48734-9 · Cited by 12
Khan, N. H., Abbas, A. M., Almukhtar, R., Cole, E. B., & Khan, A. N. (2014) · The American Journal of Gastroenterology · doi:10.1038/ajg.2013.486 · Cited by 12
Bandirali, M., Sconfienza, L. M., Aliprandi, A., Leo, G. D., Marchelli, D., Ulivieri, F. M., & Sardanelli, F. (2013) · La radiologia medica · doi:10.1007/s11547-013-0342-3 · Cited by 12
“A summary of the advantages of DXA over other densitometric techniques may be found in the review by Blake and Fogelman [8].”
BackgroundOommen, A., & AlZahrani, I. (2014) · International Journal of Research in Medical Sciences · doi:10.5455/2320-6012.ijrms20140252 · Cited by 12
Itje, E., & Widyaningrum, R. (2015) · International Journal of Advanced Computer Science and Applications · doi:10.14569/ijacsa.2015.060933 · Cited by 12
“The screening of bone mass density (BMD) is an ideal method for early detection of osteoporosis [5][6][7].”
MethodJoseph, G. B., McCulloch, C. E., Nevitt, M. C., Gersing, A. S., Schwaiger, B. J., Kretzschmar, M., Heilmeier, U., & Link, T. M. (2017) · Journal of Magnetic Resonance Imaging · doi:10.1002/jmri.25662 · Cited by 12
“4 (from a one unit increase in hip BMD T-score).(42) Accordingly, the magnitudes of risk for prediction of fracture and odds for prediction of OA are approximately comparable.”
ResultBarbieri, M., Brizi, L., Bortolotti, V., Fantazzini, P., d’Eurydice, M. N., Obruchkov, S. I., Liu, H., & Galvosas, P. (2017) · Microporous and Mesoporous Materials · doi:10.1016/j.micromeso.2017.05.023 · Cited by 12
Chen, Q., Wei, P., Pu, H. Y., & Huang, K. (2023) · Zeitschrift für Orthopädie und Unfallchirurgie · doi:10.1055/a-1984-0466 · Cited by 11
Common errors in dual-energy X-ray absorptiometry scans in imaging centers in Ecuador
Maldonado, G., Intriago, M., Larroudé, M. S., Aguilar, G. H., Moreno, M., Gonzalez, J. A., Vargas, S., Vera, C., Rios, K., & Ríos, C. (2020) · Archives of Osteoporosis · doi:10.1007/s11657-019-0673-3 · Cited by 11
Lee, S.-K., Jun, D. S., Lee, D.-K., & Baik, J.-M. (2022) · Geriatrics · doi:10.3390/geriatrics7060123 · Cited by 11
“T e Internati nal Society for Clinical Densit metry (ISCD) recommends the measurement of BMD to make diagnosis of osteoporosis at the hip and lumbar spine [33].”
BackgroundHosseini, S. A., Cumming, R. G., Bijani, A., Ghadimi, R., Noreddini, H., & Hosseini, S. R. (2022) · Journal of Clinical Densitometry · doi:10.1016/j.jocd.2022.12.008 · Cited by 11
Bone Mineral Density and Hemoglobin Levels: Opposite Associations in Younger and Older Women
Chuang, T., Koo, M., Chuang, M., & Wang, Y. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph18105495 · Cited by 11
“Moreover, its ability to identify patients at risk of fracture has been demonstrated in many epidemiological studies [21].”
BackgroundDowling, L., Jakeman, P. M., Norton, C., Skelly, M. M., Yousuf, H., Kiernan, M. G., Toomey, M., Bowers, S., Dunne, S. S., Coffey, J. C., et al. (2021) · Scientific Reports · doi:10.1038/s41598-021-98798-9 · Cited by 11
Reliability of Lateral Distal Femur Dual-Energy X-Ray Absorptiometry Measures
Mueske, N. M., Chan, L. S., & Wren, T. A. L. (2013) · Journal of Clinical Densitometry · doi:10.1016/j.jocd.2013.02.010 · Cited by 11
“assessments, particularly in clinical settings, because of its low cost, low radiation exposure, ease of use, and demonstrated relationship to fracture risk in adults (1, 2).”
BackgroundTransfer Learning-Based Osteoporosis Classification Using Simple Radiographs
Dodamani, P. S., & Danti, A. (2023) · International Journal of Online and Biomedical Engineering (iJOE) · doi:10.3991/ijoe.v19i08.39235 · Cited by 10
Reiner, E., Weston, F., Pleshko, N. L., & Querido, W. (2023) · Applied Spectroscopy · doi:10.1177/00037028231201427 · Cited by 10
“20 29 With so many factors to consider, de fi ning clear submicron scale parameters that contribute to bone strength has proved challenging.”
BackgroundMesenchymal stem cells enhance targeted bone growth from injectable hydrogels with BMP‐2 peptides
Love, S. A., Gultian, K. A., Jalloh, U. S., Stevens, A., Kim, T. W. B., & Vega, S. L. (2024) · Journal of Orthopaedic Research® · doi:10.1002/jor.25798 · Cited by 10
“8 Prophylactic treatments to prevent fracture include exercise, hip protectors, and adequate calcium and vitamin D intake.”
BackgroundPTH 1-34 promoted bone formation by regulating iron metabolism in unloading-induced bone loss
Che, J., Ren, W., Chen, X., Wang, F., Zhang, G., & Shang, P. (2023) · Frontiers in Endocrinology · doi:10.3389/fendo.2022.1048818 · Cited by 9
“BMD and BMC are important markers of bone quality, reflecting the degree of osteoporosis (36).”
BackgroundAustermann, K., Baecker, N., Zwart, S. R., Fimmers, R., Stehle, P., Smith, S. M., & Heer, M. A. (2023) · Nutrition Bulletin · doi:10.1111/nbu.12619 · Cited by 9
Mobasseri, M., Tarverdizadeh, N., Mirghafourvand, M., Salehi‐Pourmehr, H., Ostadrahimi, A., & Farshbaf‐Khalili, A. (2023) · Journal of Research in Medical Sciences · doi:10.4103/jrms.jrms_612_22 · Cited by 10
“The assessment of bone mineral density (BMD) through dual‐energy X‐ray absorptiometry (DXA) is currently the gold standard method for diagnosing osteoporosis.[7,8] The American Association of Clinical Endocrinologists suggests BMD testing for women above 65 years or younger who are at a high risk of fracture, but BMD…”
Method
Metadata
- 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
- 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
- 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 › Infectious Diseases › 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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