Abstract
Measurement of bone mineral density (BMD) with central dual-energy X-ray absorptiometry (DXA) is the current “gold standard” for diagnosing osteoporosis and for monitoring patients. Errors in demographic information, improper patient positioning, incorrect scan analysis, and mistakes in interpretation can all lead to a wrong clinical decision or action. This paper reviews the fundamentals of positioning, scan analysis, and interpretation for central DXA and highlights some of the common pitfalls that may lead to erroneous results.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
NIH (2000) Osteoporosis prevention, diagnosis, and therapy. NIH Consensus Statement 17:1–45
Silverman SL, Greenwald M, Klein RA, Drinkwater BL (1997) Effect of bone density information on decisions about hormone replacement therapy: a randomized trial. Obstet Gynecol 89:321–325
Tosteson AN, Grove MR, Hammond CS, Moncur MM, Ray T, Hebert GM et al. (2003) Early discontinuation of treatment for osteoporosis. Am J Med 115:209–216
Kanis JA, Melton LJ, III, Christiansen C, Johnston CC, Khaltaev N (1994) The diagnosis of osteoporosis. J Bone Miner Res 9:1137–1141
Hodgson SF, Watts NB (2003) American Association of Clinical Endocrinologists medical guidelines for clinical practice for the prevention and management of postmenopausal osteoporosis, 2001 Edition, with selected updates for 2003. Endocrine Practice 9:544–564
Hodgson SF, Watts NB (2001) The 2001 AACE medical guidelines for clinical practice for the prevention and management of postmenopausal osteoporosis. Endocrine Practice 7:293–312
Marshall D, Johnell O, Wedel H (1996) Meta-analysis of how well measures of bone mineral density predict occurrence of osteoporotic fractures. BMJ 312:1254–1259
Hamdy RC, Petak SM, Lenchik L, International Society for Clinical Densitometry Position Development Panel and Scientific Advisory Committee (2002) Which central dual X-ray absorptiometry skeletal sites and regions of interest should be used to determine the diagnosis of osteoporosis? J Clin Densitom 5:S11–S18
Greenspan SL, Maitland-Ramsey L, Myers E (1996) Classification of osteoporosis in the elderly is dependent on site-specific analysis. Calcif Tiss Int 58:409–414
US Preventive Services Task Force (2002) Screening for osteoporosis in postmenopausal women: recommendations and rationale. Ann Int Med 137:526–528
Nelson HD, Helfand M, Woolf SH, Allan JD (2002) Screening for postmenopausal osteoporosis: a review of the evidence for the US Preventive Services Task Force. Ann Int Med 137:529–541
Physician’s guide to prevention and treatment of osteoporosis, 2003. National Osteoporosis Foundation, Washington D.C.
Binkley NC, Schmeer P, Wasnich RD, Lenchik L (2002) What are the criteria by which a densitometric diagnosis of osteoporosis can be made in males and non-Caucasians? J Clin Densitom 5:S19–S28
Watts NB (1999) Understanding the Bone Mass Measurement Act. J Clin Densitom 2:211–217
The Writing Group for the ISCD Position Development Conference (2004) Technical standardization for dual-energy X-ray absorptiometry. J Clin Densitom 7:27–36
Lenchik L, Kiebzak GM, Blunt BA, International Society for Clinical Densitometry Position Development Panel and Scientific Advisory Committee (2002) What is the role of serial bone mineral density measurements in patient management? J Clin Densitom 5:S29–S38
Fewtrell MS, British Paediatric Adolescent Bone Group (2003) Bone densitometry in children assessed by dual X ray absorptiometry: uses and pitfalls. Arch Dis Child 88:795–798
Peel NF, Johnson A, Barrington NA, Smith TW, Eastell R (1993) Impact of anomalous vertebral segmentation on measurements of bone mineral density. J Bone Miner Res 8:719–723
Genant HK, Grampp S, Gluer CC, Faulkner KG, Jergas M, Engelke K et al. (1994) Universal standardization for dual X-ray absorptiometry: patient and phantom cross-calibration results (see comment). J Bone Miner Res 9:1503–1514
Yu W, Gluer CC, Fuerst T, Grampp S, Li J, Lu Y et al. (1995) Influence of degenerative joint disease on spinal bone mineral measurements in postmenopausal women. Calcif Tissue Int 57:169–174
Acknowledgements
I thank bone density technologists Sally Moody, Angie Buettner, and Terri Schmitter, who provided comments and examples for this manuscript, and other past bone density technologists and colleagues. I have learned an extraordinary amount from my associations with ISCD. I appreciate manufacturers’ input for this paper; thanks to Ken Faulkner and Jeff Franz from GE Medical Systems Lunar, Eric von Stetten and Kevin Wilson from Hologic, and Marc Zimmer and Tom Sanchez from Norland-Cooper Surgical.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Watts, N.B. Fundamentals and pitfalls of bone densitometry using dual-energy X-ray absorptiometry (DXA). Osteoporos Int 15, 847–854 (2004). https://doi.org/10.1007/s00198-004-1681-7
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00198-004-1681-7