Fracture Risk Assessment with Dual-Energy X-ray Absorptiometry: Applications and Limitations

Dual-energy X-ray absorptiometry (DXA) is the worldwide standard technology for measuring bone mineral density (BMD) in population studies. It is used to diagnose osteoporosis, assess bone strength, estimate fracture risk, and monitor BMD changes. It is an important tool in epidemiological studies to establish the prevalence of osteoporosis for populations in different countries/regions and the correlation between BMD and fractures. DXA is also used to diagnose osteoporosis in individual patients, assist in making treatment choices, and assess a patient’s response to treatment. The clinical utility of DXA is enhanced by non-BMD functions, such as lateral spine imaging to detect vertebral fractures and trabecular bone score to assess bone microarchitecture. Fracture risk algorithms that combine BMD and clinical risk factors for fracture predict fracture risk better than BMD or clinical risk factors alone.